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Wu X, Ma L, Wei P, Shan Y, Chan P, Wang K, Zhao G. Wearable sensor devices can automatically identify the ON-OFF status of patients with Parkinson's disease through an interpretable machine learning model. Front Neurol 2024; 15:1387477. [PMID: 38751881 PMCID: PMC11094303 DOI: 10.3389/fneur.2024.1387477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 04/12/2024] [Indexed: 05/18/2024] Open
Abstract
Introduction Accurately and objectively quantifying the clinical features of Parkinson's disease (PD) is crucial for assisting in diagnosis and guiding the formulation of treatment plans. Therefore, based on the data on multi-site motor features, this study aimed to develop an interpretable machine learning (ML) model for classifying the "OFF" and "ON" status of patients with PD, as well as to explore the motor features that are most associated with changes in clinical symptoms. Methods We employed a support vector machine with a recursive feature elimination (SVM-RFE) algorithm to select promising motion features. Subsequently, 12 ML models were constructed based on these features, and we identified the model with the best classification performance. Then, we used the SHapley Additive exPlanations (SHAP) and the Local Interpretable Model agnostic Explanations (LIME) methods to explain the model and rank the importance of those motor features. Results A total of 96 patients were finally included in this study. The naive Bayes (NB) model had the highest classification performance (AUC = 0.956; sensitivity = 0.8947, 95% CI 0.6686-0.9870; accuracy = 0.8421, 95% CI 0.6875-0.9398). Based on the NB model, we analyzed the importance of eight motor features toward the classification results using the SHAP algorithm. The Gait: range of motion (RoM) Shank left (L) (degrees) [Mean] might be the most important motor feature for all classification horizons. Conclusion The symptoms of PD could be objectively quantified. By utilizing suitable motor features to construct ML models, it became possible to intelligently identify whether patients with PD were in the "ON" or "OFF" status. The variations in these motor features were significantly correlated with improvement rates in patients' quality of life. In the future, they might act as objective digital biomarkers to elucidate the changes in symptoms observed in patients with PD and might be used to assist in the diagnosis and treatment of patients with PD.
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Affiliation(s)
- Xiaolong Wu
- Department of Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing, China
- International Neuroscience Institute (China-INI), Beijing, China
| | - Lin Ma
- Department of Neurorehabilitation, Rehabilitation Medicine of Capital Medical University, China Rehabilitation Research Centre, Beijing, China
| | - Penghu Wei
- Department of Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing, China
- International Neuroscience Institute (China-INI), Beijing, China
| | - Yongzhi Shan
- Department of Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing, China
- International Neuroscience Institute (China-INI), Beijing, China
| | - Piu Chan
- Department of Neurology and Neurobiology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Kailiang Wang
- Department of Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing, China
- International Neuroscience Institute (China-INI), Beijing, China
| | - Guoguang Zhao
- Department of Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing, China
- International Neuroscience Institute (China-INI), Beijing, China
- Beijing Municipal Geriatric Medical Research Center, Beijing, China
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Petry-Schmelzer JN, Abicht A, Barbe MT, Wunderlich G. Myofibrillar myopathy: a rare but important differential diagnosis of camptocormia in a patient with Parkinson's Disease. Neurol Res Pract 2023; 5:26. [PMID: 37287054 PMCID: PMC10249326 DOI: 10.1186/s42466-023-00250-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/20/2023] [Indexed: 06/09/2023] Open
Abstract
Here we report on a patient with Parkinson's Disease and camptocormia due to Myofibrillar Myopathy Type 3. By leading the reader through the clinical reasoning process and highlighting the respective red flags we aim to increase the readers' awareness for the differential diagnosis of camptocormia.
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Affiliation(s)
- Jan Niklas Petry-Schmelzer
- Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
| | - Angela Abicht
- Medizinisch Genetisches Zentrum (MGZ) München, Munich, Germany
- Department of Neurology, Friedrich-Baur-Institute, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Michael T Barbe
- Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Gilbert Wunderlich
- Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
- Center for Rare Diseases, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
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Geroin C, Artusi CA, Nonnekes J, Aquino C, Garg D, Dale ML, Schlosser D, Lai Y, Al-Wardat M, Salari M, Wolke R, Labou VT, Imbalzano G, Camozzi S, Merello M, Bloem BR, Capato T, Djaldetti R, Doherty K, Fasano A, Tibar H, Lopiano L, Margraf NG, Moreau C, Ugawa Y, Bhidayasiri R, Tinazzi M. Axial Postural Abnormalities in Parkinsonism: Gaps in Predictors, Pathophysiology, and Management. Mov Disord 2023; 38:732-739. [PMID: 37081741 DOI: 10.1002/mds.29377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 04/22/2023] Open
Affiliation(s)
- Christian Geroin
- Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Carlo Alberto Artusi
- Department of Neuroscience Rita Levi Montalcini, University of Turin, Torino, Italy
| | - Jorik Nonnekes
- Department of Rehabilitation, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Camila Aquino
- Department of Clinical Neurosciences, and Department of Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Divyani Garg
- Department of Neurology, Lady Hardinge Medical College, New Delhi, India
- Department of Neurology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Marian L Dale
- Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA
| | - Darbe Schlosser
- Motor Learning Program, Teachers College, Columbia University, New York, New York, USA
| | - Yijie Lai
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mohammad Al-Wardat
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Mehri Salari
- Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Robin Wolke
- Department of Neurology, UKSH, Christian-Albrechts-University, Kiel, Germany
| | | | - Gabriele Imbalzano
- Department of Neuroscience Rita Levi Montalcini, University of Turin, Torino, Italy
| | - Serena Camozzi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Marcelo Merello
- Movement Disorders Service, FLENI, CONICET, Buenos Aires, Argentina
| | - Bastiaan R Bloem
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Tamine Capato
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
- Department of Neurology, Movement Disorders Center, University of São Paulo, São Paulo, Brazil
| | - Ruth Djaldetti
- Department of Neurology, Rabin Medical Center, Petah Tikva Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Karen Doherty
- Department of Neurology, Royal Victoria Hospital, Belfast, UK
- Centre for Medical Education, Queens University Belfast, Belfast, UK
| | - Alfonso Fasano
- Krembil Brain Institute, Toronto, Ontario, Canada
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Houyam Tibar
