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

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

doi:10.1155/2018/8673486

Cited by 10 publications

(12 citation statements)

References 26 publications

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“…Vestibular hypofunction has been also reported to have a role in the pathogenesis of PS in patients with PD. In PD patients with PS, vestibulospinal function, measured by cervical vestibular evoked myogenic potentials, was more severely deteriorated compared to those without PS ( Di Lazzaro et al, 2018 ). Previous studies evaluating peripheral vestibular function by using bithermal caloric test demonstrated that patients with PD-PS showed peripheral vestibular hypofunction more frequently compared to those without PS, presenting either unilateral or bilateral canal paresis ( Vitale et al, 2011 ; Tang et al, 2021 ).…”

Section: Discussionmentioning

confidence: 98%

Factors Contributing to the Severity and Laterality of Pisa Syndrome in Parkinson’s Disease

Huh

Seo

Kim

et al. 2022

Front. Aging Neurosci.

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Objective: Pisa syndrome (PS) is a disabling postural deformity in Parkinson’s disease (PD). We aimed to elucidate clinical factors determining the severity and laterality of PS in PD.Methods: In 54 PD patients with PS, we measured the clinical factors that are previously known to contribute to the occurrence of PS as follows: asymmetry of motor symptoms for the evaluation of asymmetric basal ganglia dysfunction, the degree and direction of subjective visual vertical (SVV) tilt for the misperception of body verticality, the canal paresis for unilateral peripheral vestibulopathy, and the tonic electromyographic (EMG) hyperactivity of paraspinal muscles for dystonia. Multivariable linear and logistic regression analyses were conducted to identify the clinical factors associated with the degree of truncal tilt, for the quantification of the severity of PS, and PS tilting to the less affected side, respectively.Results: The multivariable linear regression analyses revealed that the larger degree of SVV tilt (β = 0.29, SE = 0.10, p = 0.005), right-sided SVV tilt (β = 2.32, SE = 0.82, p = 0.007), and higher Hoehn and Yahr (HY) stage (β = 4.01, SE = 1.29, p = 0.003) significantly increased the severity of PS. In the multivariable logistic regression analyses, greater asymmetry of motor symptoms [odds ratio (OR) = 2.01, 95% CI = 1.34–3.49] was significantly associated with PS tilting to the less affected side, while right-sided SVV tilt (OR = 0.02, 95% CI = 0.001–0.21), unilateral canal paresis (OR = 0.06, 95% CI = 0.003–0.79), and higher HY stage (OR = 0.04, 95% CI = 0.002–0.46) were associated with PS tilting to the more affected side.Conclusion: Misperception of verticality, asymmetric basal ganglia dysfunction, unilateral peripheral vestibulopathy, and motor disability are the clinical factors associated with the severity and laterality of PS in patients with PD.

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Section: Discussionmentioning

confidence: 98%

Factors Contributing to the Severity and Laterality of Pisa Syndrome in Parkinson’s Disease

Huh

Seo

Kim

et al. 2022

Front. Aging Neurosci.

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“…It can be seen that both the VST and the RST are involved in maintaining an upright posture in humans. However, it has been suggested that damage to the VST underlies the impaired postural control seen in diseases such as Parkinson's disease and stroke (Miller et al, 2014;Lazzaro et al, 2018). This would suggest that the VST in particular plays an important role in controlling posture.…”

Section: Introductionmentioning

confidence: 99%

“…As previously stated, human postural control is achieved by generating muscle output from sensory information via the descending tract. Furthermore, the relationship between descending tracts and postural control disorders in various diseases [Parkinson's disease (Lazzaro et al, 2018), stroke (Miller et al, 2014)] have been shown. Therefore, although the model considering both RST and VST is essential to examine postural control of these diseases, none of the studies using the inverted pendulum models considered the descending tracts.…”

Section: Introductionmentioning

confidence: 99%

A Neural Controller Model Considering the Vestibulospinal Tract in Human Postural Control

Omura

Kaminishi

Chiba

et al. 2022

Front. Comput. Neurosci.

