Treatment of Camptocormia in Parkinsonism: A Comparison of Different Interventions in a Single Center
Carly Olszewski1, Jessica Tate2, Mark Hirsch3, Erwin van Wegen4, Mustafa Siddiqui2
1Wake Forest School of Medicine, 2Neurology, Wake Forest Baptist Medical Center, 3Physical Medicine and Rehabilitation, Carolinas Rehabilitation, 4Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, VU University Medical Center
Objective:
To evaluate (1) the clinical features of Camptocormia and (2) the efficacy of various treatments for Camptocormia of Parkinson’s Disease (PD) and Atypical Parkinsonism (AP).
Background:
Camptocormia is a complex, highly disabling condition in people with Parkinsonism, and effective treatments are lacking. Treatment outcomes have been incompletely characterized to date.
Design/Methods:
A retrospective chart review was performed on 19 consecutive patients with diagnoses of both camptocormia and Parkinsonism at a large medical center. Treatment interventions included dopamine replacement therapy (DRT), physical therapy, steroids, deep brain stimulation (DBS) of subthalamic nucleus (STN) or globus pallidus interna (GPi), and spinal fixation surgery. Camptocormia severity and treatment outcomes were assessed with Clinical Global Impression Severity and Change Scales (GCI-S and CGI-C, respectively). Treatment responders were defined as those with CGI-C≤3 (with CGI-C=3 indicating mild improvement).
Results:
58% of patients were male (n=9), with a median age of 74 years and median disease duration of 11 years. All 19 patients had camptocormia in addition to the following types of Parkinsonism: PD (68%, n=13), Multiple System Atrophy (MSA, 21%, n=4), or both PD and MSA features (11%, n=2). Camptocormia responded to DRT in 6% of cases (n=1/18, CGI-C=3), to physical therapy in 22% (n=4/18, median CGI-C=3), to steroids in 33% (n=1/3, CGI-C=2), to DBS in 33% (n=1/3, CGI-C=3), and to surgery in 56% (n=5/9, median CGI-C=2). Of the patients who underwent surgery, 67% (n=6) required ICU-level post-operative care, 44% (n=4) required inpatient hospital rehabilitation, and 44% (n=4) ultimately required >1 additional surgery.
Conclusions:
Camptocormia remains a very challenging condition to treat. In this study, treatment outcomes for camptocormia in Parkinsonism were highly variable and unpredictable. Further research is desperately needed to improve understanding of the various mechanisms underlying camptocormia in order to provide effective management for this disabling condition.