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Journal ArticleDOI

Parkinson’s disease with camptocormia

TL;DR: Patients with camptocormia were characterised by prominent levodopa-unresponsive axial symptoms (ie, axial rigidity, gait disorder and postural instability), along with a tendency for greater error in the antisaccade paradigm, and it is suggested that the salient features of parkinsonism observed in patients with camps are likely to represent a specific form of Parkinson’s disease.
Abstract: Background: Camptocormia is defined as an abnormal flexion of the trunk that appears when standing or walking and disappears in the supine position. The origin of the disorder is unknown, but it is usually attributed either to a primary or a secondary paravertebral muscle myopathy or a motor neurone disorder. Camptocormia is also observed in a minority of patients with parkinsonism. Objective: To characterise the clinical and electrophysiological features of camptocormia and parkinsonian symptoms in patients with Parkinson’s disease and camptocormia compared with patients with Parkinson’s disease without camptocormia. Methods: Patients with parkinsonism and camptocormia (excluding patients with multiple system atrophy) prospectively underwent a multidisciplinary clinical (neurological, neuropsychological, psychological, rheumatological) and neurophysiological (electromyogram, ocular movement recording) examination and were compared with age-matched patients with Parkinson’s disease without camptocormia. Results: The camptocormia developed after 8.5 (SD 5.3) years of parkinsonism, responded poorly to levodopa treatment (20%) and displayed features consistent with axial dystonia. Patients with camptocormia were characterised by prominent levodopa-unresponsive axial symptoms (ie, axial rigidity, gait disorder and postural instability), along with a tendency for greater error in the antisaccade paradigm. Conclusion: We suggest that (1) the salient features of parkinsonism observed in patients with camptocormia are likely to represent a specific form of Parkinson’s disease and camptocormia is an axial dystonia and (2) both camptocormia and parkinsonism in these patients might result from additional, non-dopaminergic neuronal dysfunction in the basal ganglia.

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Journal ArticleDOI
TL;DR: 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.
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.

17 citations


Cites background from "Parkinson’s disease with camptocorm..."

  • ...Approximately 20% of PD patients with camptocormia might receive some benefit from levodopa (Bloch et al. 2006)....

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Journal ArticleDOI
TL;DR: Findings suggest that levodopa does have a beneficial effect on anterior flexion of the thoracolumbar spine, and thus indicate that the disorder of stooped posture in PD is mediated, at least in part, by dopamine deficiency.

17 citations

Journal ArticleDOI
TL;DR: Postural abnormalities in Parkinson's disease patients and unimpaired elderly are not well differentiated and factors related to postural abnormality associated with PD are controversial.
Abstract: Background Postural abnormalities in Parkinson's disease (PD) patients and unimpaired elderly are not well differentiated. Factors related to postural abnormality associated with PD are controversial. Objective We assessed differences in postural change between PD patients and unimpaired elderly and elucidated factors related to abnormal posture in PD patients. Methods We measured the dropped head angle (DHA), anterior flexion angle (AFA), and lateral flexion angle (LFA) of the thoracolumbar spine of an unprecedented 1,117 PD patients and 2,732 general population participants (GPPs) using digital photographs. Two statistical analyses were used for elucidating factors related to these angles. Results In GPPs, age was correlated with DHA, AFA, and LFA. DHAs, AFAs, and LFAs of PD patients and age-matched GPPs were 21.70° ± 14.40° and 13.13° ± 10.79°, 5.98° ± 12.67,°and - 3.82° ± 4.04°, and 0.86° ± 4.25° and 1.33° ± 2.16°, respectively. In PD patients, factors related to DHA were age, male sex, and H & Y stage during ON time. Factors related to AFA were age, duration of disease, H & Y stage during ON and OFF times, pain, vertebral disease, and bending to the right. A factor related to LFA was AFA. Conclusions DHA and AFA of GGPs correlated with age and were larger in PD patients than those with in GPPs. Some PD patients showed angles far beyond the normal distribution. Thus, factors associated with disease aggravation affected postural abnormality in PD patients.

