Pisa Syndrome in Parkinson's Disease: Evidence for Bilateral Vestibulospinal Dysfunction

Giulia Di Lazzaro, Tommaso Schirinzi, Maria Pia Giambrone, Roberta Di Mauro, Maria Giuseppina Palmieri, Camilla Rocchi, Michele Tinazzi, Nicola Biagio Mercuri, Stefano Di Girolamo, Antonio Pisani

Research output: Contribution to journalArticle

Abstract

Introduction: Pisa syndrome (PS) is a postural complication of Parkinson's disease (PD). Yet, its pathophysiology remains unclear, although a multifactorial component is probable. Cervical vestibular evoked myogenic potentials (cVEMPs) explore vestibulospinal pathway, but they have not been measured yet in PD patients with PS (PDPS) to assess a potential vestibular impairment.

Materials and Methods: We enrolled 15 PD patients, 15 PDPS patients, and 30 healthy controls (HCs). They underwent neurological examination and were examined with Unified Parkinson's Disease Rating Scale II-III (UPDRSII-III), audiovestibular workup, and cVEMP recordings. Data were analysed with Chi-square, one-way ANOVA, multinomial regression, nonparametric, and Spearman's tests.

Results: cVEMPs were significantly impaired in both PD and PDPS compared with HCs. PDPS exhibited more severe cVEMP abnormalities with prevalent bilateral loss of potentials, compared with the PD group, in which a prevalent unilateral loss was instead observed. No clinical-neurophysiological correlations emerged.

Conclusions: Differently from HC, cVEMPs are altered in PD. Severity of cVEMPs alterations increases from PD without PS to PDPS, suggesting an involvement of vestibulospinal pathway in the pathophysiology of PS. Our results provide evidence for a significant impairment of cVEMPs in PDPS patients and encourage further studies to test validity of cVEMPs as diagnostic and prognostic biomarkers of PD progression.

Original languageEnglish
Pages (from-to)8673486
JournalParkinson's Disease
Volume2018
DOIs
Publication statusPublished - 2018

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Vestibular Evoked Myogenic Potentials
Parkinson Disease
Neurologic Examination
Disease Progression
Analysis of Variance
Biomarkers

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Pisa Syndrome in Parkinson's Disease : Evidence for Bilateral Vestibulospinal Dysfunction. / Di Lazzaro, Giulia; Schirinzi, Tommaso; Giambrone, Maria Pia; Di Mauro, Roberta; Palmieri, Maria Giuseppina; Rocchi, Camilla; Tinazzi, Michele; Mercuri, Nicola Biagio; Di Girolamo, Stefano; Pisani, Antonio.

In: Parkinson's Disease, Vol. 2018, 2018, p. 8673486.

Research output: Contribution to journalArticle

Di Lazzaro, G, Schirinzi, T, Giambrone, MP, Di Mauro, R, Palmieri, MG, Rocchi, C, Tinazzi, M, Mercuri, NB, Di Girolamo, S & Pisani, A 2018, 'Pisa Syndrome in Parkinson's Disease: Evidence for Bilateral Vestibulospinal Dysfunction', Parkinson's Disease, vol. 2018, pp. 8673486. https://doi.org/10.1155/2018/8673486
Di Lazzaro, Giulia ; Schirinzi, Tommaso ; Giambrone, Maria Pia ; Di Mauro, Roberta ; Palmieri, Maria Giuseppina ; Rocchi, Camilla ; Tinazzi, Michele ; Mercuri, Nicola Biagio ; Di Girolamo, Stefano ; Pisani, Antonio. / Pisa Syndrome in Parkinson's Disease : Evidence for Bilateral Vestibulospinal Dysfunction. In: Parkinson's Disease. 2018 ; Vol. 2018. pp. 8673486.
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abstract = "Introduction: Pisa syndrome (PS) is a postural complication of Parkinson's disease (PD). Yet, its pathophysiology remains unclear, although a multifactorial component is probable. Cervical vestibular evoked myogenic potentials (cVEMPs) explore vestibulospinal pathway, but they have not been measured yet in PD patients with PS (PDPS) to assess a potential vestibular impairment.Materials and Methods: We enrolled 15 PD patients, 15 PDPS patients, and 30 healthy controls (HCs). They underwent neurological examination and were examined with Unified Parkinson's Disease Rating Scale II-III (UPDRSII-III), audiovestibular workup, and cVEMP recordings. Data were analysed with Chi-square, one-way ANOVA, multinomial regression, nonparametric, and Spearman's tests.Results: cVEMPs were significantly impaired in both PD and PDPS compared with HCs. PDPS exhibited more severe cVEMP abnormalities with prevalent bilateral loss of potentials, compared with the PD group, in which a prevalent unilateral loss was instead observed. No clinical-neurophysiological correlations emerged.Conclusions: Differently from HC, cVEMPs are altered in PD. Severity of cVEMPs alterations increases from PD without PS to PDPS, suggesting an involvement of vestibulospinal pathway in the pathophysiology of PS. Our results provide evidence for a significant impairment of cVEMPs in PDPS patients and encourage further studies to test validity of cVEMPs as diagnostic and prognostic biomarkers of PD progression.",
author = "{Di Lazzaro}, Giulia and Tommaso Schirinzi and Giambrone, {Maria Pia} and {Di Mauro}, Roberta and Palmieri, {Maria Giuseppina} and Camilla Rocchi and Michele Tinazzi and Mercuri, {Nicola Biagio} and {Di Girolamo}, Stefano and Antonio Pisani",
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T1 - Pisa Syndrome in Parkinson's Disease

