Botulinum toxin treatment of paraspinal muscles for improving abnormal posture in Parkinson’s disease

Abstract

The patient was a 64-year-old man who presented with gait disturbance at the age of 58. He was later diagnosed with Parkinson’s disease. At the age of 64, he felt severe right abdominal pain because his right abdomen was compressed by his abnormal posture. Neurological examinations showed axial flexion to the anterior and right sides, i.e. a combination of camptocormia and Pisa syndrome, and hypertrophy of the right lumbar paraspinal muscles in addition to parkinsonism. Surface electromyography and body computed tomography suggested axial dystonia, i.e. right dominant hyperactivity and hypertrophy of the lumbar paraspinal muscles. Botulinum toxin was injected into the right lumbar paraspinal muscles. One month later, his abnormal posture improved and his right abdominal pain was also relieved. In general, botulinum toxin treatment of the paraspinal muscles has the potential to improve Pisa syndrome but carries the risk of worsening camptocormia. However, in our case, not only Pisa syndrome but also camptocormia improved. Therefore, we should note that botulinum toxin treatment of paraspinal muscles is able to improve not only Pisa syndrome but also camptocormia. As a plausible explanation, botulinum toxin treatment could control the hyperactivity of the bilateral paraspinal muscles symmetrically, which might improve camptocormia in addition to Pisa syndrome.