17 citations


Cites background from "Parkinson’s disease with camptocorm..."

  • ...However, we regarded these as confounding factors because quantities of TABLE 2 Postural abnormality and related factors in PD Author Year N Postural Abnormality Method Related Factors Djaldetti et al.20 1999 8 Camptocormia Unmeasured Male sex, duration of PD, H & Y stage Bloch et al.21 2006 63 Camptocormia Unmeasured UPDRS Part III scores Tipple et al.1 2009 275 Camptocormia Unmeasured (partially goniometer) Age, duration of PD, dosage of L-dopa, duration of L-dopa treatment, H & Y stage, rigidity and bradykinesia item score of UPDRS PPart III, dementia, vertebral surgery Seki et al.13 2011 531 Camptocormia Measured (photograph) Age, H & Y stage, UPDRS Part III scores, total LED, dosage of L-dopa, urinary incontinence, severe constipation Kashihara et al.22 2012 365 Dropped head Unmeasured H & Y stage Camptocormia H & Y stage, age, female sex, deterioration of MMSE score, duration of PD, lumber pain Lateral flexion H & Y stage, age, female sex, deterioration of MMSE score, duration of PD, lumber pain Song et al.14 2013 705 Camptocormia Measured (goniometer) Duration of PD, H & Y stage, UPDRS Part III scores, motor fluctuation, dyskinesia, MMSE Oeda et al.7 2013 216 Dropped head Measured (photograph) H & Y stage, history of postural abnormalities induced by dopamine agonists Camptocormia Age, duration of PD, H & Y stage, UPDRS Part III score, dosage of L-dopa, LED of dopamine agonists, vertebral disease, mental symptoms Zinazzi et al.2 2015 1,631 Lateral flexion Measured (goniometer) Age, body mass index, duration of PD, H & Y stage, UPDRS scores, LED, ongoing pharmacological therapy, falls, veering gait Khlebtovsky et al.19 2017 190 Camptocormia Measured (spinal mouse) Age, older age at disease onset, duration pf PD, UPDRS motor and posture scores, back pain Ameghino et al.16 2018 63 Dropped head Unmeasured Urinary incontinence, exposure to pribedil and quetiapine Camptocormia Age, history of orthopedic disorder, duration of PD, H & Y stage, UPDRS Part III scores, exposure to dopamine agonists and amantadine Lateral flexion H & Y stage, less depression, exposure to amantadine Present study 2018 1,117 Dropped head Measured (photograph) Age, male sex, H & Y stage during ON time Camptocormia Duration of PD, H & Y stage during ON and OFF times, spinal disease, LFA to the right Lateral flexion Anterior flexion angle MOVEMENT DISORDERS CLINICAL PRACTICE 2019; 6(3): 213–221. doi: 10.1002/mdc3....

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  • ...1999 8 Camptocormia Unmeasured Male sex, duration of PD, H & Y stage Bloch et al.(21) 2006 63 Camptocormia Unmeasured UPDRS Part III scores Tipple et al....

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  • ...Bloch et al.(21) found that the UPDRS Part III scores of patients with waist bending were significantly high, especially on the walk item....

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  • ...Bloch et al.21 found that the UPDRS Part III scores of patients with waist bending were significantly high, especially on the walk item....

