Parkinson’s disease (PD): Pisa syndrome
Written and reviewed by Dr Ibrahim Imam, Consultant Neurologist. Last reviewed .
Parkinson’s disease (PD): Pisa syndrome. This is an axial (trunkal) dystonia. Fully referenced neurology checklist.
Pathology
- This is an axial (trunkal) dystonia
- There is a >10° sustained lateral flexion of the spine when standing
- There is associated slight backward rotation of the spine
- It is caused by poor paraspinal muscle recruitment on getting erect
- There is fixed bony spinal fusion in a quarter of cases
Clinical features
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Complications
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Electromyogram (EMG): features
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Differential diagnosis: lateral flexion
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Differential diagnosis: medication induced
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Differential diagnosis: others
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Treatment
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Synonym
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References
- Di Matteo A, Fasano A, Squintani G, et al. Lateral trunk flexion in Parkinson's disease: EMG features disclose two different underlying pathophysiological mechanisms. J Neurol 2011; 258:740-745.
- Yokochi F. Lateral flexion in Parkinson's disease and Pisa syndrome. J Neurol 2006; 253: (Suppl7):VII/17-VII/20.
- Cannas A, Solla P, Floris G, et al. Reversible Pisa syndrome in patients with Parkinson's disease in dopaminergic therapy. J Neurol 2009; 256:390-395.
- Barone P, Santangelo G, Amboni M, Pellecchia MT, Vitale C. Pisa syndrome in Parkinson's disease and parkinsonism: clinical features, pathophysiology, and treatment. Lancet Neurol 2016; 15:1063-1074.
- Doherty KM, Davagnanam I, Molloy S, Silveira-Moriyama L, Lees AJ. Pisa syndrome in Parkinson's disease: a mobile or fixed deformity? JNNP 2013; 84:1400-1403.
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