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

Young Eun Huh; Dae-Won Seo; Kunhyun Kim; Won-Ho Chung; Seonwoo Kim; Jin Whan Cho

doi:10.3389/fnagi.2021.716990

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

Front Aging Neurosci. 2022 Jan 3:13:716990. doi: 10.3389/fnagi.2021.716990. eCollection 2021.

Authors

Young Eun Huh¹, Dae-Won Seo², Kunhyun Kim², Won-Ho Chung³, Seonwoo Kim⁴, Jin Whan Cho²

Affiliations

¹ Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea.
² Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
³ Department of Otolaryngology, Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
⁴ Statistics and Data Center, Samsung Medical Center, Research Institute for Future Medicine, Seoul, South Korea.

Abstract

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.

Keywords: Parkinson’s disease; asymmetry of motor symptoms; misperception of verticality; peripheral vestibular hypofunction; pisa syndrome.