- Service de Neurologie B et de Neurogénétique Hôpital des Spécialités OTO-Neuro-Ophtalmologique, Ibn Sina University Hospital, Medical School of Rabat, Mohamed 5 University of Rabat, Rabat, Morocco
| | - Leonardo Lopiano
- Department of Neuroscience Rita Levi Montalcini, University of Turin, Torino, Italy
- Neurology 2 Unit, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Nils G Margraf
- Department of Neurology, UKSH, Christian-Albrechts-University, Kiel, Germany
| | - Caroline Moreau
- Neurological Department, Expert Center for Parkinson's Disease, Inserm UMR 1172, Lille University Hospital, Lille, France
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Roongroj Bhidayasiri
- Department of Medicine, Faculty of Medicine, Chulalongkorn Centre of Excellence for Parkinson's Disease and Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand
| | - Michele Tinazzi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Yilmaz R, Wolke R, Puls N, Sorgun MH, Deuschl G, Berg D, Margraf NG. Characterizing Camptocormia in Parkinson's Disease Using Muscle Ultrasonography. JOURNAL OF PARKINSON'S DISEASE 2023; 13:819-827. [PMID: 37334619 PMCID: PMC10473098 DOI: 10.3233/jpd-230037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/22/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Camptocormia (CC) is the forward-bending of the spine of more than 30 degrees that can be found in Parkinson's disease (PD) as a disabling complication. Detection of changes in paraspinal lumbar musculature in CC is of value for choosing treatment strategies. OBJECTIVE To investigate whether these changes can be detected using muscle ultrasonography (mUSG). METHODS Age and sex-matched groups comprised 17 PD patients with CC (seven acute, PD-aCC; 10 chronic PD-cCC), 19 PD patients with no CC, and 18 healthy controls (HC). Lumbar paravertebral muscles (LPM) on both sides were assessed using mUSG by two different raters blinded to the group assignment. Groups were compared with regard to the linear measurements of the muscle thickness as well as semi-quantitative and quantitative (grayscale) analyses of muscle echogenicity using a univariate general linear model. RESULTS All assessments showed substantial interrater reliability. The PD-cCC group had significantly thinner LPM compared to groups with no CC (PD and HC). Groups of PD-aCC and PD-cCC differed from the groups of no CC in quantitative and semi-quantitative analyses of LPM echogenicity, respectively. CONCLUSION Assessment of LPM in PD patients with CC can be reliably performed using mUSG. Also, mUSG may be used as a screening tool to detect CC-related changes in thickness and echogenicity of the LPM in patients with PD.
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Affiliation(s)
- Rezzak Yilmaz
- Department of Neurology, Ankara University School of Medicine, Ankara, Turkey
| | - Robin Wolke
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Nina Puls
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Mine Hayriye Sorgun
- Department of Neurology, Ankara University School of Medicine, Ankara, Turkey
| | - Günther Deuschl
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Daniela Berg
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Nils G. Margraf
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
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Eker A, Kaymakamzade B, Diker S, Cumaogulları O, Yigitoglu PH. Axial posture disorders in Parkinson's disease: Clinical correlates and future treatment directions1. J Back Musculoskelet Rehabil 2022; 35:1321-1328. [PMID: 35964166 DOI: 10.3233/bmr-210263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Postural disorders are frequently observed in Parkinson's disease (PD). The underlying mechanisms that cause postural disorders are not fully understood and the majority of these disorders have no response to antiparkinsonian treatments. These disabling conditions require further investigation to better understand the underlying mechanisms in order to develop effective treatments. OBJECTIVE The aim of this study was to investigate the frequency of axial postural disorders in PD and to determine the associated clinical risk factors. METHODS In this single-center clinical trial, the data of PD patients were reviewed retrospectively. The frequencies of postural disorders were determined, and the demographic clinical characteristics of the patients were compared. RESULTS The records of 127 patients with idiopathic PD were analyzed. Axial posture disorders were found in 42.6% of patients. Patients with axial posture disorders were older when the disease onset was detected, amongst these patients the condition was also longer lasting. The mean levodopa dose was higher in the patients with posture disorders. The initial symptom was bradykinesia and the Hoehn and Yahr's score was ⩾ 3 in the majority of the patients with posture disorder. Additionally, constipation, hallucinations, postural instability, and falls were significantly more common in patients with posture disorders. CONCLUSION Posture disorders were observed in nearly half of PD patients and were more frequently observed in patients with an advanced condition. In addition, our investigation has found that it is crucial to follow up with patients who present with bradykinesia for the development of postural disorder.
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Affiliation(s)
- Amber Eker
- Department of Neurology, Faculty of Medicine, Eastern Mediterranean University, Famagusta, North Cyprus, Mersin 10, Turkey
| | - Bahar Kaymakamzade
- Department of Neurology, Near East University Faculty of Medicine, Nicosia, Cyprus
| | - Sevda Diker
- Department of Neurology, Faculty of Medicine, Cyprus International University, Nicosia, Cyprus
| | - Ozge Cumaogulları
- Eastern Mediterranean University Faculty of Medicine, Famagusta, North Cyprus, Mersin 10, Turkey
| | - Pembe Hare Yigitoglu
- Department of Physical Medicine and Rehabilitation, Near East University Faculty of Medicine, Nicosia, Cyprus
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Tinazzi M. “A man with an arched back”: Expert commentary. Parkinsonism Relat Disord 2022; 103:177-178. [DOI: 10.1016/j.parkreldis.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 11/25/2022]
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Lacroix M, Nguyen C, Burns R, Laporte A, Rannou F, Feydy A. Degenerative Lumbar Spine Disease: Imaging and Biomechanics. Semin Musculoskelet Radiol 2022; 26:424-438. [PMID: 36103885 DOI: 10.1055/s-0042-1748912] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Chronic low back pain (CLBP) is one of the most common diagnoses encountered when considering years lived with disability. The degenerative changes of the lumbar spine include a wide spectrum of morphological modifications visible on imaging, some of them often asymptomatic or not consistent with symptoms. Phenotyping by considering both clinical and imaging biomarkers can improve the management of CLBP. Depending on the clinical presentation, imaging helps determine the most likely anatomical nociceptive source, thereby enhancing the therapeutic approach by targeting a specific lesion. Three pathologic conditions with an approach based on our experience can be described: (1) pure painful syndromes related to single nociceptive sources (e.g., disk pain, active disk pain, and facet joint osteoarthritis pain), (2) multifactorial painful syndromes, representing a combination of several nociceptive sources (such as lumbar spinal stenosis pain, foraminal stenosis pain, and instability pain), and (3) nonspecific CLBP, often explained by postural (muscular) syndromes.
