Objective: This study has two main objectives. The first objective is to elucidate the effects of distraction and alteration of sensorimotor inputs (visual and proprioceptive clues) on the development of lateral truncal flexion in patients with Pisa Syndrome (PS) and Parkinson’s disease (PD). The second objective is to examine the contribution of vestibular system dysfunction on the development of lateral truncal flexion in patients with PS and PD.

Background: PS is defined as lateral truncal flexion of greater than or equal to 10 degrees, which is not due to an underlying mechanical restriction and is almost completely alleviated by passive mobilization or supine positioning. PS has been seen to develop after exposure to various medications and also in the context of certain neurodegenerative conditions, including PD. There is currently no consensus on the pathophysiologic mechanisms driving the development of PS in PD; however, both central and peripheral generators have been implicated. The development of PS in PD can cause a significant increase in disability and there are currently no effective evidence-based therapies that significantly rectify lateral postural deviation in this syndrome.

Methods: This is an observational study. Our goal is to recruit 20 subjects with the diagnosis of PD and PS and 20 patients with PD without PS who will act as controls. Inclusion criteria include having the diagnosis of idiopathic PD, having objective findings consistent with PS which developed during the course of the patient’s PD and requiring the patient to be able to ambulate unassisted for 1 minute. Our outcome measures include degree of trunk lateral inclination (measured objectively with motion analysis) while standing quietly under different sensorimotor manipulation (foam/eyes closed) and with a concurrent dual-task as well as vestibular function measures (head thrust, Vestibular Evoked Myogenic Potentials (VEMPs) and calorics).

Results: This study is currently ongoing. We have recruited and completed 4 study visits at this time (all patients who have been seen have PD and PS). We plan on having half of our study visits (10 patients with PD and PS and 10 control patients) completed and data analyzed by the time we present our data at MDS.

Conclusions: Study is currently ongoing.

References: Castrioto, A., Piscicelli, C., Pérennou, D., Krack, P., & Debû, B. (2014). The pathogenesis of Pisa syndrome in Parkinson’s disease. Movement Disorders, 29(9), 1100–1107. 

Vitale, C., Marcelli, V., Furia, T., Santangelo, G., Cozzolino, A., Longo, K., … Barone, P. (2011). Vestibular impairment and adaptive postural imbalance in parkinsonian patients with lateral trunk flexion. Movement Disorders, 26(8), 1458–1463.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/characterization-of-pisa-syndrome-in-parkinsons-disease/