Objective: To confirm the role of external oblique muscles (EO) in upper Camptocormia (CC) and Pisa Syndrome (PS) and evaluate the beneficial effect of a combined therapeutic approach, with lidocaine injections and exercise program, in the treatment of postural deformities in Parkinson’s disease (PD).

Background: The prevalence of CC and PS in PD is 3-18% and 2%, respectively. The exact etiology of these conditions has not been determined yet and treatment options are limited. Recent data suggest the role of EO muscles particularly concerning CC.

Methods: We selected 10 PD patients not significantly different for age (71,3±5,1 years), UPDRS III (28±10) and cognitive impairment (MMSE 28,6±1,3). Five patients had PS (defined as a trunk lateral deviation ≥ 15°) and five had CC (with trunk forward flexion ≥ 40°). AntiParkinsonian therapy did not change during the whole rehabilitation period. We performed 3D gait analysis with surface EMG recording of abdominal muscles and needle EMG of EO and paravertebral muscles. Then we inoculated 50 mg per day of lidocaine in EO, under EMG guidance, for 5 consecutive days followed by a regular daily rehabilitative program. The functional evaluation was performed before treatment (T0), at the end (T1) and at 15 days follow up (T2). Outcomes measures were: trunk flexion angle (TFA); Camptocormia Questionnaire (CQ); Berg Balance Scale (BBS); Ten-Meter Walk Test (10mWT); Timed Up and Go Test (TUG); Six Minutes Walking Test (6MWT) and Physiological Cost Index (PCI).

Results: All patients showed EO hyperactivity (unilateral in PS, corresponding to the tilt side, and bilateral in CC). At T1 we detected a significant reduction of: TFA (43,7±13,36 vs 31,7±16,9 p≤0,05); CQ (19,7±4,4 vs 13,4±4,7 p≤0,05); BBS (48,3±7,3 vs 52,2±5,1 p≤0,05); 6MWT (285,6±119,4 vs 348,9±92,3 p≤0,05). Patients referred a subjective improvement with greater independence in the ADL (as evidenced by CQ). The 10MWT, TUG and PCI did not show significant changes. The beneficial effect of combined treatment persisted even at T2 as showed by TFA (32±17,8 p≤0,05) and CQ (13,7±5,1 p≤0,05). No correlation was found between disease duration, postural deformity duration and functional outcomes.

Conclusions: We confirm the role of EO in CC and PS. The combined therapeutic approach seems to be a good option for the management of abnormal postures in PD. An expansion of the study is currently in progress.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-combined-therapeutic-approach-in-the-management-of-abnormal-postures-in-parkinsons-disease/