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Affiliation(s)
- Maxime Lacroix
- Department of Musculoskeletal Radiology, Hôpital Cochin, Université de Paris, Paris, France.,Department of Radiology, Hôpital Européen Georges-Pompidou, Université de Paris, Paris, France
| | - Christelle Nguyen
- Department of Physical and Rehabilitation Medicine, Hôpital Cochin, Université de Paris, Paris, France
| | - Robert Burns
- Department of Musculoskeletal Radiology, Hôpital Cochin, Université de Paris, Paris, France
| | - Amandine Laporte
- Department of Musculoskeletal Radiology, Hôpital Cochin, Université de Paris, Paris, France
| | - François Rannou
- Department of Physical and Rehabilitation Medicine, Hôpital Cochin, Université de Paris, Paris, France
| | - Antoine Feydy
- Department of Musculoskeletal Radiology, Hôpital Cochin, Université de Paris, Paris, France
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Hoffman RJ, Garner HW, Rojas CA, Grage RA, Sonavane SK, Johnson EM, Mergo PJ, Walker CM, Stowell JT. Atypical Causes of Dyspnea: A Review of Neuromuscular and Chest Wall Disorders that Compromise Ventilation. J Thorac Imaging 2022; 37:W45-W55. [PMID: 35213124 DOI: 10.1097/rti.0000000000000641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Dyspnea is a common presenting symptom among patients with cardiopulmonary diseases. However, several neuromuscular and chest wall conditions are often overlooked and under-recognized causes of dyspnea. These disorders frequently adversely affect the structure and function of the ventilatory pump (diaphragm, accessory muscles of ventilation) and can precipitate respiratory failure despite normal lung parenchyma. Weakened musculature impairs clearance of airway secretions leading to aspiration and pneumonia, further compromising respiratory function. Radiologists should be aware of the pathophysiology and imaging manifestations of these conditions and might suggest them to be causes of dyspnea which otherwise may not have been considered by referring clinicians.
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Affiliation(s)
| | | | | | - Rolf A Grage
- Department of Radiology, Mayo Clinic, Jacksonville, FL
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Beni KN, Wolke R, Finck MJ, Elfrath E, Margraf NG, Rieger R. Acquisition and Automated Segmentation of Inertia Sensor Data for Mobile Camptocormia Assessment. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:105-108. [PMID: 36086086 DOI: 10.1109/embc48229.2022.9871886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The camptocormia angle has been established as a strong indicator for evaluating the progress of Parkinson's disease and the efficacy of therapeutical approaches. A wearable setup is proposed to measure the camptocormia angle with the perpendicular method using five inertial sensors. This study identifies suitable inertial measurement unit sensors for mobile long-term measurement. Moreover, a machine-learning approach is presented for segmenting the recorded data into periods with different dominant activities. An artificial neural network was the better classifier compared to a support vector machine to recognize certain common activities in patients with camptocormia. The artificial neural network's accuracy, sensitivity, and F1-score were 92.4 %, 82.9 %, and 82.1 %, respectively. Clinical Relevance- The presented approach is expected to lead to a wearable system for long-term monitoring of the progress of camptocormia, yielding improved parameters compared to the conventional static photo method.
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Zhang P, Li D, Liu J, Chen S, Tan Y, Zhou H. Temporary Stimulation Switch-off Successfully Applied in a Dystonic Camptocormia Patient. Mov Disord Clin Pract 2022; 9:255-258. [PMID: 35146066 PMCID: PMC8810441 DOI: 10.1002/mdc3.13397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 10/20/2021] [Accepted: 12/03/2021] [Indexed: 01/05/2023] Open
Affiliation(s)
- Pingchen Zhang
- Department of Neurology & Collaborative Innovation Center for Brain ScienceRuijin Hospital Affiliated to Shanghai Jiaotong University School of MedicineShanghaiChina
| | - Dianyou Li
- Department of Functional NeurosurgeryRuijin Hospital Affiliated to Shanghai Jiaotong University School of MedicineShanghaiChina
| | - Jun Liu
- Department of Neurology & Collaborative Innovation Center for Brain ScienceRuijin Hospital Affiliated to Shanghai Jiaotong University School of MedicineShanghaiChina
| | - Shengdi Chen
- Department of Neurology & Collaborative Innovation Center for Brain ScienceRuijin Hospital Affiliated to Shanghai Jiaotong University School of MedicineShanghaiChina
| | - Yuyan Tan
- Department of Neurology & Collaborative Innovation Center for Brain ScienceRuijin Hospital Affiliated to Shanghai Jiaotong University School of MedicineShanghaiChina
| | - Haiyan Zhou
- Department of Neurology & Collaborative Innovation Center for Brain ScienceRuijin Hospital Affiliated to Shanghai Jiaotong University School of MedicineShanghaiChina
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Fransson PA, Nilsson MH, Rehncrona S, Tjernström F, Magnusson M, Johansson R, Patel M. Deep brain stimulation in the subthalamic nuclei alters postural alignment and adaptation in Parkinson's disease. PLoS One 2021; 16:e0259862. [PMID: 34905546 PMCID: PMC8670690 DOI: 10.1371/journal.pone.0259862] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 10/27/2021] [Indexed: 12/02/2022] Open
Abstract
Parkinson’s disease (PD) can produce postural abnormalities of the standing body position such as kyphosis. We investigated the effects of PD, deep brain stimulation (DBS) in the subthalamic nucleus (STN), vision and adaptation on body position in a well-defined group of patients with PD in quiet standing and during balance perturbations. Ten patients with PD and 25 young and 17 old control participants were recruited. Body position was measured with 3D motion tracking of the ankle, knee, hip, shoulder and head. By taking the ankle as reference, we mapped the position of the joints during quiet standing and balance perturbations through repeated calf muscle vibration. We did this to explore the effect of PD, DBS in the STN, and vision on the motor learning process of adaptation in response to the repeated stimulus. We found that patients with PD adopt a different body position with DBS ON vs. DBS OFF, to young and old controls, and with eyes open vs. eyes closed. There was an altered body position in PD with greater flexion of the head, shoulder and knee (p≤0.042) and a posterior position of the hip with DBS OFF (p≤0.014). With DBS ON, body position was brought more in line with the position taken by control participants but there was still evidence of greater flexion at the head, shoulder and knee. The amplitude of movement during the vibration period decreased in controls at all measured sites with eyes open and closed (except at the head in old controls with eyes open) showing adaptation which contrasted the weaker adaptive responses in patients with PD. Our findings suggest that alterations of posture and greater forward leaning with repeated calf vibration, are independent from reduced movement amplitude changes. DBS in the STN can significantly improve body position in PD although the effects are not completely reversed. Patients with PD maintain adaptive capabilities by leaning further forward and reducing movement amplitude despite their kyphotic posture.
