Camptocormia in Parkinson’s disease: clinical and pathogenetic features

Cаmptocormia (CC), an abnormal posture with involuntary forward flexion of the trunk, occurs in many neurological disorders, most frequent among which is Parkinson’s disease (PD). Axial segmental dystonia and/or focal myopathy of paravertebral muscles are considered to be possible causes of CC in PD, but exact mechanisms remain unclear. CC is a highly disabling condition leading to dependency in daily living and gait problems. Treatment of CC in PD include adjustment of antiparkinsonian medication, injections of botulinum toxin and orthopedical interventions; however, the results are mainly disappointing. Some authors report the efficacy of deep brain stimulation (DBS) for CC in PD. We describe four patients with PD and CC who underwent implantation of DBS systems bilaterally into subthalamic nucleus (STN) or globus pallidus internus (GPI). In two cases of DBS STN, marked alleviation of bradykinesia, rigidity, and motor fluctuations were noticed. In only one patient with L-dopa responsive CC, we observed significant reduction of trunk flexion, and in the other patient the favorable effect was limited due to the fixed skeletal deformity. In two cases of DBS GPI, parkinsonian state improved moderately without changes in CC severity. Thus, the benefit of DBS STN or GPI for CC associated with PD remains indefinite. Our observations confirm an important predictive role in operation outcome of such factors as the sensitivity of CC to L-dopa and the presence of degenerative spinal disease. Better understanding of CC pathogenesis and studies on larger cohorts of patients are necessary to elaborate an appropriate treatment algorithm.