Camptocormia in Parkinson’s disease: clinical and pathogenetic features

Abstract

Cаmptocormia (CC), an abnormal posture with involuntaryforward flexion of the trunk, occurs in many neurological disorders,most frequent among which is Parkinsons disease (PD).Axial segmental dystonia and/or focal myopathy of paravertebralmuscles are considered to be possible causes of CC in PD,but exact mechanisms remain unclear. CC is a highly disablingcondition leading to dependency in daily living and gait problems.Treatment of CC in PD include adjustment of antiparkinsonianmedication, injections of botulinum toxin and orthopedicalinterventions; however, the results are mainly disappointing.Some authors report the efficacy of deep brain stimulation(DBS) for CC in PD. We describe four patients with PD and CCwho underwent implantation of DBS systems bilaterally intosubthalamic nucleus (STN) or globus pallidus internus (GPI).In two cases of DBS STN, marked alleviation of bradykinesia,rigidity, and motor fluctuations were noticed. In only onepatient with L-dopa responsive CC, we observed significantreduction of trunk flexion, and in the other patient the favorableeffect was limited due to the fixed skeletal deformity. In twocases of DBS GPI, parkinsonian state improved moderatelywithout changes in CC severity. Thus, the benefit of DBS STNor GPI for CC associated with PD remains indefinite. Ourobservations confirm an important predictive role in operationoutcome of such factors as the sensitivity of CC to L-dopa andthe presence of degenerative spinal disease. Better understandingof CC pathogenesis and studies on larger cohorts of patientsare necessary to elaborate an appropriate treatment algorithm.

Keywords

• camptocormia
• parkinson’s disease
• deep brain stimulation