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Affiliation(s)
| | - Maria H. Nilsson
- Department of Health Sciences, Lund University, Lund, Sweden
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
- Clinical Memory Research Unit, Faculty of Medicine, Lund University, Lund, Sweden
| | - Stig Rehncrona
- Department of Neurosurgery, Lund University, Lund, Sweden
| | | | - Måns Magnusson
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Rolf Johansson
- Department of Automatic Control, Lund University, Lund, Sweden
| | - Mitesh Patel
- School of Medicine & Clinical Practice, Faculty of Science, University of Wolverhampton, Wolverhampton, United Kingdom
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Colucci F, Carvalho V, Gonzalez-Robles C, Bhatia KP, Mulroy E. From Collar to Coccyx: Truncal Movement Disorders: A Clinical Review. Mov Disord Clin Pract 2021; 8:1027-1033. [PMID: 34631937 DOI: 10.1002/mdc3.13325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 07/24/2021] [Accepted: 07/27/2021] [Indexed: 12/25/2022] Open
Abstract
Background Movement disorders affecting the trunk remain a diagnostic challenge even for experienced clinicians. However, despite being common and debilitating, truncal movement disorders are rarely discussed and poorly reviewed in the medical literature. Objectives To review common movement disorders affecting the trunk and provide an approach for clinicians based on the truncal region involved (shoulder, chest, diaphragm, abdomen, pelvis, and axial disorders). For each disorder, clinical presentation, etiologic differential diagnosis, and "clinical clues" are discussed. Conclusion This review provides a clinically focused, practical approach to truncal movement disorders, which will be helpful for physicians in everyday practice.
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Affiliation(s)
- Fabiana Colucci
- Clinical and Biological Sciences Department, Neurology Unit San Luigi Gonzaga Hospital Turin Italy
| | - Vanessa Carvalho
- Department of Neurology Hospital Pedro Hispano/Unidade Local de Saúde de Matosinhos Matosinhos Portugal
| | - Cristina Gonzalez-Robles
- Department of Clinical and Movement Neurosciences UCL Queen Square Institute of Neurology London United Kingdom
| | - Kailash P Bhatia
- Department of Clinical and Movement Neurosciences UCL Queen Square Institute of Neurology London United Kingdom
| | - Eoin Mulroy
- Department of Clinical and Movement Neurosciences UCL Queen Square Institute of Neurology London United Kingdom
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Abstract
STUDY DESIGN Narrative review. OBJECTIVES Describe a comprehensive spine telemedicine examination. METHODS We discuss telemedicine examination techniques for commonly encountered spine conditions. RESULTS Techniques to evaluate gait, the cervical spine, the lumbar spine, adult spinal deformity patients, and adolescent scoliosis patients via telemedicine are described. We review limitations of the spine telemedicine examination and discuss special considerations such as patient safety and criteria for in-person assessment. CONCLUSIONS While there are limitations to the spine telemedicine examination, unique strategies exist to provide important information to the examiner. Efforts have already been undertaken to validate and expand the capabilities of the spine telemedicine examination.
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Affiliation(s)
- Alexander M. Satin
- Texas Back Institute, Plano, TX, USA,Alexander M. Satin, Texas Back Institute, 6020 West Parker Road, #200, Plano, TX 75093, USA.
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Barriga-Martín A, Romero-Muñoz LM, Caba-Mora D, Rodríguez de Lope-Llorca A, López-Ariztegui N. «El convento de las monjas torcidas». Síndrome de Pisa y camptocormia inducido por antipsicóticos. Neurocirugia (Astur) 2021; 32:148-152. [DOI: 10.1016/j.neucir.2020.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 05/05/2020] [Accepted: 05/16/2020] [Indexed: 11/16/2022]
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Late-onset camptocormia caused by a heterozygous in-frame CAPN3 deletion. Neuromuscul Disord 2021; 31:450-455. [PMID: 33741228 DOI: 10.1016/j.nmd.2021.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 12/09/2020] [Accepted: 02/11/2021] [Indexed: 02/06/2023]
Abstract
Camptocormia is defined by a pathological involuntary flexion of the thoracic and lumbar spine that is fully reducible in the supine position. Although originally described as a manifestation of conversion disorder, it is more commonly caused by a wide range of neurological diseases, in particular movement and neuromuscular disorders. We describe here a rare case of late onset camptocormia caused by autosomal dominant calpainopathy due to a heterozygous in-frame deletion in CAPN3 leading to loss of a single lysin amino acid in the catalytic domain of calpain-3. Creatine kinase levels, electromyography, and thigh muscle MRI were normal. Muscle biopsy did not show lobulated fibers and calpain-3 protein expression was not decreased, but in vitro functional assays showed impaired proteolytic function of. Lys254del CAPN3. Autosomal dominant calpainopathy should be considered in the differential diagnosis of late onset camptocormia and unexplained paravertebral myopathies even in presence of normal creatine kinase levels, and in absence of lobulated fibers, of decreased calpain-3 protein expression, and of muscle limb involvement.
