POSTURAL DEFORMITIES IN PARKINSON ’S DISEASE: CLINICAL OBSERVATION

Khubetova I. V., Pavlyshyna N. N., Balduk I. I.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

Abstract. Postural deformities are frequent disabling complications of Parkinson’s disease and atypical parkinsonism. According to international studies, they occur in one third of patients with PD. The most common types of postural deformations are: camptocormia, Pisa syndrome, antecollis and scoliosis. In practical medicine, there are no clear criteria for diagnosing these deformities, and patients for a long time can ignore and not complain about the existing impairments of posture until there are difficulties in walking or impaired vision. Postural deformations, which are based on a complex set of pathophysiological changes, are quite frequent, albeit not an «obligate» sign of PD. Clinicians should always remember a wide range of differential diagnosis of postural disorders with a view to correcting them and preventing the development of complications. Currently, there is a need for a more detailedunderstanding of different mechanisms of postural deformities in order to find an effective therapy options that will improve patient’s quality of life. The aim: clinical study of the prevalence of postural deformities in patients with Parkinson disease. It is shown that postural deformities, which are based on a complex set of pathophysiological disorders, are quite common, although not “obligatory” sign of PD, they are found in 29.6% of examined patients. The most common type of PD is camptocarmia, which significantly limits motor function and reduces the quality of life of patients at all stages of the disease. The age of onset of CC correlates with the age prevalence of PD. CC is noted more often in males, and SPT – in women. AK – a rare manifestation of PD, the detection of this deformity suggests the presence of patients with another neurodegenerative disease, or is the result of incorrect dopaminergic. The clinician should always keep in mind the wide range of differential diagnosis of posture disorders in order to correct them and prevent complications. The presence of severe postural deformities, especially in the early stages of PD, requires careful study of autonomic status to exclude possible MSA.

Parkinson’s disease, postural deformities, camptocormia, Pisa syndrome, scoliosis, antecollis.

1. Ashour R, Jankovich J. Joint and skeletal deformities in Parkinson’s disease, multiple system atrophy, and progressive supranuclear palsy. Mov Disord. 2006;21:1856-63.
2. Benatru I, Vaugoyeau M, Azulay JP. Postural disorders in Parkinson’s disease. Neurophysiol Clin. 2008;38(6):459-465.
3. Jankovic J. Camptocormia, head drop and other bent spine syndromes: heterogeneous etiology and pathogenesis of Parkinsonian deformities. Mov Disord. 2010;25(5):527.
4.  Azher SN, Jankovich J. Camptocormia: pathogenesis, classification, and response to therapy. Neurology. 2005;65:355-59.
5. Djaldetti R, Morsberg-Galili R, Sroka H. Camptocormia (bent spine) in patients with Parkinson’s disease – characterization and possible pathogenesis of an unusual phenomenon. Mov Disord. 1999;14:443-447.
6. Melamed E, Djaldetti R. Camptocormia in Parkinson’s disease. J Neurol. 2006;253(7):14-16.
7. Lepoutre AC, Devos D, Blanchard-Dauphin A, Pardessus V, Maurage CA, Ferriby D, et al. A specific clinical pattern of camptocormia in Parkinson’s disease. J Neurol Neurosurg Psychiatry. 2006;77(11):1229-1234.
8. Abe K, Uchida Y, Notani M. Camptocormia in Parkinson’s disease. Parkinsons Dis. 2010;2010:267-640.
9. Margraf NG, Wrede A, Rohr A, Schulz-Schaeffer WJ, Raethjen J, Eymess A, et al. Camptocormia in idiopathic Parkinson’s disease: a focal myopathy of the paravertebral muscles. Mov Disord. 2010 Apr 15;25(5):542-51.
10. Spuler S, Krug H, Klein C, Medialdea IC, Jakob W, Ebersbach G, et al. Myopathy causing camptocormia in idiopathic Parkinson’s disease: a multidisciplinary approach. Mov Disord. 2010 Apr 15;25(5):552-9.
11. Ali F, Matsumoto JY, Hassan A. Camptocormia: Etiology, diagnosis, and treatment response. Neurol Clin Pract. 2018;8(3):240-248.
12. Doherty KM, van de Warrenburg BP, Peralta M, Silveira-Moriyama L, Azulay JP, Gershanik OS, et al. Postural deformities in Parkinson’s disease. Lancet Neurol. 2011;10:538-49.
13. Gdynia HJ, Sperfeld AD, Unrath A, Ludolph AC, Sabolek M, Storch A, Kassubek J. Histopathological analysis of skeletal muscle in patients with Parkinson’s disease and ‘dropped head’/’bent spine’ syndrome. Parkinsonism Relat Disord. 2009;15(9):633-9.
14. van de Warrenburg BP, Cordivari C, Ryan AM, Phadke R, Holton JL, Bhatia KP, et al. The phenomenon of disproportionate antecollis in Parkinson’s disease and multiple system atrophy. Movement Disorders. 2007;22(16):2325-31.
15. Cannas A, Solla P, Floris G, Tacconi P, Serra A, Piga M, et al. Reversible Pisa syndrome in patients with Parkinson’s disease on dopaminergic therapy. J Neurol. 2009;256(3):390-5.
16. Tinazzi M, Gandolfi M, Ceravolo R, Capecci M, Andrenelli E, Ceravolo MG, et al. Postural Abnormalities in Parkinson’s Disease: An Epidemiological and Clinical Multicenter Study. Mov Disord Clin Pract. 2019 Jun 29;6(7):576-585.
17. Ando Y, Fujimoto KI, Ikeda K, Utsumi H, Okuma Y, Oka H, et al. Postural Abnormality in Parkinson’s Disease: A Large Comparative Study With General Population. Mov Disord Clin Pract. 2019 Jan 25;6(3):213-221.
18. Alwardat M, Schirinzi T, Di Lazzaro G, Franco D, Sinibaldi SP, Mercuri NB, et al. The effect of postural deformities on back function and pain in patients with Parkinson’s disease. Neuro Rehabilitation. 2019;44(3):419-424.

«Bulletin of problems biology and medicine» Issue 2 (160), 2021 year, 144-148 pages, index UDK 616-009.12

10.29254/2077-4214-2021-2-160-144-148