Research Group: Cristina Tassorelli, Pacchetti C.

Lateral trunk flexion, also called Pisa Syndrome, represents a complication of the middle-late phase of idiopathic Parkinson disease and is associated with balance impairment, low back pain and greater disability. Regarding the pathogenesis, a “central” hypothesis has been proposed in which an asymmetric cortical and basal ganglia outflow is crucial, that produce a dystonic activation of trunk muscles. It is well known that an improvement of Pisa Syndrome is rarely achieved with a pharmacological therapy, therefore advanced techniques have to be taken into account.
Neuro-rehabilitation represents the first line in approach and a four-week trunk specific programme proved to be effective on the lateral deviation in patients with Pisa Syndrome and Parkinson disease. Moreover the inoculation of botulinum toxin potentiates the effects of physiotherapy alone. Recently non-invasive techniques of neuromodulation such as t-DCS (transcranial direct current stimulation) and r-TMS (repetitive transcranial magnetic stimulation) proved to be effective in the treatment of focal dystonia associated or not with parkinsonian syndromes. The proposed research program aim to evaluate the efficacy of a combined approach made with non-invasive techniques of neuromodulation in the management of Pisa Syndrome in Parkinson’s Disease.

Recent Publications:

• Tassorelli C, De Icco R, Alfonsi E, Bartolo M, Serrao M, Avenali M, De Paoli I, Conte C, Pozzi NG, Bramanti P, Nappi G, Sandrini G. Botulinum toxin type A potentiates the effect of neuromotor rehabilitation of Pisa syndrome in Parkinson disease: a placebo controlled study. Parkinsonism Relat Disord. 2014 Nov;20(11):1140-4.
• Tassorelli C, Furnari A, Buscone S, Alfonsi E, Pacchetti C, Zangaglia R, Pichiecchio A, Bastianello S, Lozza A, Allena M, Bolla M, Sandrini G, Nappi G, Martignoni E. Pisa syndrome in Parkinson’s disease: clinical, electromyographic, and radiological characterization. Mov Disord. 2012 Feb;27(2):227-35.
• Bartolo M, Serrao M, Tassorelli C, Don R, Ranavolo A, Draicchio F, Pacchetti C, Buscone S, Perrotta A, Furnari A, Bramanti P, Padua L, Pierelli F, Sandrini G. Four-week trunk-specific rehabilitation treatment improves lateral trunk flexion in Parkinson’s disease. Mov Disord. 2010 Feb 15;25(3):325-31