Objective: The aim was to evaluate the activation characteristics of the muscles involved in patients with Pisa Syndrome with surface electromyography (EMG) during walking after Botulinum Toxin Type A treatment.

Background: The Pisa Syndrome is a lateral axial trunk dystonia characterized by marked flexion of the thoraco-lumbar spine in the frontal plane, described in Parkinsonian patients receiving neuroleptic drugs. Some studies have evaluated the activity of paravertebral muscles with needle EMG describing different patterns of muscle activation, both ipsilateral and contralateral to the convexity of the lateral flexion curve of the spine.

Method: 7 patients with Pisa Syndrome underwent Gait Analysis, according to the modified Davis protocol, adding to the 22 standard marks 20 marks at the level of the vertebral spines and surface electrodes at the level of the thoracic and lumbar paravertebral muscles, gluteus medius and bilateral rectus femoris. Subsequently, the patients underwent myometric evaluation of the cervical, dorsal and lumbar paravertebral muscles and were treated with Onabotulinum toxin type A (BoTN/A), 300U diluted at 1%, inoculated in the lumbar and thoracaliliocostalis muscles, longissimus thoracis and latissimus dorsi muscles, bilaterally. The detections were made before (T0) and after inoculation with TB (T1).

Results: At T0, continuous muscle activity was observed in both patients in the paravertebral muscles bilaterally, mostly in the muscles contralateral to the flexion curve; this continuous activity is interspersed with peaks corresponding to the detachment phases of the gait cycle. In the gluteus and rectus femoris muscles there is a continuous basal activity with activation peaks congruent to the various phases of the gait cycle, in both patients. An improvement of all the parameters already mentioned was found in T1.

Conclusion: Our analysis highlights continuous muscle activity in the paravertebral muscles, especially contralateral to the flexion curve. The dystonic-like activation pattern already described in other studies is therefore confirmed, and this explains the rationale of BoTN/A therapy. In our study the observations were made in the two conditions (static and dynamic). This methodology allows adherence more in line with clinical reality.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/gait-analysis-in-parkinsonian-subjects-with-pisa-syndrome-subjected-to-treatment-with-botulinum-toxin/