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Journal ArticleDOI
TL;DR: Disorders of the posture and spinal alignment, both in the sagittal and in the coronal planes, are common in Parkinson's disease patients, and have a major impact on the quality of life.
Abstract: Most patients suffering from Parkinson’s disease (PD) exhibit alterations in the posture, which can in several cases give rise to spine deformities, both in the sagittal and the coronal plane. In addition, degenerative disorders of the spine frequently associated to PD, such as spinal stenosis and sagittal instability, can further impact the quality of life of the patient. In recent years, spine surgery has been increasingly performed, with mixed results. The aim of this narrative review is to analyze the spinal disorders associated to PD, and the current evidence about their surgical treatment. Narrative review. Camptocormia, i.e., a pronounced flexible forward bending of the trunk with 7% prevalence, is the most reported sagittal disorder of the spine. Pisa syndrome and scoliosis are both common and frequently associated. Disorders to the spinopelvic alignment were not widely investigated, but a tendency toward a lower ability of PD patients to compensate the sagittal malalignment with respect to non-PD elderly subjects with imbalance seems to emerge. Spine surgery in PD patients showed high rates of complications and re-operations. Disorders of the posture and spinal alignment, both in the sagittal and in the coronal planes, are common in PD patients, and have a major impact on the quality of life. Outcomes of spine surgery are generally not satisfactory, likely mostly due to muscle dystonia and poor bone quality. Knowledge in this field needs to be consolidated by further clinical and basic science studies. These slides can be retrieved under Electronic Supplementary Material.

17 citations


Cites background from "Parkinson’s disease with camptocorm..."

  • ...First, postural control is often impaired for the altered muscular tonus of axial muscles, unresponsive to L-DOPA medication....

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  • ...In general, camptocormia does not respond well to treatment with L-DOPA [11, 12]....

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  • ...In a case–control study on PD patients with camptocormia and age-matched patients also suffering from PD but not exhibiting the sagittal deformity [12], the authors concluded that PD with camptocormia shows specific characteristics such 1 3 as axial rigidity, disorders and instability during gait, limited response to L-DOPA also for the axial symptoms, which cannot be observed in the control group and may be due to a significantly higher neurological dysfunction, although other authors hypothesized that it might simply reflect a more severe parkinsonian phenotype or a longer duration of the symptoms [1]....

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  • ...Scoliosis in PD patients usually shows a single curve, is more common in female patients rather than in males and is not respondent to L-DOPA treatment [22, 30]....

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  • ...In addition to age and sex and the severity of the PD symptoms, other clinically relevant variables usually taken into account in scientific papers are the duration of the symptoms, i.e., the time period between the diagnosis of PD and the collection of the data, the possible presence of back pain which is assessed by means of its conventional grading systems and the possible treatment with L-DOPA and/or deep brain stimulation....

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Journal ArticleDOI
TL;DR: Assessment of the efficacy of subthalamic nucleus deep brain stimulation in Parkinson's disease (PD)‐associated trunk posture abnormalities retrospectively analyzing data from 101 patients reporting mild‐to‐severe trunk posture irregularities.
Abstract: OBJECTIVES We sought to assess the efficacy of subthalamic nucleus deep brain stimulation (STN-DBS) in Parkinson's disease (PD)-associated trunk posture abnormalities retrospectively analyzing data from 101 patients reporting mild-to-severe trunk posture abnormalities of a cohort of 216 PD patients treated with STN-DBS at our center. METHODS Abnormal trunk posture was rated on a scale of 0 (normal) to 4 (marked flexion with an extreme abnormality of posture) as per the grading score reported in the Unified Parkinson's Disease Rating Scale. The independent effect of STN-DBS on trunk posture was assessed comparing Medication-Off (presurgery) vs Stimulation-On/Medication-Off (post-surgery). The combined effect of STN-DBS plus levodopa was evaluated comparing Medication-On (presurgery) vs Stimulation-On/Medication-On (post-surgery). Analyses were conducted considering both the entire cohort of patients and the subgroup with camptocormia (CMC) and Pisa syndrome (PS). RESULTS The independent effect of STN-DBS resulted in a 41.4% improvement in abnormal trunk posture severity (P < .001), with 78.2% of patients (n = 79) reporting an improvement of at least 1 point. The combined effect of STN-DBS and levodopa resulted in a 30.9% improvement (P = .061), with 54.5% of patients (n = 55) reporting an improvement of at least 1 point. The subanalysis of patients with CMC (n = 23) and PS (n = 5) showed a 42.7% improvement in abnormal posture severity when considering the independent effect of STN-DBS (P < .001) and 30.5% when considering the combined effect of STN-DBS and levodopa (P < .001). CONCLUSIONS STN-DBS may have the potential for improving posture in patients with advanced PD.

