Therapeutic interventions for Pisa syndrome in idiopathic Parkinson's disease. A Scoping Systematic Review

• Published in: Clinical neurology and neurosurgery 2020-11, Vol.198, p.106242-106242, Article 106242
• Main Authors: Etoom, Mohammad, Alwardat, Mohammad, Aburub, Ala’ S., Lena, Francesco, Fabbrizo, Roberto, Modugno, Nicola, Centonze, Diego
• Format: Article
• Language: English
• Subjects: Botulinum toxin; Clinical trials; Cofactors; Deep brain stimulation; Hyperactivity; ICF; Injection; Intervention; Lidocaine; Movement disorders; Neurodegenerative diseases; Neurology; Parkinson's disease; Pisa Syndrome; postural deformity; Posture; Quality of life; Questionnaires; Side effects; Spinal cord; Systematic review; Therapeutic applications; therapeutics
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2020.106242

•PS is a postural deformity that can worsen PD outcomes.•We did a scoping systematic review to view the therapeutic interventions for PS.•The therapeutic interventions were deep brain stimulation, Botulinum toxin, therapeutic exercise, lidocaine injection, oculomotor correction, and spinal cord stimulation.•The interventions showed various degree of improvements on PS outcomes. Pisa syndrome (PS) is a postural deformity characterized by marked and reversible lateral trunk flexion. PS can be seen in Parkinson's disease (PD) and several neurodegenerative diseases. A scoping systematic review was conducted to view the therapeutic interventions for PS in PD, their effectiveness, outcome measurements, and related cofactors. Databases and manual searches were performed. Studies that evaluate the effect of interventions on PS were included. Data were extracted and categorized by the main applied therapeutic intervention. A total of 19 published and 2 unpublished studies met the inclusion criteria. Wall and traditional goniometer, kinematic analysis, and clinical observations were used to detect PS. The included studies applied the following therapeutic protocols: Deep brain stimulation (DBS), Botulinum toxin injection, posture exercises, lidocaine injection, oculomotor correction, and spinal cord stimulation. The outcomes measurements of the included studies were linked to International Classification of Functioning, Disability and Health (ICF) model. The therapeutic interventions variously improve PS outcomes at short and long-term follow-up. The interventions did not report side effects or adverse events except DBS. PS severity was related to the DBS voltage amount in one study, and one participant in another study relapsed due to DBS. There are missing reported data in terms of participants' characteristics, medication status, and side effects. The current evidence shows the available interventions for PS, outcomes measurements, and related cofactors. The interventions may be safe and beneficial for PS. Further powerful studies are required.