Postural & striatal deformities in Parkinson`s disease: Are these rare?

Sanjay Pandey, Hitesh Garg, Sanjay Pandey, Hitesh Garg

Abstract

Parkinson`s disease (PD) is the most common neurodegenerative disease and is characterized by tremor, rigidity and akinesia. Diagnosis is clinical in the majority of the patients. Patients with PD may have stooped posture but some of them develop different types of postural and striatal deformities. Usually these deformities are more common in atypical parkinsonian disorders such as progressive supranuclear palsy and multisystem atrophy. But in many studies it has been highlighted that these may also be present in approximately one third of PD patients leading to severe disability. These include antecollis or dropped head, camptocormia, p0 isa syndrome, scoliosis, striatal hands and striatal toes. The pathogenesis of these deformities is a complex combination of central and peripheral influences such as rigidity, dystonia and degenerative skeletal changes. Duration of parkinsonism symptoms is an important risk factor and in majority of the patients these deformities are seen in advanced statge of the disease. The patients with such symptoms may initially respond to dopaminergic medications but if not intervened they may become fixed and difficult to treat. Pain and restriction of movement are most common clinical manifestations and these may mimick symptoms of musculoskeletal disorders like rheumatoid arthritis. Early diagnosis is important as the patients may respond to adjustment in dopaminergic medications. Recent advances such as deep brain stimulation (DBS) and ultrasound guided botulinum toxin injection are helpful in management of these deformities in patients with PD.

Figures

Fig. 1
Fig. 1
Line diagrams showing antecollis (a), camptocormia (b) and Pisa syndrome (c).
Fig. 2
Fig. 2
Striatal deformity of left hand characterized by flexion at metacarpophalangeal joint in a Parkinson's disease patient (71 yr old male).
Fig. 3
Fig. 3
Striatal deformity of left foot characterized by big toe lateral flexion in a Parkinson's disease patient (66 yr old female).
Fig. 4
Fig. 4
Pathogenesis and spectrum of postural and striatal deformities in Parkinson's disease.

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Source: PubMed

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