Frequency and clinical correlates of postural and striatal deformities in Parkinson’s disease

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Highlights

  • 416 patients with PD were evaluated for musculoskeletal deformities.

  • The overall prevalence of musculoskeletal deformities was 19.7%.

  • Striatal deformities were the most frequent deformities (9.9%).

  • Striatal deformities appear to be more related to dopaminergic treatment.

  • Postural deformities are associated with the motor state.

Abstract

Objective

To assess the frequency of postural and striatal deformities in patients with Parkinson’s disease.

Patients and methods

A total of 416 consecutive patients with Parkinson’s disease were evaluated for musculoskeletal deformities using a standardized criteria. Data including disease history, motor complications and antiparkinsonic treatment were collected.

Results

The overall frequency of musculoskeletal deformities was 19.7%. Striatal deformities were the most frequent deformities (9.9%). Scoliosis was the deformity most frequently found. No cases with Pisa syndrome or antecollis were found. Striatal deformities were associated with a younger age at onset, more frequent use of levodopa, as well as higher levodopa equivalent daily dose. Postural deformities were associated with higher motor scores.

Conclusion

Postural and striatal deformities are common in Parkinson’s disease. Striatal deformities appear to be more related to dopaminergic treatment, while postural deformities are associated with the motor state.

Introduction

Musculoskeletal problems are frequent in Parkinson’s disease (PD); Kim et al. reported that 66.3% of patients with PD had a musculoskeletal symptom, usually involving the low back, knee and shoulder [1].

On the other hand, musculoskeletal deformities and abnormal postures are also frequent in patients with PD. These include the so-called “striatal deformities” as well as camptocormia, Pisa syndrome, scoliosis and antecollis (also known as “dropped head”).

Ashour and Jankovic reported an overall prevalence of deformities of 33.5% in 164 patients with PD patients. Striatal limb deformities were present in 12.8% of the sample; while involuntary trunk flexion was present in 12.2%, antecollis in 12.2%, and scoliosis in 8.5% [2].

Despite being relatively frequent, misdiagnosis of the deformities in PD is common. Deformities in PD may resemble those seen in the orthopaedic setting [3]. For instance, striatal hand or foot are similar to the deformities seen in rheumatoid arthritis, and postural abnormalities can be associated to aging.

The objective of this study is to describe the frequency of abnormal postures and striatal deformities in a sample of subjects with PD. In addition, clinical and demographic correlates are analyzed.

Section snippets

Material and methods

Consecutive PD patients from different referral hospitals in Mexico (two in Mexico City and one in Zacatecas) were included. PD was diagnosed according to the Queen Square Brain Bank Criteria [4]. Demographic data including gender and age were recorded. Clinical data regarding age at motor onset, predominant symptoms at motor onset, and current treatment and dose were also collected. Levodopa equivalent daily dose (LEDD) and dopamine agonist (DA) LEDD were calculated as published elsewhere [5].

Results

A total of 416 consecutive patients were included (53.1% male and 46.9% female). The mean age of the sample was 62.7 ± 12.6 years. The mean age at disease onset was 54.6 ± 13.5 years; while mean disease duration was 7.1 ± 5.7 years (median 6 years, range 1.5 to 13 years). Severity according to the HY stage was as follows: 74.3% of the sample had a mild disease (13.7% was in HY 1), 18.7% had a moderate (HY 3) and 7% had a severe disease (HY4-5). In regards to the antiparkinsonian treatment, 74.5% were

Discussion

Patients with PD often present with an abnormal posture. The classic stooped posture with flexion of the hips and knees is the most recognized deformity associated with advanced PD. Nevertheless, some patients present with more severe abnormalities of the posture.

In the present study, the overall frequency of postural and striatal deformities was about 20%. This frequency is lower than reported, even though the mean age and disease duration were similar to other reports. An explanation for the

Conflict of interests

The authors declare that there is no conflict of interests regarding the publication of this paper.

Acknowledgement

Our study was supported by the Consejo Nacional de Ciencia y Tecnología (CONACyT), grant number 182133.

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