Predictors and Pathophysiology of Axial Postural Abnormalities in Parkinsonism: A Scoping Review

Carlo Alberto Artusi¹, Christian Geroin², Jorik Nonnekes³, Camila Aquino⁴, Divyani Garg⁵, Marian L Dale⁶, Darbe Schlosser⁷, Yijie Lai⁸, Mohammad Al-Wardat⁹, Mehri Salari¹⁰, Robin Wolke¹¹, Valery Tsinda Labou¹², Gabriele Imbalzano¹, Serena Camozzi², Marcelo Merello¹³, Bastiaan R Bloem¹⁴, Tamine Capato^{14

15}, Ruth Djaldetti¹⁶, Karen Doherty^{17

18}, Alfonso Fasano^{19

20

21}, Houyam Tibar²², Leonardo Lopiano¹, Nils G Margraf¹¹, Caroline Moreau²³, Yoshikazu Ugawa²⁴, Roongroj Bhidayasiri^{25

26}, Michele Tinazzi²; International Parkinson and Movement Disorders Society Task Force on Postural Abnormalities

Affiliations

¹ Department of Neuroscience Rita Levi Montalcini, University of Turin, Torino, Italy.
² Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
³ Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, The Netherlands.
⁴ Hotchkiss Brain Institute, Department of Clinical Neurosciences, and Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
⁵ Department of Neurology, Lady Hardinge Medical College, New Delhi, India. Department of Neurology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
⁶ Oregon Health & Science University, Department of Neurology, Portland, OR, USA.
⁷ Graduate Student in the Motor Learning Program at Teachers College, Columbia University, New York, NY, USA.
⁸ Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁹ Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan.
¹⁰ Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
¹¹ Department of Neurology, UKSH, Christian-Albrechts-University, Kiel, Germany.
¹² Neurorehabilitation and Movement Disorders Society, Yaoundé, Cameroon.
¹³ Movement Disorders Service, FLENI, CONICET, Buenos Aires, Argentina.
¹⁴ Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.
¹⁵ University of São Paulo, Department of Neurology, Movement Disorders Center, São Paulo, Brazil.
¹⁶ Department of Neurology, Rabin Medical Center, Petah Tikva; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
¹⁷ Department of Neurology, Royal Victoria Hospital, Belfast, United Kingdom.
¹⁸ Centre for Medical Education, Queens University Belfast, Belfast, United Kingdom.
¹⁹ Division of Neurology, University of Toronto, Toronto, ON, Canada.
²⁰ Krembil Brain Institute, Toronto, ON, Canada.
²¹ Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman, Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, ON, Canada.
²² Service de Neurologie B et de Neurogénétique Hôpital des Spécialités OTO-Neuro-Ophtalmologique, Ibn Sina University Hospital, Medical School of Rabat, Mohamed 5 University of Rabat, Rabat, Morocco.
²³ Expert Center for Parkinson's Disease, Neurological Department, Inserm UMR 1172, Lille University Hospital, Lille, France.
²⁴ Department of Human Neurophysiology, School of Medicine, Fukushima Medical University, Fukushima, Japan.
²⁵ Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
²⁶ The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand.

PMID: 38026508
PMCID: PMC10654876
DOI: 10.1002/mdc3.13879

Predictors and Pathophysiology of Axial Postural Abnormalities in Parkinsonism: A Scoping Review

Carlo Alberto Artusi et al. Mov Disord Clin Pract. 2023.

. 2023 Sep 25;10(11):1585-1596.

doi: 10.1002/mdc3.13879. eCollection 2023 Nov.