16 citations

References
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Journal ArticleDOI
TL;DR: A simplified, scored form of the cognitive mental status examination, the “Mini-Mental State” (MMS) which includes eleven questions, requires only 5-10 min to administer, and is therefore practical to use serially and routinely.

76,181 citations

01 Jan 2002
TL;DR: The Mini-Mental State (MMS) as mentioned in this paper is a simplified version of the standard WAIS with eleven questions and requires only 5-10 min to administer, and is therefore practical to use serially and routinely.
Abstract: EXAMINATION of the mental state is essential in evaluating psychiatric patients.1 Many investigators have added quantitative assessment of cognitive performance to the standard examination, and have documented reliability and validity of the several “clinical tests of the sensorium”.2*3 The available batteries are lengthy. For example, WITHERS and HINTON’S test includes 33 questions and requires about 30 min to administer and score. The standard WAIS requires even more time. However, elderly patients, particularly those with delirium or dementia syndromes, cooperate well only for short periods.4 Therefore, we devised a simplified, scored form of the cognitive mental status examination, the “Mini-Mental State” (MMS) which includes eleven questions, requires only 5-10 min to administer, and is therefore practical to use serially and routinely. It is “mini” because it concentrates only on the cognitive aspects of mental functions, and excludes questions concerning mood, abnormal mental experiences and the form of thinking. But within the cognitive realm it is thorough. We have documented the validity and reliability of the MMS when given to 206 patients with dementia syndromes, affective disorder, affective disorder with cognitive impairment “pseudodementia”5T6), mania, schizophrenia, personality disorders, and in 63 normal subjects.

70,887 citations

Journal ArticleDOI
TL;DR: It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.
Abstract: A self-assessment scale has been developed and found to be a reliable instrument for detecting states of depression and anxiety in the setting of an hospital medical outpatient clinic. The anxiety and depressive subscales are also valid measures of severity of the emotional disorder. It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.

35,518 citations

Journal Article
TL;DR: The Mini-International Neuropsychiatric Interview is designed to meet the need for a short but accurate structured psychiatric interview for multicenter clinical trials and epidemiology studies and to be used as a first step in outcome tracking in nonresearch clinical settings.
Abstract: The Mini-International Neuropsychiatric Interview (M.I.N.I.) is a short structured diagnostic interview, developed jointly by psychiatrists and clinicians in the United States and Europe, for DSM-IV and ICD-10 psychiatric disorders. With an administration time of approximately 15 minutes, it was designed to meet the need for a short but accurate structured psychiatric interview for multicenter clinical trials and epidemiology studies and to be used as a first step in outcome tracking in nonresearch clinical settings. The authors describe the development of the M.I.N.I. and its family of interviews: the M.I.N.I.-Screen, the M.I.N.I.-Plus, and the M.I.N.I.-Kid. They report on validation of the M.I.N.I. in relation to the Structured Clinical Interview for DSM-III-R, Patient Version, the Composite International Diagnostic Interview, and expert professional opinion, and they comment on potential applications for this interview.

19,347 citations

Journal ArticleDOI
TL;DR: Controversy over the effectiveness of therapeutic measures for parkinsonism is due partially to this wide variability and to the paucity of clinical information about the natural history of the syndrome.
Abstract: PARKINSONISM, described in its entirety over one hundred and fifty years ago,’ rarely presents itself as a diagnostic problem. In consequence, little scrutiny has been directed to the marked variability of this frequently encountered neurological syndrome and to the progression of the disease in large groups of patients. As with most chronic neurological disorders, marked diversity can be expected to exist in age and mode of onset, relative prominence of the cardinal signs and symptoms, rate of progression, and resultant degree of functional impairment. Controversy over the effectiveness of therapeutic measures for parkinsonism is due partially to this wide variability and to the paucity of clinical information about the natural history of the syndrome. It is also re-

11,606 citations