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Published on: June 23, 2023
Pisa syndrome in Parkinson disease: An observational multicenter Italian study
Michele Tinazzi1, Alfonso Fasano1, Christian Geroin1
1From the Department of Neurological and Movement Sciences (M.T., C.G.) and Neuromotor and Cognitive Rehabilitation Research Centre (C.G.), University of Verona, Italy; Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease (A.F.), Toronto Western Hospital and Division of Neurology, University of Toronto, Canada; Department of Clinical and Experimental Medicine (F.M.), University of Messina; Neurology Unit (R.C.), Department of Clinical and Experimental Medicine, University of Pisa; Department of Neurological and Neurosensorial Sciences (S.R.), Neurology and Neurophysiology Unit, University of Siena; Department of Neuroscience and Imaging (A.T.), University of Chieti-Pescara; Aging Research Center Ce.S.I. University Foundation (A.T.), Chieti Behavioural Neurology and Movement Disorders Unit; Department of Neurology and Psychiatry (G.F.), University of Rome Sapienza; IRCSS Neuromed Institute (G.F., N.M.), Pozzilli-Isernia; Department of Geriatrics, Neuroscience and Orthopedics (A.B.), Università Cattolica del Sacro Cuore, University Hospital Agostino Gemelli, Rome; Department of Neurology (F.T.), F. Miulli General Hospital, Acquaviva delle Fonti (BA); Department of Neurology (G.C.), AOB Brotzu, Cagliari; Department G.F. Ingrassia (M.Z.), Area of Neurosciences, University of Catania; Neurological Department and INSPE-Institute of Experimental Neurology (M.A.V.), University Hospital San Raffaele, Milan; Division of Neurology (C.D.), Civil Hospital Voghera (PV); Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.A.), University of Genova; U.O.C. Parkinson e Disordini del Movimento (C.P.), IRCCS Fondazione Istituto Neurologico Nazionale C. Mondino, Pavia; Neurology Unit (R. Marconi), Ospedale Misericordia, Grosseto; Department of Basic Medical Sciences (G.D.), Neuroscience and Sense Organs, University of Bari Aldo Moro; Parkinson Institute (M.C.), Istituti Clinici di Perfe
Objective:
To estimate the prevalence of Pisa syndrome (PS) in patients with Parkinson disease (PD) and to assess the association between PS and demographic and clinical variables.
Methods:
In this multicenter cross-sectional study, consecutive outpatients with PD attending 21 movement disorders Italian tertiary centers were enrolled and underwent standardized clinical evaluation. PS was defined as trunk lateral deviation ≥10°. Patients with PD were compared according to the presence of PS for several demographic and clinical variables.
Results:
Among 1,631 enrolled patients with PD, PS was detected in 143 patients (8.8%, 95% confidence interval 7.4%-10.3%). Patients with PS were older, had lower body mass index, longer disease duration, higher disease stages, and poorer quality of life. Falls were more frequent in the PS group as well as occurrence of "veering gait" (i.e., the progressive deviation toward one side when patient walked forward and backward with eyes closed). Patients with PS received higher daily levodopa equivalent daily dose and were more likely to be treated with combination of levodopa and dopamine agonists. Osteoporosis and arthrosis were significantly the most frequent associated medical conditions in patients with PS. Multiple explanatory variable logistic regression models confirmed the association of PS with the following variables: Hoehn and Yahr stage, ongoing combined treatment with levodopa and dopamine agonist, associated medical conditions, and presence of veering gait.
Conclusions:
Our results suggest that PS is a relatively frequent and often disabling complication in PD, especially in the advanced disease stages. The association is dependent on a number of potentially relevant demographic and clinical variables.
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