Abstract
Objective: To observe the efficacy of bilateral subthalamic nucleus deep brain stimulation on Pisa syndrome in patients with Parkinson's disease.Methods: A total of 52 patients with Parkinson's disease who underwent deep brain stimulation in Beijing Hospital from July 1, 2016 to July 1, 2020 were reviewed. The clinical data were collected for the patients who met the diagnostic criteria of Pisa syndrome on “Medication-Off” state pre-operatively.Results: Two patients met the diagnostic criteria of Pisa syndrome before operation, with a Pisa angle of 10 and 14°, respectively. The lateral trunk flexion of the two patients improved after operation. In stimulation-on/medication-off state, the Pisa angle decreased from 10 to 2° and from 14 to 6°, respectively.Conclusion: Bilateral subthalamic nucleus deep brain stimulation might have beneficial effects on lateral trunk flexion in PD patients, but the predictors of curative effect are not clear.
Highlights
Pisa syndrome (PS), scoliosis, camptocormia, and anterocollis are considered to be major postural abnormalities of Parkinson’s disease (PD)
After administration of a levodopa challenge dose (1.5 times the usual morning dose), the score of UPDRS-III remarkably decreased to 26, item 28 of the UPDRS scored 0, and Pisa angle ameliorated to 2◦
The UPDRS-III score decreased to 20 points and the Pisa angle ameliorated to 2◦ in the Med-Off/Stim-On state
Summary
Pisa syndrome (PS), scoliosis, camptocormia, and anterocollis are considered to be major postural abnormalities of Parkinson’s disease (PD). PS is defined as trunk lateral flexion more than 10 or 15◦ and can be improved by passive movement or supine [1]. It is reported that the incidence of PS in PD patients is 1.9–8.8% in Europe [2]. A study on the prevalence and clinical characteristics of PS in 2167 Chinese patients with Parkinson’s disease showed that the incidence of PS was 3.6% if Pisa angle was defined as more than 10◦. The majority of PD patients with Pisa syndrome are chronic onset and no obvious causes. A small number of PD patients develop Pisa syndrome in the form of subacute onset, which are generally related to the adjustment of medication
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