The pathogenesis of Pisa syndrome in Parkinson's disease

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  • Anna Castrioto
    Grenoble University Hospital Psychiatry and Neurology Dept. Grenoble France
  • Céline Piscicelli
    Grenoble University Hospital Physical Medicine and Rehabilitation Dept. Grenoble France
  • Dominic Pérennou
    Grenoble University Hospital Physical Medicine and Rehabilitation Dept. Grenoble France
  • Paul Krack
    Grenoble University Hospital Psychiatry and Neurology Dept. Grenoble France
  • Bettina Debû
    Grenoble Institute of Neuroscience INSERM‐UJF‐CEA U836 Grenoble France

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<jats:title>ABSTRACT</jats:title><jats:p>Postural abnormalities such as postural deviations affect nearly all patients with advanced Parkinson's disease and represent an important source of disability. Although their existence has long been known, their management remains a challenge as they respond poorly to medication, brain surgery, or physiotherapy. Improving management strategies will require better understanding of the mechanisms underlying such postural deformities.</jats:p><jats:p>In this review on the pathophysiology of Pisa syndrome, we examine the data supporting the central and peripheral hypotheses that attempt to explain these lateral trunk deviations. Although the pathophysiology is very probably multifactorial, the bulk of the data supports central, rather than peripheral, hypotheses. The central hypotheses that are best supported by both animal studies and clinical data include asymmetry of basal ganglia output and abnormalities in the central integration of sensory information. Further studies are needed to elucidate the pathophysiology underlying Pisa syndrome. © 2014 International Parkinson and Movement Disorder Society</jats:p>

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