Università degli studi di Napoli Parthenope, Naples, Italy.
Mov Disord. 2011 Jul;26(8):1458-63. doi: 10.1002/mds.23657. Epub 2011 Apr 4.
Lateral trunk flexion is a very common clinical observation in patients affected by Parkinson's disease. Postural control is known to depend on vestibular, visual, and somatosensory information. The aim of this study was to investigate whether impairment of vestibular function can account for the postural alterations observed in parkinsonian patients with lateral trunk flexion. We evaluated vestibular function in 11 parkinsonian patients with lateral trunk flexion and in 11 age-, sex-, and disease duration-matched patients without lateral trunk flexion. The following vestibular tests were performed: infrared videonystagmography including fast and slow ocular movements, spontaneous-positional and evoked nystagmus search with and without visual fixation, fast positioning maneuvers, the bithermal caloric test, and the vibration test. A peripheral, unilateral vestibular hypofunction was identified in all patients with lateral trunk flexion. The vestibular hypofunction was ipsilateral to the leaning side and contralateral to the most affected parkinsonian side in all patients. In the control group, 7 subjects had no vestibular signs; 4 subjects had unilateral vestibular hypofunction without clinically evident lateral trunk flexion. Two of the latter patients subsequently developed lateral trunk flexion ipsilateral to the vestibular deficit and contralateral to the side most affected by Parkinson's disease. The processing of vestibular information was impaired in parkinsonian patients affected by lateral trunk flexion. The impairment was at least in part responsible for the patients' postural abnormality. We propose that the acronym PISA (Postural Imbalance Syndrome with vestibular Alterations) be used to describe the specific postural change observed in parkinsonian patients affected by a vestibular defect and lateral trunk flexion.
横向躯干弯曲是帕金森病患者中非常常见的临床观察。姿势控制已知依赖于前庭、视觉和躯体感觉信息。本研究旨在探讨前庭功能障碍是否可以解释帕金森病患者伴有横向躯干弯曲的姿势改变。我们评估了 11 例伴有横向躯干弯曲的帕金森病患者和 11 例年龄、性别和疾病持续时间相匹配的无横向躯干弯曲的患者的前庭功能。进行了以下前庭测试：包括快速和慢速眼球运动的红外视频眼动图、自发性-位置性和诱发性眼球震颤搜索，有和没有视觉固定、快速定位动作、双温测听和振动测试。所有伴有横向躯干弯曲的患者均存在外周性单侧前庭功能低下。在所有患者中，前庭功能低下均位于倾斜侧同侧和帕金森病最受累侧对侧。在对照组中，7 例患者无前庭体征；4 例患者存在单侧前庭功能低下，但无明显的横向躯干弯曲。其中 2 例随后出现了与前庭缺陷同侧、与帕金森病最受累侧对侧的横向躯干弯曲。帕金森病患者的前庭信息处理受损。这种损伤至少部分导致了患者的姿势异常。我们建议使用缩写 PISA（伴有前庭改变的姿势平衡综合征）来描述伴有前庭缺陷和横向躯干弯曲的帕金森病患者的特定姿势改变。