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16
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Wolke R, Kuhtz-Buschbeck JP, Deuschl G, Margraf NG. Insufficiency of trunk extension and impaired control of muscle force in Parkinson's disease with camptocormia. Clin Neurophysiol 2020; 131:2621-2629. [PMID: 32932021 DOI: 10.1016/j.clinph.2020.07.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 07/04/2020] [Accepted: 07/12/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To examine the aetiology of parkinsonian camptocormia, a non-fixed pathological forward bending of the trunk, by measuring trunk muscle activation and force regulation in Parkinson patients with (PD + CC) and without (PD) camptocormia matched for disease severity, and in age- and sex-matched healthy controls (HC). METHODS The isometric forces of trunk extension and flexion were measured in PD + CC, PD and HC. Neuromuscular efficiency (increase of extension force per increase of paravertebral muscle surface electromyography signal) and the ability to maintain a constant submaximal trunk extension force were examined. RESULTS Peak trunk extension force was significantly lower in PD + CC and PD than in HC, with PD + CC non-significantly weaker than PD. Compared with HC and with PD, the neuromuscular efficiency of trunk extension was significantly reduced in PD + CC. The variability of the force output (coefficient of variation) was significantly larger for PD + CC than for HC or PD. CONCLUSION The reduced neuromuscular efficiency of trunk extension separates PD + CC from PD. Moreover, control of the trunk extensor force is impaired in PD + CC. SIGNIFICANCE There is weakness and a force control deficit in parkinsonian camptocormia suggesting a disturbed sensory-motor integration, which may contribute to myopathic changes in the trunk extensor muscles.
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Affiliation(s)
- R Wolke
- Department of Neurology, Kiel University, UKSH, Germany
| | | | - G Deuschl
- Department of Neurology, Kiel University, UKSH, Germany.
| | - N G Margraf
- Department of Neurology, Kiel University, UKSH, Germany
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Liang S, Yu Y, Li H, Wang Y, Cheng Y, Yang H. The Study of Subthalamic Deep Brain Stimulation for Parkinson Disease-Associated Camptocormia. Med Sci Monit 2020; 26:e919682. [PMID: 32222721 PMCID: PMC7139194 DOI: 10.12659/msm.919682] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 01/15/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Camptocormia is an axis symptom of Parkinson disease. It remains uncertain whether treatment with medications and surgery are effective. In this study, we assessed the efficacy of subthalamic nucleus deep brain stimulation (STN DBS) in Parkinson disease-associated camptocormia and explored some of its mechanisms. MATERIAL AND METHODS Parkinson disease-associated camptocormia was diagnosed by the following procedures. All patients underwent bilateral STN DBS. The patents' camptocormia was rated by degree and MDS Unified Parkinson's Disease Rating Scale (UPDRS) item 3.13 before and after DBS surgery. Rehabilitation and psychological interventions were used after surgery, in addition to adjustments of medication and stimulus parameters. The treatment effects on camptocormia were assessed comparing medication-off (presurgery) versus stimulation-on (post-surgery). Ethical approval for this study was provided through the Center of Human Research Ethics Committee (No. 2019-35). This study trial was registered in Chinese Clinical Trial Registry (No. ChiCTR1900022655). All the participants provided written informed consent. RESULTS After DBS surgery, all of study patients' symptoms were improved, with different levels of improvement. The minimum and maximum improvement rates were 20% and 100% respectively. The score of item 3.13 of the MDS-UPDRS III and the degree of camptocormia were found to be obviously improved (P<0.05). CONCLUSIONS STN DBS can improve Parkinson disease-associated camptocormia; STN DBS assisted with rehabilitation and psychological intervention appears to be more effective.
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Affiliation(s)
- Siquan Liang
- Department of Neurosurgery, Tianjin Huanhu Hosptial, Tianjin, P.R. China
| | - Yang Yu
- Department of Neurological Rehabilitation, Tianjin Huanhu Hosptial, Tianjin, P.R. China
| | - Haitao Li
- Department of Neurosurgery, Tianjin Huanhu Hosptial, Tianjin, P.R. China
| | - Yue Wang
- Department of Neurological Rehabilitation, Tianjin Huanhu Hosptial, Tianjin, P.R. China
| | - Yuanyuan Cheng
- Department of Neurological Rehabilitation, Tianjin Huanhu Hosptial, Tianjin, P.R. China
| | - Hechao Yang
- Department of Psychology, Tianjin Huanhu Hosptial, Tianjin, P.R. China
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Magrinelli F, Geroin C, Squintani G, Gandolfi M, Rizzo G, Barillari M, Vattemi G, Morgante F, Tinazzi M. Upper camptocormia in Parkinson's disease: Neurophysiological and imaging findings of both central and peripheral pathophysiological mechanisms. Parkinsonism Relat Disord 2020; 71:28-34. [PMID: 31981996 DOI: 10.1016/j.parkreldis.2020.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 01/07/2020] [Accepted: 01/10/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Camptocormia is a disabling complication of Parkinson's disease (PD), but its pathophysiology is poorly elucidated. Depending on the fulcrum of forward trunk flexion, two subtypes have been defined, upper (UCC) and lower camptocormia, the former being much more frequent. The aim of the study was to explore possible pathophysiological mechanisms of PD-related UCC. METHODS Ten PD patients with UCC (UCC-PD) and ten PD patients without camptocormia (NoUCC-PD) underwent simultaneous electromyography (EMG) of thoracic paraspinal (TPS), obliquus externus abdominis (OEA), rectus abdominis (RA), and iliopsoas (IP) muscles during relaxed standing (both groups) and trunk realignment (UCC-PD group). Quantitative EMG and magnetic resonance imaging (MRI) of TPS muscles were also performed. RESULTS UCC-PD patients showed hyperactivity of TPS and OEA muscles in quiet stance. During voluntary trunk extension, hyperactivity of OEA muscles persisted, thus revealing a co-contraction of flexor and extensor trunk muscles. Motor unit potentials (MUP) of TPS muscles showed shorter duration (p = 0.005) and lower amplitude (p = 0.004) in UCC-PD than in NoUCC-PD patients. MRI did not detect significant between-group differences in the cross-sectional area and fat fraction of TPS muscles, although the latter was higher in the UCC-PD than in the NoUCC-PD group at all thoracic levels. CONCLUSION Our findings suggest that hyperactivity of OEA might sustain UCC in PD. Concurrent mild myopathic changes in TPS muscles in PD with UCC may be secondary to muscle disuse but nevertheless may contribute to abnormal trunk posture.
