Carlo Alberto Artusi1, Sara Bortolani2, Aristide Merola3, Maurizio Zibetti4, Marco Busso5, Stefania De Mercanti6, Paolo Arnoffi7, Simone Martinetto8, Elena Gaidolfi9, Andrea Veltri10, Pierangelo Barbero11, Leonardo Lopiano12. 1. Department of Neuroscience "Rita Levi Montalcini", University of Turin, Torino, Italy. Electronic address: caartusi@gmail.com. 2. Department of Neuroscience "Rita Levi Montalcini", University of Turin, Torino, Italy. Electronic address: s.bortolani@gmail.com. 3. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA. Electronic address: merolaae@ucmail.uc.edu. 4. Department of Neuroscience "Rita Levi Montalcini", University of Turin, Torino, Italy. Electronic address: maurizio.zibetti@gmail.com. 5. Oncology Department, Radiology Unit, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Torino, Italy. Electronic address: busso.marco@gmail.com. 6. Clinical and Biological Sciences Department, Neurology Unit, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Torino, Italy. Electronic address: sdemercanti@yahoo.it. 7. Oncology Department, Radiology Unit, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Torino, Italy. Electronic address: arnoffipaolo@gmail.com. 8. Oncology Department, Radiology Unit, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Torino, Italy. Electronic address: martinetto.simone@gmail.com. 9. Centro Diagnostico Cernaia, Magnetic Resonance Unit, Turin, Italy. Electronic address: e.gaidolfi@gruppocdc.it. 10. Oncology Department, Radiology Unit, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Torino, Italy. Electronic address: andrea.veltri@unito.it. 11. Clinical and Biological Sciences Department, Neurology Unit, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Torino, Italy. Electronic address: pierangelobarbero@gmail.com. 12. Department of Neuroscience "Rita Levi Montalcini", University of Turin, Torino, Italy. Electronic address: leonardo.lopiano@unito.it.
Abstract
INTRODUCTION: Pisa syndrome is a disabling, medication-resistant, postural abnormality that may affect 7-10% of patients with Parkinson's disease. In this study, we sought to assess the efficacy of botulinum toxin injections in Parkinson's disease-associated Pisa syndrome using a Magnetic Resonance Imaging-, Ultrasonography-, and Electromyography-guided combined approach. METHODS: We conducted a pilot study to evaluate the efficacy of botulinum toxin type-A injection in paraspinal and non-paraspinal axial muscles after a Magnetic Resonance Imaging and ultrasound-guided electromyography evaluation. Inclusion criteria were Pisa syndrome, idiopathic Parkinson's disease, and stable dopaminergic medications. Exclusion criteria were previous treatment with botulinum toxin, history of major spine surgery, and severe orthopedic diseases. As primary endpoint, we measured the rate of patients improving by at least 5° in the lateral trunk flexion 2 months after therapy. Secondary endpoints were the extent of lateral trunk flexion improvement, and changes in PS-associated pain/discomfort, measured by the Visual Analogue Scale. RESULTS: Out the 15 patients initially enrolled, 13 completed the follow-up assessment, while 2 joined a rehabilitation program and were excluded from the analyses. The rate of responders was 84.6% (n = 11/13), with 40% average reduction in trunk bending. Pain/discomfort improved in all patients, with 52.2% amelioration at the Visual Analogue Scale. The procedure was well tolerated in all cases, without side effects or complications. CONCLUSION: A combined imaging and EMG botulinum toxin approach to Pisa syndrome may yield a success rate greater than 80% in Parkinson's disease.
INTRODUCTION:Pisa syndrome is a disabling, medication-resistant, postural abnormality that may affect 7-10% of patients with Parkinson's disease. In this study, we sought to assess the efficacy of botulinum toxin injections in Parkinson's disease-associated Pisa syndrome using a Magnetic Resonance Imaging-, Ultrasonography-, and Electromyography-guided combined approach. METHODS: We conducted a pilot study to evaluate the efficacy of botulinum toxin type-A injection in paraspinal and non-paraspinal axial muscles after a Magnetic Resonance Imaging and ultrasound-guided electromyography evaluation. Inclusion criteria were Pisa syndrome, idiopathic Parkinson's disease, and stable dopaminergic medications. Exclusion criteria were previous treatment with botulinum toxin, history of major spine surgery, and severe orthopedic diseases. As primary endpoint, we measured the rate of patients improving by at least 5° in the lateral trunk flexion 2 months after therapy. Secondary endpoints were the extent of lateral trunk flexion improvement, and changes in PS-associated pain/discomfort, measured by the Visual Analogue Scale. RESULTS: Out the 15 patients initially enrolled, 13 completed the follow-up assessment, while 2 joined a rehabilitation program and were excluded from the analyses. The rate of responders was 84.6% (n = 11/13), with 40% average reduction in trunk bending. Pain/discomfort improved in all patients, with 52.2% amelioration at the Visual Analogue Scale. The procedure was well tolerated in all cases, without side effects or complications. CONCLUSION: A combined imaging and EMG botulinum toxin approach to Pisa syndrome may yield a success rate greater than 80% in Parkinson's disease.
Authors: Christian Geroin; Carlo Alberto Artusi; Marialuisa Gandolfi; Elisabetta Zanolin; Roberto Ceravolo; Marianna Capecci; Elisa Andrenelli; Maria Gabriella Ceravolo; Laura Bonanni; Marco Onofrj; Roberta Telese; Giulia Bellavita; Mauro Catalan; Paolo Manganotti; Sonia Mazzucchi; Sara Giannoni; Laura Vacca; Fabrizio Stocchi; Miriam Casali; Cristian Falup-Pecurariu; Maurizio Zibetti; Alfonso Fasano; Leonardo Lopiano; Michele Tinazzi Journal: Front Neurol Date: 2020-03-31 Impact factor: 4.003