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Humans are able to control their posture in their daily lives. It is important to understand how this is achieved in order to understand the mechanisms that lead to impaired postural control in various diseases. The descending tracts play an important role in controlling posture, particularly the reticulospinal and the vestibulospinal tracts (VST), and there is evidence that the latter is impaired in various diseases. However, the contribution of the VST to human postural control remains unclear, despite extensive research using neuroscientific methods. One reason for this is that the neuroscientific approach limits our understanding of the relationship between an array of sensory information and the muscle outputs. This limitation can be addressed by carrying out studies using computational models, where it is possible to make and validate hypotheses about postural control. However, previous computational models have not considered the VST. In this study, we present a neural controller model that mimics the VST, which was constructed on the basis of physiological data. The computational model is composed of a musculoskeletal model and a neural controller model. The musculoskeletal model had 18 degrees of freedom and 94 muscles, including those of the neck related to the function of the VST. We used an optimization method to adjust the control parameters for different conditions of muscle tone and with/without the VST. We examined the postural sway for each condition. The validity of the neural controller model was evaluated by comparing the modeled postural control with (1) experimental results in human subjects, and (2) the results of a previous study that used a computational model. It was found that the pattern of results was similar for both. This therefore validated the neural controller model, and we could present the neural controller model that mimics the VST.

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“…The deposition of Lewy bodies has recently been demonstrated in all brainstem fiber tracts. Therefore, the brainstem is recognized as playing a key role in the pathological spreading of PD [ 6 ]. According to the sequence of pathological spreading—which starts caudally from the dorsal motor vagal nucleus in the medulla, then ascends in the brainstem, and finally involves the neocortex—brainstem involvement occurs in the early stages of PD [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…cVEMP responses are mainly influenced in lower brainstem (the pontine and upper medullary) lesions, whereas oVEMP responses are influenced in upper brainstem (midbrain) lesions [ 11 ]. Recently, VEMP responses were reported to be correlated with multiple motor and non-motor symptoms of PD [ 6 , 12 , 13 , 14 , 15 ]. Hence, combining VEMP findings with these symptoms may strengthen the detection of PD.…”

Section: Introductionmentioning

confidence: 99%

Assessment of Vestibular-Evoked Myogenic Potentials in Parkinson’s Disease: A Systematic Review and Meta-Analysis

2022

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(1) Background: The brainstem plays an essential role in the early stage of Parkinson’s disease (PD), but it is not widely tested in clinical examinations of PD. Vestibular-evoked myogenic potentials (VEMPs) are recognized as fundamental tools in the assessment of brainstem function. The aim of our meta-analysis was to assess the abnormal findings of VEMPs in patients with PD. (2) Methods: Up to 14 February 2022, PubMed, Embase, and Web of Science were searched to evaluate VEMPs in patients with PD in comparison with respective controls. The study protocol was registered at PROSPERO (CRD42022311103). (3) Results: A total of 15 studies were finally included in our meta-analysis. The absence rates of VEMPs in patients with PD were significantly higher than those of control groups (cVEMP: OR = 6.77; oVEMP: OR = 13.9; mVEMP: OR = 7.52). A delayed P13 latency, a decreased peak-to-peak amplitude, and an increased AAR of cVEMP, and a delayed oVEMP P15 latency were also found in patients with PD. (4) Conclusions: Our meta-analysis indicates abnormal VEMP findings in patients with PD, revealing the dysfunction of the brainstem in PD. VEMP tests, especially cVEMP tests, could be a helpful method for the early detection of PD.

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

Cited by 10 publications

References 26 publications

Factors Contributing to the Severity and Laterality of Pisa Syndrome in Parkinson’s Disease

Factors Contributing to the Severity and Laterality of Pisa Syndrome in Parkinson’s Disease

A Neural Controller Model Considering the Vestibulospinal Tract in Human Postural Control

Assessment of Vestibular-Evoked Myogenic Potentials in Parkinson’s Disease: A Systematic Review and Meta-Analysis

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