T2 - Evidence for Bilateral Vestibulospinal Dysfunction

AU - Di Lazzaro, Giulia

AU - Schirinzi, Tommaso

AU - Giambrone, Maria Pia

AU - Di Mauro, Roberta

AU - Palmieri, Maria Giuseppina

AU - Rocchi, Camilla

AU - Tinazzi, Michele

AU - Mercuri, Nicola Biagio

AU - Di Girolamo, Stefano

AU - Pisani, Antonio

PY - 2018

Y1 - 2018

N2 - Introduction: Pisa syndrome (PS) is a postural complication of Parkinson's disease (PD). Yet, its pathophysiology remains unclear, although a multifactorial component is probable. Cervical vestibular evoked myogenic potentials (cVEMPs) explore vestibulospinal pathway, but they have not been measured yet in PD patients with PS (PDPS) to assess a potential vestibular impairment.Materials and Methods: We enrolled 15 PD patients, 15 PDPS patients, and 30 healthy controls (HCs). They underwent neurological examination and were examined with Unified Parkinson's Disease Rating Scale II-III (UPDRSII-III), audiovestibular workup, and cVEMP recordings. Data were analysed with Chi-square, one-way ANOVA, multinomial regression, nonparametric, and Spearman's tests.Results: cVEMPs were significantly impaired in both PD and PDPS compared with HCs. PDPS exhibited more severe cVEMP abnormalities with prevalent bilateral loss of potentials, compared with the PD group, in which a prevalent unilateral loss was instead observed. No clinical-neurophysiological correlations emerged.Conclusions: Differently from HC, cVEMPs are altered in PD. Severity of cVEMPs alterations increases from PD without PS to PDPS, suggesting an involvement of vestibulospinal pathway in the pathophysiology of PS. Our results provide evidence for a significant impairment of cVEMPs in PDPS patients and encourage further studies to test validity of cVEMPs as diagnostic and prognostic biomarkers of PD progression.

AB - Introduction: Pisa syndrome (PS) is a postural complication of Parkinson's disease (PD). Yet, its pathophysiology remains unclear, although a multifactorial component is probable. Cervical vestibular evoked myogenic potentials (cVEMPs) explore vestibulospinal pathway, but they have not been measured yet in PD patients with PS (PDPS) to assess a potential vestibular impairment.Materials and Methods: We enrolled 15 PD patients, 15 PDPS patients, and 30 healthy controls (HCs). They underwent neurological examination and were examined with Unified Parkinson's Disease Rating Scale II-III (UPDRSII-III), audiovestibular workup, and cVEMP recordings. Data were analysed with Chi-square, one-way ANOVA, multinomial regression, nonparametric, and Spearman's tests.Results: cVEMPs were significantly impaired in both PD and PDPS compared with HCs. PDPS exhibited more severe cVEMP abnormalities with prevalent bilateral loss of potentials, compared with the PD group, in which a prevalent unilateral loss was instead observed. No clinical-neurophysiological correlations emerged.Conclusions: Differently from HC, cVEMPs are altered in PD. Severity of cVEMPs alterations increases from PD without PS to PDPS, suggesting an involvement of vestibulospinal pathway in the pathophysiology of PS. Our results provide evidence for a significant impairment of cVEMPs in PDPS patients and encourage further studies to test validity of cVEMPs as diagnostic and prognostic biomarkers of PD progression.

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DO - 10.1155/2018/8673486

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JO - Parkinson's Disease

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SN - 2090-8083

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