Correcting vertical perception to reverse Pisa syndrome in Parkinson's disease: A case report.

Osteoporotic fracture and conservative management in Parkinson's disease and Pisa syndrome: Case report

Benefits of intensive speech treatment have been documented for a range of speech signs in English speakers with Parkinson's Disease (PD). However, the answer to a critical question that whether the same treatment benefits speech variables including intelligibility in Mandarin speakers is still unclear. In order to develop a targeted speech treatment for Mandarin speakers with PD, we reviewed the efficacy of intensive speech treatment to improve vocal loudness and functional communication and discuss possible explanations for efficacy on Mandarin speakers with PD. Literatures about intensive speech treatment for Mandarin speakers with PD were retrieved from PubMed, Web of Science, Embase, China National Knowledge Infrastructure (CNKI), Wanfang and Weipu Database for Chinese Technical Periodicals (VIP) Database. Search strategy was (voice therapy OR speech therapy OR voice treatment OR speech treatment OR voice training OR speech training OR voice rehabilitation OR speech rehabilitation OR Lee Silverman voice treatment OR intensive speech treatment) and (Parkinson's disease) and (Mandarin speakers OR Chinese OR Chinese people). Five randomized controlled trials were selected and possible explanations for efficacy on individuals with PD are discussed. Further research directions are suggested. The existing evidence from treatment efficacy studies of intensive speech treatment provides support for improving vocal loudness, speech intelligibility, pitch and rate in Mandarin speakers with PD. Our future research will continue to work to conduct a large sample multicenter randomized controlled trial to provide high quality evidence and understand the basic mechanisms accompanying treatment-related change.

Axial Postural Abnormalities in Parkinsonism: Gaps in Predictors, Pathophysiology, and Management.

Apomorphine infusion for improving sleep in Parkinson's disease

Background: Pisa syndrome (PS) is a lateral flexion of the trunk frequently associated with Parkinson's disease (PD). The pathophysiology of PS remains unclear, but the role of cognitive deficits has been postulated.Methods: We included 12 consecutive PD patients with PS (PS+) and 12 PD patients without PS (PS–) matched for gender, age, level of education, PD duration, and PD stage. As primary aim, we compared the neuropsychological scores of 16 tests evaluating 6 cognitive domains between PS+ and PS–. Additionally, we evaluated the presence of misperception of the trunk position in PS+, defined as a mismatch between the objective vs. subjective evaluation of the trunk bending angle >5°, and analyzed whether a correlation exists between the misperception of the trunk position and alterations in the visual-spatial abilities.Results: PS+ group showed significantly worse performances in the visual-spatial abilities (p: 0.008), attentional domain (p: 0.001), and language domain (p: 0.023). No differences were found in the other cognitive domains nor in the general cognitive assessment. All PS+ patients showed a misperception of the trunk position, with an average underestimation of the trunk bending angle of 11.7° ± 4.3. The degree of misperception of the trunk position showed a trend toward a correlation with the visual-spatial scores (p: 0.089).Conclusions: The study reveals an association between PS and specific cognitive alterations, suggesting a possible link between the abnormal posture of PD patients with PS and their cognitive functions.

Capgras syndrome during the course of Parkinson disease dementia.

Clinical, electrophysiological, and imaging study in essential tremor-Parkinson's disease syndrome

Introduction Pisa syndrome (PS) is a postural complication of Parkinson's disease (PD). Yet, its pathophysiology remains unclear, although a multifactorial component is probable. Cervical vestibular evoked myogenic potentials (cVEMPs) explore vestibulospinal pathway, but they have not been measured yet in PD patients with PS (PDPS) to assess a potential vestibular impairment. Materials and Methods We enrolled 15 PD patients, 15 PDPS patients, and 30 healthy controls (HCs). They underwent neurological examination and were examined with Unified Parkinson's Disease Rating Scale II-III (UPDRSII-III), audiovestibular workup, and cVEMP recordings. Data were analysed with Chi-square, one-way ANOVA, multinomial regression, nonparametric, and Spearman's tests. Results cVEMPs were significantly impaired in both PD and PDPS compared with HCs. PDPS exhibited more severe cVEMP abnormalities with prevalent bilateral loss of potentials, compared with the PD group, in which a prevalent unilateral loss was instead observed. No clinical-neurophysiological correlations emerged. Conclusions Differently from HC, cVEMPs are altered in PD. Severity of cVEMPs alterations increases from PD without PS to PDPS, suggesting an involvement of vestibulospinal pathway in the pathophysiology of PS. Our results provide evidence for a significant impairment of cVEMPs in PDPS patients and encourage further studies to test validity of cVEMPs as diagnostic and prognostic biomarkers of PD progression.

