Camptocormia

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ΕΤΥΜΟΛΟΓΙΑ

Greek:κάμπτω, kamptó - bend or kamptos to bend, κορμός, kormos -trunk
introduced by Alexandre-Achille Souques, a French neurologist

Camptocormia (bent spine syndrome, BSS), an abnormal thoracolumbar spinal flexion, occurs when the patient is able to straighten their spine when supine but gradually carries it to a 45 degree angle or more when erect and starts walking. It is a relatively rare association with various movement disorders such as primary dystonia or idiopathic Parkinson's disease[1]. It has also been described in various myopathies[2] such as myasthenia gravis and after exposure to wide radiation fields including many spinal segments with paraspinal muscles[3]. It is often associated with spondyloarthritic changes and pain and back surgery appears to help some. The aetiology may be complex[4] or with medication exposure such as with atomoxetine[5].

Possibly similar conditions

  • Dropped-head syndrome (Gerlier disease, kubisagari) has many similarities, including its associations[6].
  • Pisa syndrome (pleurothotonus) has lateral trunk flexion and is also found in Parkinson's disease, with the acute or subacute presentations being pure abnormalities in the coronal plane. They can be reversible as they are often precipitated by medication changes[7]. Sometimes gradual onset seems related to the neurodegenerative process and evolution of the disease. A chronic form occurs often in a combined fashion with camptocormia that is more refractory.

Treatment

There is no clear treatment of choice as of 2016. In Parkinson's disease apomorphine[8] or some forms of deep brain stimulation may be successful[9] but treatment appears to be necessary early[10]. Mechanical treatment is often tried with say braces[11]. Some treatments tried such as anaesthetic agents[12], botulinum toxin[13] and spinal magnetic stimulation[14] may be only of transient usefulness.

References

  1. Lepoutre AC, Devos D, Blanchard-Dauphin A, Pardessus V, Maurage CA, Ferriby D, Hurtevent JF, Cotten A, Destée A, Defebvre L. A specific clinical pattern of camptocormia in Parkinson's disease. Journal of neurology, neurosurgery, and psychiatry. 2006 Nov; 77(11):1229-34.(Link to article – subscription may be required.)
  2. Ghosh PS, Milone M. Camptocormia as presenting manifestation of a spectrum of myopathic disorders. Muscle & nerve. 2015 Dec; 52(6):1008-12.(Link to article – subscription may be required.)
  3. Seidel C, Kuhnt T, Kortmann RD, Hering K. Radiation-induced camptocormia and dropped head syndrome: Review and case report of radiation-induced movement disorders. Strahlentherapie und Onkologie : Organ der Deutschen Röntgengesellschaft ... et al.. 2015 Oct; 191(10):765-70.(Link to article – subscription may be required.)
  4. Furusawa Y, Hanakawa T, Mukai Y, Aihara Y, Taminato T, Iawata Y, Takei T, Sakamoto T, Murata M. Mechanism of camptocormia in Parkinson's disease analyzed by tilt table-EMG recording. Parkinsonism & related disorders. 2015 Jul; 21(7):765-70.(Link to article – subscription may be required.)
  5. Bhattacharya A, Praharaj SK, Sinha VK. Persistent camptocormia associated with atomoxetine in a child with attention-deficit/hyperactivity disorder. Journal of child and adolescent psychopharmacology. 2014 Dec; 24(10):596-7.(Link to article – subscription may be required.)
  6. Gdynia HJ, Sperfeld AD, Unrath A, Ludolph AC, Sabolek M, Storch A, Kassubek J. Histopathological analysis of skeletal muscle in patients with Parkinson's disease and 'dropped head'/'bent spine' syndrome. Parkinsonism & related disorders. 2009 Nov; 15(9):633-9.(Link to article – subscription may be required.)
  7. Galati S, Möller JC, Städler C. Ropinirole-induced Pisa syndrome in Parkinson disease. Clinical neuropharmacology. 2014 Mar-Apr; 37(2):58-9.(Link to article – subscription may be required.)
  8. Mensikova K, Kaiserova M, Vastik M, Kurcova S, Kanovsky P. Treatment of camptocormia with continuous subcutaneous infusions of apomorphine: 1-year prospective pilot study. Journal of neural transmission (Vienna, Austria : 1996). 2015 Jun; 122(6):835-9.(Link to article – subscription may be required.)
  9. Chieng LO, Madhavan K, Wang MY. Deep brain stimulation as a treatment for Parkinson's disease related camptocormia. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia. 2015 Oct; 22(10):1555-61.(Link to article – subscription may be required.)
  10. Schulz-Schaeffer WJ, Margraf NG, Munser S, Wrede A, Buhmann C, Deuschl G, Oehlwein C. Effect of neurostimulation on camptocormia in Parkinson's disease depends on symptom duration. Movement disorders : official journal of the Movement Disorder Society. 2015 Mar; 30(3):368-72.(Link to article – subscription may be required.)
  11. Ye BK, Kim HS, Kim YW. Correction of camptocormia using a cruciform anterior spinal hyperextension brace and back extensor strengthening exercise in a patient with Parkinson disease. Annals of rehabilitation medicine. 2015 Feb; 39(1):128-32.(Link to article – subscription may be required.)
  12. Furusawa Y, Mukai Y, Kawazoe T, Sano T, Nakamura H, Sakamoto C, Iwata Y, Wakita M, Nakata Y, Kamiya K, Kobayashi Y, Sakamoto T, Takiyama Y, Murata M. Long-term effect of repeated lidocaine injections into the external oblique for upper camptocormia in Parkinson's disease. Parkinsonism & related disorders. 2013 Mar; 19(3):350-4.(Link to article – subscription may be required.)
  13. Bertram KL, Stirpe P, Colosimo C. Treatment of camptocormia with botulinum toxin. Toxicon : official journal of the International Society on Toxinology. 2015 Dec 1; 107(Pt A):148-53.(Link to article – subscription may be required.)
  14. Arii Y, Sawada Y, Kawamura K, Miyake S, Taichi Y, Izumi Y, Kuroda Y, Inui T, Kaji R, Mitsui T. Immediate effect of spinal magnetic stimulation on camptocormia in Parkinson's disease. Journal of neurology, neurosurgery, and psychiatry. 2014 Nov; 85(11):1221-6.(Link to article – subscription may be required.)