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Parkinson’s Disease
Volume 2015 (2015), Article ID 437190, 6 pages
Research Article

Pisa Syndrome in Parkinson’s Disease: Electromyographic Aspects and Implications for Rehabilitation

1Department of Parkinson’s Disease, Movement Disorders and Brain Injury Rehabilitation, “Moriggia-Pelascini” Hospital, Gravedona ed Uniti, 22015 Como, Italy
2Department of Neurorehabilitation, “Salvatore Maugeri” Foundation, IRCCS, Scientific Institute of Pavia, via Boezio, 27100 Pavia, Italy
3Department of Biomedical Engineering, S. Maugeri Foundation, IRCCS, Scientific Institute of Montescano, 27040 Pavia, Italy
4Movement Disorders Unit, Neurological Institute, Tel Aviv Medical Centre, Sieratzki Chair of Neurology, Sackler School of Medicine, Sagol School for Neuroscience, Tel-Aviv University, 69978 Tel-Aviv, Israel

Received 7 October 2015; Accepted 9 November 2015

Academic Editor: Hélio Teive

Copyright © 2015 Giuseppe Frazzitta et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Pisa Syndrome (PS) is a real clinical enigma, and its management remains a challenge. In order to improve the knowledge about resting state and during maximal voluntary muscle contraction (MVMC) of the axial muscles, we described the electromyography results of paraspinal muscles, rectus abdominis, external oblique, and quadratus lumborum of both sides of 60 patients. Electromyography was assessed at rest, during MVMC while bending in the opposite direction of the PS and during MVMC while bending in the direction of the PS. The MVMC gave information about the interferential pattern (INT) or subinterferential pattern (sub-INT). We defined asymmetrical activation (AA) when a sub-INT was detected on the muscle on the side opposite to the PS bending and an INT of same muscle in the direction of PS bending. We observed significant AA during MVMC only in the external oblique muscles in 78% of the subjects. Our results of asymmetric ability to generate maximal voluntary force of the external oblique muscles support a central dissynchronisation of axial muscles as a significant contributor for the bending of the spine in erect position. These results could have important implication to physiotherapy and the use of botulinum toxin in the treatment of PS.