AUTHOR=De Icco Roberto , Putortì Alessia , Allena Marta , Avenali Micol , Dagna Carlotta , Martinelli Daniele , Cristina Silvano , Grillo Valentina , Fresia Mauro , Bitetto Vito , Cosentino Giuseppe , Valentino Francesca , Alfonsi Enrico , Sandrini Giorgio , Pisani Antonio , Tassorelli Cristina 

TITLE=Non-Invasive Neuromodulation in the Rehabilitation of Pisa Syndrome in Parkinson's Disease: A Randomized Controlled Trial

JOURNAL=Frontiers in Neurology

VOLUME=13

YEAR=2022

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.849820

DOI=10.3389/fneur.2022.849820

ISSN=1664-2295

ABSTRACT=<sec><title>Background</title><p>Pisa syndrome (PS) is a frequent postural complication of Parkinson's disease (PD). PS poorly responds to anti-parkinsonian drugs and the improvement achieved with neurorehabilitation tends to fade in 6 months or less. Transcranial direct current stimulation (t-DCS) is a non-invasive neuromodulation technique that showed promising results in improving specific symptoms in different movement disorders.</p></sec><sec><title>Objectives</title><p>This study aimed to evaluate the role of bi-hemispheric t-DCS as an add-on to a standardized hospital rehabilitation program in the management of PS in PD.</p></sec><sec><title>Methods</title><p>This study included 28 patients with PD and PS (21 men, aged 72.9 ± 5.1 years) who underwent a 4-week intensive neurorehabilitation treatment and were randomized to receive: i) t-DCS (t-DCS group, <italic>n</italic> = 13) for 5 daily sessions (20 min−2 mA) with bi-hemispheric stimulation over the primary motor cortex (M1), or ii) sham stimulation (sham group, <italic>n</italic> = 15) with the same duration and cadence. At baseline (T0), end of rehabilitation (T1), and 6 months later (T2) patients were evaluated with both trunk kinematic analysis and clinical scales, including UPDRS-III, Functional Independence Measure (FIM), and Numerical Rating Scale for lumbar pain.</p></sec><sec><title>Results</title><p>When compared to the sham group, the t-DCS group achieved a more pronounced improvement in several variables: overall posture (<italic>p</italic> = 0.014), lateral trunk inclination (<italic>p</italic> = 0.013) during upright standing position, total range of motion of the trunk (<italic>p</italic> = 0.012), FIM score (<italic>p</italic> = 0.048), and lumbar pain intensity (<italic>p</italic> = 0.017).</p></sec><sec><title>Conclusions</title><p>Our data support the use of neuromodulation with t-DCS as an add-on to neurorehabilitation for the treatment of patients affected by PS in PD.</p></sec>