Pisa syndrome (PS) and camptocormia (CC) are postural abnormalities frequently associated with Parkinson's disease (PD). Their pathophysiology remains unclear, but the role of cognitive deficits has been postulated. To identify differences in the neuropsychological functioning of patients with PD with PS or CC compared with matched patients with PD without postural abnormalities. We performed a case-control study including 57 patients with PD with PS (PS+) or CC (CC+) and 57 PD controls without postural abnormalities matched for sex, age, PD duration, phenotype, and stage. Patients were divided into four groups: PS+ (n=32), PS+ controls (PS-, n=32), CC+ (n=25), and CC+ controls (CC-, n=25). We compared PS+ versus PS- and CC+ versus CC- using a neuropsychological battery assessing memory, attention, executive functions, visuospatial abilities, and language. Subjective visual vertical (SVV) perception was assessed by the Bucket test as a sign of vestibular function; the misperception of trunk position, defined as a mismatch between the objective versus subjective evaluation of the trunk bending angle >5°, was evaluated in PS+ and CC+. PS+ showed significantly worse visuospatial performances (P = 0.025) and SVV perception (P = 0.038) than their controls, whereas CC+ did not show significant differences compared with their control group. Reduced awareness of postural abnormality was observed in >60% of patients with PS or CC. Low visuospatial performances and vestibular tone imbalance are significantly associated with PS but not with CC. These findings suggest different pathophysiology for the two main postural abnormalities associated with PD and can foster adequate therapeutic and prevention strategies.

The Role of Focused Ultrasound in the Management of Movement Disorders: Insights after 5 Years of Experience.

Parkinson's disease (PD) is a common progressive neurodegenerative disease. The management of PD including Pisa syndrome (PS), a postural deformity in PD characterized by reversible lateral bending of the trunk on the side, is often challenging. Recently, acupuncture has been a recognized intervention for treating motor or non-motor symptoms in PD management. However, very few of these studies or cases have been reported from Japan. A 58-year-old man with a four-year history of PD (Hoehn and Yahr Scale: Stage 2) presented to the acupuncture department of our hospital with dysphasia, bradykinesia, forward posture, and newly appeared right-side bending of the trunk after he increased the dose of rotigotine delivered via skin patches six months earlier. There was no change in the right-sided bending of the trunk two months after the withdrawal of the dopaminergic agents. A traditional Japanese acupuncture and moxibustion treatment, Hokushin-kai, was started. According to the Oriental medical diagnosis, he was categorized with "liver depression," "kidney deficiency," and "dampness" patterns. The treatment was administered once a week, and only one or two needles were used. The acupoints, such as Ququan (LR8) or Houxi (SI3), were selected according to the Oriental medical diagnosis and the findings of the acupoint examination. At first, the Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) score was 34 points, and the Parkinson's Disease Questionnaire (PDQ-39) score was 42 points; the Cobb angle was 45°. After 10 weeks, he could walk smoothly and almost upright. MDS-UPDRS-3 and PDQ-39 scores improved to 12 points and 34 points, respectively, while the Cobb angle improved to 32°. Changes (improvements) in his gait and posture are shown in the videos included in this case report. We present a case of PD bradykinesia, forward posture, and drug-induced PS alleviated with traditional Japanese acupuncture. This case report suggests that acupuncture using this Japanese method would achieve similar efficacies to those achieved in conventional case reports or clinical trials, and it could be one of the optional treatments available for PD. Further studies, such as the long-term effect of acupuncture on PD patients or improved outcomes of PD patients with early-phase intervention, are required.

Pisa syndrome (PS) is a postural abnormality that frequently manifests in various neurological disorders. In recent years, the dangers associated with Parkinson's disease (PD) and PS have been increasingly acknowledged, leading to heightened research efforts directed toward the treatment of PS. Nevertheless, the underlying causes of PS remain complex, and no clinically effective treatments have been established. While several studies have demonstrated the significant effects of Qigong in treating PD, there is currently no evidence to support the efficacy of Qigong in the treatment of PS. To assess the immediate and long-term effects of Zhan Zhuang Qigong on PS in participants with PD using a rigorous randomised, parallel-control design with assignment concealment and evaluator-blinding methodologies. 60 PD participants meeting the inclusion criteria will be recruited and randomly assigned to one of two groups: conventional treatment (n=30) or Zhan Zhuang Qigong (n=30). The conventional treatment group will receive standard medications and physical therapy. The Zhan Zhuang Qigong group will receive conventional medicine plus 30 min of Zhan Zhuang Qigong practiced five times per week. The long-term effects of Qigong on PS will be evaluated after 6 months and 1 year of follow-up. Assessment tools will include the NeuroPostureApp, the B-PHY(A model of a balance testing system) balance check training system, the Unified Parkinson's Disease Rating Scale and the Parkinson's Disease Quality of Life Questionnaire, which will measure total camptocormia, upper hump degree, Pisa angles, plantar pressure distribution, motor function and quality of life in participants with PD. The local ethics committee approved this study (approval number: 2023-K068). The committee will oversee the study throughout its duration and will be notified of any protocol modifications. The results of the study will be disseminated through publication in an international journal or presentation at a conference. ChiCTR2400079696.

