Objective: To establish the simple therapeutic algorithm for abnormal posture in Parkinson’s disease (PD) or related disorders.

Background: Camptocormia or dropped head are sometimes accompanied with PD or related disorders patients, which are often very difficult to be treated. We previously reported that lidocaine injection is useful in treating them. However, as the evaluation method we previously established for determining the target of the muscles is too complicated to perform the lidocaine injection routinely, it is necessary to simplify our method.

Methods: Forty two PD or related disorders patients with abnormal postures were recruited for this study (30 camptocormia patients and 12 dropped head patients). As a preliminary evaluation, we performed the radiography of the spine and took the systemic photos. According to the flexion position, camptocormia was classified as upper type, lower type, lateroflexion type, and lateral shift type. Dropped head was also classified as conventional type, sniffing type, and skull type. When rehabilitation and antiparkinson drug adjustments were invalid, lidocaine injections were added to those therapies. The lidocaine injections were carried out for 5 consecutive days. The target muscles for the injection were selected according to therapeutic algorithm based on our previous report (Furusawa et al. Parkinsonism Relat Disord. 2013; 19: 350-354.); external abdominal oblique muscle, iliopsoas, scalene, etc. Patients with skeletal problems were excluded from the injections. Three days after the final injection, the changes in the degrees of the flexion were evaluated.

Results: Lidocaine injection were performed in 23 camptocormia patients and 6 dropped head patients. Seventeen of camptocormia and 5 dropped head patients were improved, and the average of flexion angle changed from 41.1° to 30.5° (upper type), from 33.9° to 19.3° (lower type), from 14.0° to 9.0° (lateroflexion type) in the camptocormia patients, and from 22.3° to 6.7° in the dropped head patient.

Conclusions: Information of the visual inspection and X ray are necessary and sufficient in our algorithm, and anyone could easily detect the target muscles in charge. Lidocaine injection should be a therapeutic strategy for the abnormal postures complicated with the PD and related disorders patients.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/new-therapeutic-algorithm-for-abnormal-posture-in-parkinsons-disease-and-related-disorders/