Department of Neuroscience "Rita Levi Montalcini", University of Turin, 10126 Turin, Italy.
Neurology 2 Unit, AOU Città della Salute e Della Scienza, 10126 Turin, Italy.
Toxins (Basel). 2023 Sep 11;15(9):566. doi: 10.3390/toxins15090566.
Lateral trunk flexion (LTF) and its severe form, called Pisa syndrome (PS), are highly invalidating axial postural abnormalities associated with Parkinson's disease (PD). Management strategies for LTF lack strong scientific evidence. We present a real-life, longitudinal study evaluating long-term efficacy of botulinum toxin (BoNT) injections in axial muscles to reduce LTF and PS in PD. A total of 13 PD patients with LTF > 5° received ultrasound- and electromyography-guided BoNT injections every 4 months. Seven untreated matched PD patients with LTF served as controls and their changes in posture after 18 months were compared with those of seven patients continuing BoNT over 12 months. 53.8% of patients continued the BoNT injections for at least 12 months. Various individual LTF responses were observed. Overall, BoNT-treated patients obtained a not statistically significant improvement of LTF of 17 ± 41% ( = 0.237). In comparison, the seven untreated PD patients suffered a deterioration in LTF over 12 months by 36 ± 45% ( = 0.116), showing a significantly different trajectory of posture change ( = 0.026). In conclusion, repeated BoNT injections in axial muscles showed varying effects in managing PD-associated LTF, suggesting that: (a) a relevant number of patients with LTF can benefit from BoNT; (b) long-term treatment could prevent LTF worsening; (c) an instrumented, personalized approach is important; and (d) there is a need for prospective, long-term studies.
侧躯干屈曲（LTF）及其严重形式，称为比萨综合征（PS），是与帕金森病（PD）相关的高度致残性轴向姿势异常。LTF 的管理策略缺乏强有力的科学证据。我们进行了一项真实的、纵向研究，评估了轴向肌肉肉毒毒素（BoNT）注射以减少 PD 中的 LTF 和 PS 的长期疗效。13 名 LTF > 5°的 PD 患者接受了每 4 个月一次的超声和肌电图引导的 BoNT 注射。7 名未经治疗的匹配 PD 患者作为对照，比较了他们在 18 个月后与 7 名继续接受 BoNT 治疗 12 个月的患者的姿势变化。53.8%的患者至少继续接受了 12 个月的 BoNT 注射。观察到各种个体 LTF 反应。总体而言，BoNT 治疗患者的 LTF 改善了 17 ± 41%（ = 0.237），但无统计学意义。相比之下，未经治疗的 7 名 PD 患者在 12 个月内 LTF 恶化了 36 ± 45%（ = 0.116），表现出明显不同的姿势变化轨迹（ = 0.026）。总之，轴向肌肉的重复 BoNT 注射在管理 PD 相关的 LTF 方面显示出不同的效果，表明：（a）LTF 患者中有相当数量的患者可以从 BoNT 中受益；（b）长期治疗可以防止 LTF 恶化；（c）仪器化、个性化方法很重要；（d）需要进行前瞻性、长期研究。