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Affiliation(s)
- Francesca Magrinelli
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
| | - Christian Geroin
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
| | | | - Marialuisa Gandolfi
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
| | - Giulio Rizzo
- Radiology BR Unit, University Hospital of Verona, Verona, Italy.
| | - Marco Barillari
- Radiology BR Unit, University Hospital of Verona, Verona, Italy.
| | - Gaetano Vattemi
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
| | - Francesca Morgante
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom; Department of Experimental and Clinical Medicine, University of Messina, Messina, Italy.
| | - Michele Tinazzi
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
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Kataoka H, Sugie K. Recent advancements in lateral trunk flexion in Parkinson disease. Neurol Clin Pract 2019; 9:74-82. [PMID: 30859010 DOI: 10.1212/cpj.0000000000000574] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 09/13/2018] [Indexed: 11/15/2022]
Abstract
Purpose of review Understanding the pathophysiologic underpinnings of lateral trunk flexion (LTF) in Parkinson disease (PD) has been growing. Adjusting antiparkinsonian medications, botulinum toxin, or surgical intervention has been found efficacious in some patients. Nevertheless, these treatments remain limited, often resulting in inadequate outcomes. We review patients with LTF with PD, including recent advancements in treatment and neuroimaging examination. Recent findings The basal ganglia system is a major contributing factor to LTF, and the therapeutic intervention also targets the basal ganglia system, including dystonic contraction. The perceptions of the postural verticality or spatial cognition of the correct body orientation promote the severity of LTF or result in a chronic condition with irreversible structural deformities. Conclusion The combination of pharmacologic interventions with nonpharmacologic interventions, such as rehabilitation, might be needed to manage LTF, and the initiation of these treatments should be started as early as possible.
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Affiliation(s)
- Hiroshi Kataoka
- Department of Neurology, Nara Medical University, Nara Medical University, Kashihara, Nara, Japan
| | - Kazuma Sugie
- Department of Neurology, Nara Medical University, Nara Medical University, Kashihara, Nara, Japan
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20
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Wijemanne S, Jankovic J. Hand, foot, and spine deformities in parkinsonian disorders. J Neural Transm (Vienna) 2019; 126:253-264. [PMID: 30809710 DOI: 10.1007/s00702-019-01986-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 02/09/2019] [Indexed: 12/31/2022]
Abstract
Hand and foot deformities, known as "striatal deformities", and other musculoskeletal abnormalities such as dropped head, bent spine, camptocormia, scoliosis and Pisa syndrome, are poorly understood and often misdiagnosed features of Parkinson's disease and other parkinsonian syndromes. These deformities share some similarities with known rheumatologic conditions and can be wrongly diagnosed as rheumatoid arthritis, osteoarthritis, psoriatic arthritis, Dupuytren's contracture, trigger finger, or other rheumatologic or orthopedic conditions. Neurologists, rheumatologists, and other physicians must be familiar with these deformities to prevent misdiagnosis and unnecessary diagnostic tests, and to recommend appropriate treatment options.
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Affiliation(s)
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, 7200 Cambridge St, Suite #9A, Houston, TX, 77030, USA.
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21
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Mehta S, Kumar R, Lal V. An Unusual Cause of Camptocormia. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2019; 9:608. [PMID: 30783552 PMCID: PMC6377804 DOI: 10.7916/d8q82x3k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 11/13/2018] [Indexed: 12/01/2022]
Abstract
Background Camptocormia is defined as forward flexion of the spine that manifests during walking and standing and disappears in recumbent position. The various etiologies include idiopathic Parkinson’s disease, multiple system atrophy, myopathies, degenerative joint disease, and drugs. Case Report A 67-year-old diabetic female presented with bradykinesia and camptocormia that started 1 year prior to presentation. Evaluation revealed levosulpiride, a dopamine receptor blocker commonly used for dyspepsia, to be the culprit. Discussion It is well known that dopamine receptor blockers cause parkinsonism and tardive syndromes. We report a rare and unusual presentation of camptocormia attributed to this commonly used gastrointestinal drug in the Asian population.
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Affiliation(s)
- Sahil Mehta
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, IN
| | - Rajender Kumar
- Department of Nuclear Medicine and PET/CT, Post Graduate Institute of Medical Education and Research, Chandigarh, IN
| | - Vivek Lal
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, IN
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Horisawa S, Oka M, Kohara K, Kawamata T, Taira T. Staged bilateral pallidotomy for dystonic camptocormia: case report. J Neurosurg 2018; 131:839-842. [PMID: 30497197 DOI: 10.3171/2018.5.jns1840] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 05/02/2018] [Indexed: 11/06/2022]
Abstract
Camptocormia is a rare, involuntary movement disorder, presenting as truncal flexion while standing or walking, and is mainly observed as a feature of Parkinson's disease (PD) and primary dystonia. Deep brain stimulation (DBS) of the globus pallidus internus is effective for refractory camptocormia observed with PD or dystonia. However, the effectiveness of pallidotomy for camptocormia has not been investigated. The authors report the case of a 38-year-old man with anterior truncal bending that developed when he was 36 years old. Prior to the onset of the symptom, he had been taking antipsychotic drugs for schizophrenia. There were no features of PD; the symptom severely interfered with his walking and daily life. He was given anticholinergics, clonazepam, and botulinum toxin injections, which did not result in much success. Because of the patient's unwillingness to undergo implantation of a hardware device, he underwent staged bilateral pallidotomy with complete resolution for a diagnosis of tardive dystonic camptocormia. The Burke-Fahn-Marsden dystonia rating scale subscore for the trunk before and after bilateral pallidotomy was 3 and 0, respectively. No perioperative adverse events were observed. Effects have persisted for 18 months. Bilateral pallidotomy can be a treatment option for medically refractory dystonic camptocormia without the need for device implantation.