Objective: To investigate the prevalence and the clinical factors related to Pisa syndrome (PS) in Chinese Parkinson's disease (PD) patients.Methods: A total of 2,167 PD patients were continuously included in this observational study. Patients with PS were identified as presented with a lateral trunk flexion of at least 10° that can be completely alleviated by passive mobilization or supine positioning. The data of the motor and non-motor symptoms including depression, anxiety and cognitive dysfunction was collected and analyzed.Results: We found seventy-seven (3.6%) PD patients presenting with PS. The following variables including age, disease duration, levodopa equivalent daily doses (LEDD), the proportion of males, the proportion of participants using levodopa, dopaminergic agonist, amantadine and entacapone, the proportion of motor fluctuations, scores of Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), Unified PD Rating Scale (UPDRS) part III, and Hoehn and Yahr (H&Y) stage were significantly higher in patients with PS compared with patients without PS (P < 0.05). Scores of the Frontal Assessment Battery (FAB) and the Montreal Cognitive Assessment (MoCA) were not different between the two groups. The binary logistic regression model indicated that the presence of PS was associated with older age (OR = 1.027, P = 0.030), higher LEDD (OR = 1.002, P < 0.001) and a higher UPDRS III score (OR = 1.060, P < 0.001), but had no relationship with HAMD and HAMA scores.Conclusion: PS is relatively rare (3.6%) in Chinese PD patients. It is likely associated with older age, higher LEDD and more severe motor disabilities. However, non-motor symptoms such as depression, anxiety, and cognitive dysfunction have no association with PS in PD. These findings provided important complementary information for identifying the underlying mechanisms of PS.

This is a case study of 32 year old Mrs. M, a case of Young Onset Parkinson's Disease (YOPD) with hypothyroidism. With informed consent, Mrs. M was selected for the case report because Young Onset Parkinson’s Disease is a rare diagnosis. She was assessed using MDS-UPDRS pre- and post-intervention .She was provided Occupational Therapy intervention using the Person-Environment-Occupation Model for a period of three months and has shown significant improvement in UPDRS scores. Her primary diagnosis is Young Onset Parkinson’s Disease, secondary diagnosis being hypothyroidism.The patient, being in her early 30s, many of her life roles were altered. The patient’s main concerns are that she has difficulty in performing her basic and instrumental ADLs and difficulty in caring for her loved ones. Mrs. M was treated on weekly basis for an intervention period of three months using the Person Environment Occupation Model and assessed using the Unified Parkinson’s Disease Rating Scale; pre and post treatment. She was in stage 3 of Hoehn and Yahr scale of classification of Parkinson’s Disease. Scores were assessed on Unified Parkinson’s Disease Rating Scale, pre and post three months of intervention; showed improvement in non motor and motor aspects of experiences of daily living, motor examination and motor complications. Component scores were decreased dramatically especially in the areas of anxious mood, fatigue, tremors, posture and bradykinesia which revealed that functional levels improved following intervention. Keywords: Young Onset Parkinson’s Disease, Unified Parkinson’s Disease Rating Scale, Person Environment Occupation (PEO) based Occupational Therapy Intervention, case report.

Neuropsychiatric symptoms and syndromes are among the most common non-motor symptoms of Parkinson's Disease but they are frequently unrecognized and untreated. Dopamine Dysregulation Syndrome is an uncommon complication of the treatment of Parkinson's disease, characterized by an addictive use of dopamine far more than the dosage required for treatment of objective motor impairment, leading to severe dyskinesia, euphoria, aggressivity, or psychosis. We present a paradigmatic case of Dopamine Dysregulation Syndrome, Mania, and Compulsive Buying in a 55-year-old male with Parkinson's Disease. We also reviewed the risk factors and the therapeutic management of Dopamine Dysregulation Syndrome in Parkinson's Disease.