The pathogenesis of Pisa syndrome in Parkinson's disease

Authors

  • Anna Castrioto MD, PhD,

    Corresponding author
    1. Grenoble University Hospital, Psychiatry and Neurology Dept., Grenoble, France
    2. Grenoble Institute of Neuroscience, INSERM-UJF-CEA U836, Grenoble, France
    • Correspondence to: Anna Castrioto, Pavillon de Neurologie, CHU de Grenoble, B.P. 217, 38043 Grenoble Cedex, France, E-mail: ACastrioto@chu-grenoble.fr

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  • Céline Piscicelli,

    1. Grenoble University Hospital, Physical Medicine and Rehabilitation Dept., Grenoble, France
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  • Dominic Pérennou MD, PhD,

    1. Grenoble University Hospital, Physical Medicine and Rehabilitation Dept., Grenoble, France
    2. Grenoble–Alpes University, Grenoble, France
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  • Paul Krack MD, PhD,

    1. Grenoble University Hospital, Psychiatry and Neurology Dept., Grenoble, France
    2. Grenoble Institute of Neuroscience, INSERM-UJF-CEA U836, Grenoble, France
    3. Grenoble–Alpes University, Grenoble, France
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  • Bettina Debû PhD

    1. Grenoble Institute of Neuroscience, INSERM-UJF-CEA U836, Grenoble, France
    2. Grenoble–Alpes University, Grenoble, France
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  • Funding agencies: This study was supported by grants from France Parkinson Association.

  • Relevant conflicts of interest/financial disclosures: Nothing to report.

  • Full financial disclosures and author roles may be found in the online version of this article.

ABSTRACT

Postural abnormalities such as postural deviations affect nearly all patients with advanced Parkinson's disease and represent an important source of disability. Although their existence has long been known, their management remains a challenge as they respond poorly to medication, brain surgery, or physiotherapy. Improving management strategies will require better understanding of the mechanisms underlying such postural deformities.

In this review on the pathophysiology of Pisa syndrome, we examine the data supporting the central and peripheral hypotheses that attempt to explain these lateral trunk deviations. Although the pathophysiology is very probably multifactorial, the bulk of the data supports central, rather than peripheral, hypotheses. The central hypotheses that are best supported by both animal studies and clinical data include asymmetry of basal ganglia output and abnormalities in the central integration of sensory information. Further studies are needed to elucidate the pathophysiology underlying Pisa syndrome. © 2014 International Parkinson and Movement Disorder Society

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