Botulinum Toxin Type A and Physiokinesiterapy in the Treatment of PisaSyndrome

Abstract

Introduction: Pisa syndrome (PS) is a lateral axial dystonia (LAD) characterized by contraction of the trunk muscles that results in a marked tonic lateral flexion of the thoraco-lumbar. PS has been described among symptoms of tardive neuroleptic dystonia, in patients with dementia treated with cholinesterase inhibitors, in patients with idiopathic primary dystonia, in patients with Parkinson’s disease (PD), Alzheimer’s disease and multiple system atrophy. Unlike most of motor PD symptoms, PS is not significantly improved by dopaminergic medications or surgery. In this study we demonstrated efficacy of botulinumtoxinA and physiotherapy in patients with PS post PD due to paraspinal muscles overactivity. Material and methods: ten patients evaluated until 6 months after treatment with 100U of IncobotulinumtoxinA (Xeomin®, Merz Pharma) in the paraspinal muscles and physiotherapy. We assessed baropodometric exam, goniometric measurement and VAS scale. Results: Data demonstrated statistical improvement (p<0,05) until 6 months after treatment in all evaluation examined. Conclusion: BotulinumtoxinA and physiotherapy treatments were well-tolerated and effective and could be considered a possible treatment in parkinsonian patients with LAD.