Authors

Affiliations

¹ Department of Neuroscience Rita Levi Montalcini, University of Turin, Torino, Italy.
² Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
³ Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, The Netherlands.
⁴ Hotchkiss Brain Institute, Department of Clinical Neurosciences, and Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
⁵ Department of Neurology, Lady Hardinge Medical College, New Delhi, India. Department of Neurology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
⁶ Oregon Health & Science University, Department of Neurology, Portland, OR, USA.
⁷ Graduate Student in the Motor Learning Program at Teachers College, Columbia University, New York, NY, USA.
⁸ Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁹ Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan.
¹⁰ Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
¹¹ Department of Neurology, UKSH, Christian-Albrechts-University, Kiel, Germany.
¹² Neurorehabilitation and Movement Disorders Society, Yaoundé, Cameroon.
¹³ Movement Disorders Service, FLENI, CONICET, Buenos Aires, Argentina.
¹⁴ Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.
¹⁵ University of São Paulo, Department of Neurology, Movement Disorders Center, São Paulo, Brazil.
¹⁶ Department of Neurology, Rabin Medical Center, Petah Tikva; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
¹⁷ Department of Neurology, Royal Victoria Hospital, Belfast, United Kingdom.
¹⁸ Centre for Medical Education, Queens University Belfast, Belfast, United Kingdom.
¹⁹ Division of Neurology, University of Toronto, Toronto, ON, Canada.
²⁰ Krembil Brain Institute, Toronto, ON, Canada.
²¹ Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman, Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, ON, Canada.
²² Service de Neurologie B et de Neurogénétique Hôpital des Spécialités OTO-Neuro-Ophtalmologique, Ibn Sina University Hospital, Medical School of Rabat, Mohamed 5 University of Rabat, Rabat, Morocco.
²³ Expert Center for Parkinson's Disease, Neurological Department, Inserm UMR 1172, Lille University Hospital, Lille, France.
²⁴ Department of Human Neurophysiology, School of Medicine, Fukushima Medical University, Fukushima, Japan.
²⁵ Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
²⁶ The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand.

PMID: 38026508
PMCID: PMC10654876
DOI: 10.1002/mdc3.13879

Abstract

Background: Postural abnormalities involving the trunk are referred to as axial postural abnormalities and can be observed in over 20% of patients with Parkinson's disease (PD) and in atypical parkinsonism. These symptoms are highly disabling and frequently associated with back pain and a worse quality of life in PD. Despite their frequency, little is known about the pathophysiology of these symptoms and scant data are reported about their clinical predictors, making it difficult to prompt prevention strategies.

Objectives: We conducted a scoping literature review of clinical predictors and pathophysiology of axial postural abnormalities in patients with parkinsonism to identify key concepts, theories and evidence on this topic.

Methods: We applied a systematic approach to identify studies, appraise quality of evidence, summarize main findings, and highlight knowledge gaps.

Results: Ninety-two articles were reviewed: 25% reported on clinical predictors and 75% on pathophysiology. Most studies identified advanced disease stage and greater motor symptoms severity as independent clinical predictors in both PD and multiple system atrophy. Discrepant pathophysiology data suggested different potential central and peripheral pathogenic mechanisms.

Conclusions: The recognition of clinical predictors and pathophysiology of axial postural abnormalities in parkinsonism is far from being elucidated due to literature bias, encompassing different inclusion criteria and measurement tools and heterogeneity of patient samples. Most studies identified advanced disease stage and higher burden of motor symptoms as possible clinical predictors. Pathophysiology data point toward many different (possibly non-mutually exclusive) mechanisms, including dystonia, rigidity, proprioceptive and vestibular impairment, and higher cognitive deficits.

Keywords: Antecollis; Camptocormia; Parkinsonisms; Pisa syndrome; axial postural abnormalities; clinical predictors; pathophysiology.

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Figures

**Figure 1**
Study flow chart: phases of the scoping review.

See this image and copyright information in PMC

References

1. Tinazzi M, Gandolfi M, Ceravolo R, et al. Postural abnormalities in Parkinson's disease: an epidemiological and clinical multicenter study. Mov Disord Clin Pract 2019;6(7):576–585. - PMC - PubMed
1. Doherty KM, van de Warrenburg BP, Peralta MC, Silveira‐Moriyama L, Azulay JP, Gershanik OS, Bloem BR. Postural deformities in Parkinson's disease. Lancet Neurol 2011;10(6):538–549. - PubMed
1. Ashour R, Jankovic J. Joint and skeletal deformities in Parkinson's disease, multiple system atrophy, and progressive supranuclear palsy. Mov Disord 2006;21(11):1856–1863. - PubMed
1. Tinazzi M, Geroin C, Bhidayasiri R, et al. Task force consensus on nosology and cut‐off values for axial postural abnormalities in parkinsonism. Mov Disord Clin Pract 2022;9:594–603. - PMC - PubMed
1. Margraf NG, Granert O, Hampel J, Wrede A, Schulz‐Schaeffer WJ, Deuschl G. Clinical definition of Camptocormia in Parkinson's disease. Mov Disord Clin Pract 2017;4(3):349–357. - PMC - PubMed

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Predictors and Pathophysiology of Axial Postural Abnormalities in Parkinsonism: A Scoping Review

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Predictors and Pathophysiology of Axial Postural Abnormalities in Parkinsonism: A Scoping Review

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