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Galazky I, Caspari C, Heinze HJ, Franke J. The prevalence of chronic low back pain and lumbar deformities in patients with Parkinson’s disease: implications on spinal surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:2847-2853. [DOI: 10.1007/s00586-018-5748-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 07/06/2018] [Accepted: 08/24/2018] [Indexed: 11/28/2022]
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Todo H, Yamasaki H, Ogawa G, Nishida K, Futamura N, Funakawa I. Injection of Onabotulinum Toxin A into the Bilateral External Oblique Muscle Attenuated Camptocormia: A Prospective Open-Label Study in Six Patients with Parkinson's Disease. Neurol Ther 2018; 7:365-371. [PMID: 30094699 PMCID: PMC6283798 DOI: 10.1007/s40120-018-0108-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Camptocormia (severe bending of the spine) is a debilitating complication of Parkinson's disease (PD) without established treatment. Botulinum toxin (BT) may be beneficial, but data is scarce regarding the efficacy of administration of BT into the bilateral external oblique (EO) muscle for treatment of camptocormia in PD. METHODS Six patients with PD and camptocormia, with flexion of the thoracic spine, were enrolled in the study. BT (75 or 90 units, onabotulinum toxin A) were injected into each EO bilaterally under sonographic guidance. Camptocormia angle (CA) was defined as the angle between the acromion-greater trochanter line and a vertical line. CA and disabling symptoms were evaluated during the treatment course. RESULTS Two weeks after the injection of BT, the mean CA showed significant attenuation [median (interquartile range); 38° (23.5°) vs. 18° (21°), p = 0.028]. Subjective relief was present in cases 1-3 and 6, and absent in cases 4 and 5. Cases 1-3 received repeated injections to maintain the amelioration; in cases 1 and 2, this was for 1 year or longer, while falls of case 3 limited the amelioration. CONCLUSION Botulinum therapy into bilateral EO attenuated the angle of thoracic-level camptocormia in six patients with PD over the observation period of 2 weeks. The reproducibility of the results, long-term efficacy, and subjective relief of symptoms require further examination.
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Affiliation(s)
- Hiroyuki Todo
- Department of Neurology, National Hospital Organization Hyogo-Chuo National Hospital, 1314 Ohara, Sanda, 669-1592, Japan.
| | - Hiroshi Yamasaki
- Department of Neurology, National Hospital Organization Hyogo-Chuo National Hospital, 1314 Ohara, Sanda, 669-1592, Japan
| | - Go Ogawa
- Department of Neurology, National Hospital Organization Hyogo-Chuo National Hospital, 1314 Ohara, Sanda, 669-1592, Japan
| | - Katsuya Nishida
- Department of Neurology, National Hospital Organization Hyogo-Chuo National Hospital, 1314 Ohara, Sanda, 669-1592, Japan
| | - Naonobu Futamura
- Department of Neurology, National Hospital Organization Hyogo-Chuo National Hospital, 1314 Ohara, Sanda, 669-1592, Japan
| | - Itaru Funakawa
- Department of Neurology, National Hospital Organization Hyogo-Chuo National Hospital, 1314 Ohara, Sanda, 669-1592, Japan
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Fasano A, Geroin C, Berardelli A, Bloem BR, Espay AJ, Hallett M, Lang AE, Tinazzi M. Diagnostic criteria for camptocormia in Parkinson's disease: A consensus-based proposal. Parkinsonism Relat Disord 2018; 53:53-57. [PMID: 29759930 PMCID: PMC7293065 DOI: 10.1016/j.parkreldis.2018.04.033] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 04/17/2018] [Accepted: 04/29/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Camptocormia is defined as an involuntary, marked flexion of the thoracolumbar spine appearing during standing or walking and resolving in the supine position or when leaning against a wall. However, there is no established agreement on the minimum degree of forward flexion needed to diagnose camptocormia. Likewise, the current definition does not categorize camptocormia on the basis of the bending fulcrum. METHODS We performed a survey among movement disorders experts to identify camptocormia using images of patients with variable degrees and types of forward trunk flexion by fulcrum (upper and lower fulcra). We tested the subsequently generated diagnostic criteria in a sample of 131 consecutive patients referred for evaluation of postural abnormalities. RESULTS Experts reached full consensus on lower camptocormia (L1-Sacrum, hip flexion) with a bending angle ≥30° and upper camptocormia (C7 to T12-L1) with a bending angle ≥45°. This definition detected camptocormia in 9/131 consecutive PD patients (2 upper/7 lower) but excluded camptocormia in 71 patients considered to have camptocormia by the referring neurologist. CONCLUSIONS Camptocormia can be defined as "an involuntary flexion of the spine appearing during standing or walking and resolving in the supine position of at least 30° at the lumbar fulcrum (L1-Sacrum, hip flexion, i.e. lower camptocormia) and/or at least 45° at the thoracic fulcrum (C7 to T12-L1, i.e. upper camptocormia)". Strict criteria for camptocormia are met by 7% of patients with abnormal posture. The ascertainment of upper and lower camptocormia subtypes could improve the validity of epidemiological studies and assist future therapeutic trials.
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Affiliation(s)
- Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Krembil Research Institute, Toronto, Ontario, Canada.
| | - Christian Geroin
- Neuromotor and Cognitive Rehabilitation Research Center (CRRNC), Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza, University of Rome and IRCCS Neuromed Institute Pozzilli (IS), Italy.
| | - Bastiaan R Bloem
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands.
| | - Alberto J Espay
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA.
