Efficacy of a combined therapeutic approach in the management of Pisa Syndrome

BACKGROUND: Pisa syndrome (PS) represents an important source of disability in Parkinson's disease (PD). Currently no consensus has been reached on its definition or diagnostic criteria, and therapeutic approaches are unspecific and often futile. Recently the role of abdominal muscles, and in particular of the external oblique (EO), in the pathogenesis of PS was hypothesized. OBJECTIVES: To evaluate the role of EO and propose a combined therapeutic approach in the management of PS. METHODS: Ten PD patients with PS underwent a combined protocol based on repeated lidocaine injection in EO and rehabilitation program. RESULTS: Our data confirm the primary role of EO muscles in PS pathogenesis and showed an improvement in truncal flexion and balance with a positive impact on patients' quality of life after treatment. CONCLUSIONS: These data highlight the need for accurate characterization of PS focusing on the role of abdominal muscles and the need for a specific rehabilitation protocol for PS management.