Objective: To elucidate the contribution of verticality misperception to the generation of Pisa syndrome (PS) in patients with Parkinson’s disease (PD).

Background: PD patients with PS show an abnormal perception of the verticality in the roll plane. However, due to a lack of the comprehensive consideration on the potentially relevant factors contributing to PS, pathophysiological implication of verticality perception in PD patients with PS remain to be elucidated.

Methods: Fifty-four PD patients with PS and twenty without PS were tested for verticality perception by measuring subjective visual vertical (SVV). We also evaluated potential contributors to PS by assessing the asymmetry and dominant side of motor symptoms, electromyographic patterns of paraspinal muscles, bithermal caloric tests, history of severe back pain, and Berg balance scales. Multivariable logistic regression was performed for the presence of abnormal SVV and possible confounders. To examine the influence of verticality misperception on the direction of PS, We further divided PD patients with PS into 2 subgroups, based on the congruence between the direction of SVV and that of PS, and compared clinical measurements.

Results: PD patients with PS usually showed abnormal SVV (n=45, 83.3%), often deviating to the leaning side (n=34, 63.0%), while abnormal SVV was observed in one patient without PS. Multivariable analysis revealed that abnormal SVV was an independent contributor to PS. In subgroup analysis, PD patients with PS tilting to the same direction of SVV were significantly associated with electromyographic hyperactivity of paraspinal muscles contralateral to the leaning side and reduced postural, whereas severe back pain was more frequent in those exhibiting SVV incongruent with the direction of PS.

Conclusions: Verticality misperception is strongly associated with PS in distinct patterns, possibly reflecting a primary pathology or secondary deviation to compensate for a body inclination. Assessment of verticality perception may provide a better understanding of pathomechanism of PS and help develop therapeutic interventions for PS in PD patients.

« Back to 2017 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/verticality-perception-differentially-correlates-with-pisa-syndrome-in-parkinsons-disease/