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA.
| | - Anthony E Lang
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Krembil Research Institute, Toronto, Ontario, Canada.
| | - Michele Tinazzi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
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Margraf NG, Wolke R, Granert O, Berardelli A, Bloem BR, Djaldetti R, Espay AJ, Fasano A, Furusawa Y, Giladi N, Hallett M, Jankovic J, Murata M, Tinazzi M, Volkmann J, Berg D, Deuschl G. Consensus for the measurement of the camptocormia angle in the standing patient. Parkinsonism Relat Disord 2018; 52:1-5. [DOI: 10.1016/j.parkreldis.2018.06.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/02/2018] [Accepted: 06/07/2018] [Indexed: 10/14/2022]
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Camptocormia in an Adolescent: A Case Report and Review of the Literature. Case Rep Psychiatry 2018; 2018:4606171. [PMID: 29971176 PMCID: PMC6008794 DOI: 10.1155/2018/4606171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 04/15/2018] [Indexed: 11/17/2022] Open
Abstract
Camptocormia, or bent-spine syndrome, is an entity with a long history and many etiologies. We discuss below both the history of this diagnosis in light of a rare case of psychogenic camptocormia and the recent changes in nosology regarding this disorder.
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Coexistence of Ankylosing Spondylitis and Myotonic Dystrophy: Camptocormia or Thoracic Ankylosis. J Clin Neuromuscul Dis 2018; 19:147-148. [PMID: 29465620 DOI: 10.1097/cnd.0000000000000185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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St George RJ, Gurfinkel VS, Kraakevik J, Nutt JG, Horak FB. Case Studies in Neuroscience: A dissociation of balance and posture demonstrated by camptocormia. J Neurophysiol 2018; 119:33-38. [PMID: 28978769 DOI: 10.1152/jn.00582.2017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Upright stance in humans requires an intricate exchange between the neural mechanisms that control balance and those that control posture; however, the distinction between these control systems is hard to discern in healthy subjects. By studying balance and postural control of a participant with camptocormia - an involuntary flexion of the trunk during standing that resolves when supine - a divergence between balance and postural control was revealed. A kinematic and kinetic investigation of standing and walking showed a stereotyped flexion of the upper body by almost 80° over a few minutes, and yet the participant's ability to control center of mass within the base of support and to compensate for external perturbations remained intact. This unique case also revealed the involvement of automatic, tonic control of the paraspinal muscles during standing and the effects of attention. Although strength was reduced and MRI showed a reduction in muscle mass, there was sufficient strength to maintain an upright posture under voluntary control and when using geste antagoniste maneuvers or "sensory tricks" from visual, auditory, and haptic biofeedback. Dual tasks that either increased or decreased the attention given to postural alignment would decrease or increase the postural flexion, respectively. The custom-made "twister" device that measured axial resistance to slow passive rotation revealed abnormalities in axial muscle tone distribution during standing. The results suggest that the disorder in this case was due to a disruption in the automatic, tonic drive to the postural muscles and that myogenic changes were secondary. NEW & NOTEWORTHY By studying an idiopathic camptocormia case with a detailed biomechanical and sensorimotor approach, we have demonstrated unique insights into the neural control of human bipedalism 1) balance and postural control cannot be considered the same neural process, as there is a stereotyped abnormal flexed posture, without balance deficits, associated with camptocormia, and 2) posture during standing is controlled by automatic axial tone but "sensory tricks" involving sensory biofeedback to direct voluntary attention to postural alignment can override, when required.
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Affiliation(s)
- R J St George
- Sensorimotor Neuroscience and Ageing, School of Medicine, University of Tasmania , Australia
| | - V S Gurfinkel
- Department of Neurology, Oregon Health & Science University , Portland, Oregon
| | - J Kraakevik
- Department of Neurology, Oregon Health & Science University , Portland, Oregon
| | - J G Nutt
- Department of Neurology, Oregon Health & Science University , Portland, Oregon
| | - F B Horak
- Department of Neurology, Oregon Health & Science University , Portland, Oregon.,VA Health Care System, Portland, Oregon
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Trunk muscle activation pattern in parkinsonian camptocormia as revealed with surface electromyography. Parkinsonism Relat Disord 2017; 44:44-50. [DOI: 10.1016/j.parkreldis.2017.08.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 07/25/2017] [Accepted: 08/28/2017] [Indexed: 11/23/2022]
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Margraf NG, Granert O, Hampel J, Wrede A, Schulz-Schaeffer WJ, Deuschl G. Clinical Definition of Camptocormia in Parkinson's Disease. Mov Disord Clin Pract 2016; 4:349-357. [PMID: 30363363 DOI: 10.1002/mdc3.12437] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 07/19/2016] [Accepted: 08/01/2016] [Indexed: 12/29/2022] Open
Abstract
Background Clinical key aspects of camptocormia in patients with idiopathic Parkinson's disease (PD) await further definition. Methods Based on a self-assessment of PD patients, we performed an observational study, asking patients with subjectively felt involuntary forward bending to return a questionnaire and provide photographs showing their axial disorder. Forty-two matched PD patients without subjective signs of camptocormia were recruited as controls. Results The stooped posture of patients with advanced PD without camptocormia is characterized by a forward bending angle of always less than 30 degrees. Of the 145 camptocormia patients in our study, 70% had an angle ≥30 degrees. The patients with a more-severe forward bending angle were more severely affected in daily life than those with an angle of less than 30 degrees. Back pain was more frequent (81% vs. 43%) and more severe in PD patients with camptocormia than in controls. Back diseases in camptocormia PD patients were also significantly more frequent than in the PD control patients (55% vs. 26%). Camptocormia is a relevant burden in everyday life. Seventy-seven percent of patients needed walking aids and 85% reported specific disabilities attributed to camptocormia (e.g. increased risk of falling, dyspnea, problems in eating or swallowing). Conclusions Camptocormia cannot be clinically defined based on the forward bending angle alone, but an angle larger than 30 degrees is only found in camptocormia. Back pain is an essential aspect of camptocormia in PD. Back diseases can be seen as a risk factor in these patients.
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Affiliation(s)
- Nils G Margraf
- Department of Neurology University Hospital Schleswig-Holstein Kiel Germany
| | - Oliver Granert
- Department of Neurology University Hospital Schleswig-Holstein Kiel Germany
| | - Julia Hampel
- Department of Neurology University Hospital Schleswig-Holstein Kiel Germany
| | - Arne Wrede
- Institute of Neuropathology University Medical Center Göttingen Germany
| | | | - Günther Deuschl
- Department of Neurology University Hospital Schleswig-Holstein Kiel Germany
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