Botulinum toxin-A for treatment of Pisa syndrome: Towards a decision-making algorithm?

OBJECTIVE: Pisa syndrome (PS) is a common abnormal posture of the trunk in Parkinson disease which is defined as a lateral flexion of the spine in the coronal plane and/or scoliosis. Few studies described focal treatment of dystonia of paraspinal muscles, with unpredictable results, while the participation of quadratus lumborum and external oblique homolateral seem to be interesting. The aim of this study is to estimate the effects of treatment by botulinum toxin of trunk muscles dystonia in PS.

MATERIALS/PATIENTS AND METHODS: The patients were seen in multidisciplinary program to do morphological imagery of spine and electromyographic examination of quadratus lumborum, external oblique, internal oblique and paraspinal. Only the patients with dystonia in muscle that are in homolateral side were treated by toxin A. The evaluation of the effects of treatment was realized in posteriori on the data of clinical file.

RESULTS: Txenty-six patients were seen from March 2014 to January 2016. Fourteen patients did not present a dystonia of the trunk. Two of them were treated in analgesic purpose among whom, one had beneficial effects. Twelve patients were treated, among whom, 7 in quadratus lumborum, 3 in quadratus lumborum and external oblique and 2 in external oblique. The treatment was effective for 8 of them on the pain and for 6 of them on the slope of spine.

DISCUSSION/CONCLUSION: Focal dystonia treatment in quadratus lumborum and external oblique seem to be interesting in PS. A treatment with analgesic aim could be processed, at the risk of seeing deteriorating posture because of the weakening of the muscles that retain the fall. Other studies are necessary to specify the algorithm of care of this syndrome, including global rehabilitation program.