Abstract
Camptocormia in Parkinson’s disease (PD) is an axial postural disorder usually accompanied by histopathological changes in the paravertebral muscles of unknown etiology. The diagnostic potential of magnetic resonance imaging (MRI) of back muscles in camptocormia has not been systematically assessed. Our objective was to characterize pathological muscle changes with MRI and to develop radiological criteria for camptocormia. The criteria edema, swelling and fatty degeneration in 20 idiopathic PD patients with camptocormia were assessed using MRI (T1w and short tau inversion recovery (STIR) sequences) of the lumbar trunk muscles and compared with 20 group-matched PD patients without camptocormia. Edema and fatty degeneration of the paravertebral muscles were significantly more frequent in camptocormia. Edema correlated negatively and fatty degeneration positively with the duration of camptocormia and not PD. Swelling of the paravertebral muscles, edema and swelling of the quadratus lumborum muscle and rare edema of the psoas muscle were only found in camptocormia patients. In this case–control study the defined MRI criteria distinguish the group of PD patients with camptocormia versus those without. Our findings suggest dynamic changes in the MRI signals over time in the paravertebral muscles: edema and swelling are found initially, followed by fatty atrophic degeneration 2–3 years after the beginning of camptocormia. Muscle MRI qualifies as a tool for categorizing phases of camptocormia as acute or chronic, with potential consequences for therapeutic approaches. The involvement of muscles beyond an isolated impairment of the paravertebral muscles implies a more systemic view with a deregulation of lumbar trunk muscles.
Similar content being viewed by others
References
Doherty KM, van de Warrenburg BP, Peralta MC, Silveira-Moriyama L, Azulay JP, Gershanik OS, Bloem BR (2011) Postural deformities in Parkinson’s disease. Lancet Neurol 10:538–549
Finsterer J, Strobl W (2010) Presentation, etiology, diagnosis, and management of camptocormia. Eur Neurol 64:1–8
Upadhyaya CD, Starr PA, Mummaneni PV (2010) Spinal deformity and Parkinson disease: a treatment algorithm. Neurosurg Focus 28:E5
Lepoutre AC, Devos D, Blanchard-Dauphin A, Pardessus V, Maurage CA, Ferriby D, Hurtevent JF, Cotten A, Destee A, Defebvre L (2006) A specific clinical pattern of camptocormia in Parkinson’s disease. J Neurol Neurosurg Psychiatry 77:1229–1234
Tiple D, Fabbrini G, Colosimo C, Ottaviani D, Camerota F, Defazio G, Berardelli A (2009) Camptocormia in Parkinson disease: an epidemiological and clinical study. J Neurol Neurosurg Psychiatry 80:145–148
Ashour R, Jankovic J (2006) Joint and skeletal deformities in Parkinson’s disease, multiple system atrophy, and progressive supranuclear palsy. Mov Disord 21:1856–1863
Abe K, Uchida Y, Notani M (2010) Camptocormia in Parkinson’s disease. Parkinsons Dis
Wrede A, Margraf NG, Goebel HH, Deuschl G, Schulz-Schaeffer WJ (2012) Myofibrillar disorganization characterizes myopathy of camptocormia in Parkinson’s disease. Acta Neuropathol 123:419–432
Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC (1994) Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res 78–83
Fuchs B, Weishaupt D, Zanetti M, Hodler J, Gerber C (1999) Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elbow Surg 8:599–605
Hoffmann A, Mamisch N, Buck FM, Espinosa N, Pfirrmann CW, Zanetti M (2011) Oedema and fatty degeneration of the soleus and gastrocnemius muscles on MR images in patients with Achilles tendon abnormalities. Eur Radiol 21:1996–2003
Bonneville F, Bloch F, Kurys E, du Montcel ST, Welter ML, Bonnet AM, Agid Y, Dormont D, Houeto JL (2008) Camptocormia and Parkinson’s disease: MR imaging. Eur Radiol 18:1710–1719
Schabitz WR, Glatz K, Schuhan C, Sommer C, Berger C, Schwaninger M, Hartmann M, Hilmar Goebel H, Meinck HM (2003) Severe forward flexion of the trunk in Parkinson’s disease: focal myopathy of the paraspinal muscles mimicking camptocormia. Mov Disord 18:408–414
Gibb WR, Lees AJ (1988) The relevance of the Lewy body to the pathogenesis of idiopathic Parkinson’s disease. J Neurol Neurosurg Psychiatry 51:745–752
Margraf NG, Wrede A, Rohr A, Schulz-Schaeffer WJ, Raethjen J, Eymess A, Volkmann J, Mehdorn MH, Jansen O, Deuschl G (2010) Camptocormia in idiopathic Parkinson’s disease: a focal myopathy of the paravertebral muscles. Mov Disord 25:542–551
Elton S. F. a. R (1987) Unified Parkinson’s disease rating scale. In: Fahn S, M. C, Caine DB, Goldstein ME (eds) Recent developments in Parkinson’s disease. Macmillan Health Care Information, Florham Park, NJ, USA pp 153–163, 293–304
Beese MS, Winkler G, Nicolas V, Maas R, Kress D, Kunze K, Bucheler E (1993) The diagnosis of inflammatory muscular and vascular diseases using MRT with STIR sequences. Rofo 158:542–549
Ranson CA, Burnett AF, Kerslake R, Batt ME, O’Sullivan PB (2006) An investigation into the use of MR imaging to determine the functional cross sectional area of lumbar paraspinal muscles. Eur Spine J 15:764–773
Kim H, Lee CK, Yeom JS, Lee JH, Cho JH, Shin SI, Lee HJ, Chang BS (2013) Asymmetry of the cross-sectional area of paravertebral and psoas muscle in patients with degenerative scoliosis. Eur Spine J 22:1332–1338
Cohen J (1968) Weighted kappa: nominal scale agreement with provision for scaled disagreement or partial credit. Psychol Bull 70:213–220
West GA, Haynor DR, Goodkin R, Tsuruda JS, Bronstein AD, Kraft G, Winter T, Kliot M (1994) Magnetic resonance imaging signal changes in denervated muscles after peripheral nerve injury. Neurosurgery 35:1077–1085 (discussion 1085–1076)
McDonald CM, Carter GT, Fritz RC, Anderson MW, Abresch RT, Kilmer DD (2000) Magnetic resonance imaging of denervated muscle: comparison to electromyography. Muscle Nerve 23:1431–1434
Tasca G, Monforte M, Iannaccone E, Laschena F, Ottaviani P, Leoncini E, Boccia S, Galluzzi G, Pelliccioni M, Masciullo M, Frusciante R, Mercuri E, Ricci E (2014) Upper girdle imaging in facioscapulohumeral muscular dystrophy. PLoS One 9:e100292
Diekman EF, van der Pol WL, Nievelstein RA, Houten SM, Wijburg FA, Visser G (2014) Muscle MRI in patients with long-chain fatty acid oxidation disorders. J Inherit Metab Dis 37:405–413
Subhawong TK, Wang X, Machado AJ, Mammen AL, Christopher-Stine L, Barker PB, Carrino JA, Fayad LM (2013) 1H Magnetic resonance spectroscopy findings in idiopathic inflammatory myopathies at 3 T: feasibility and first results. Invest Radiol 48:509–516
Hayashi D, Hamilton B, Guermazi A, de Villiers R, Crema MD, Roemer FW (2012) Traumatic injuries of thigh and calf muscles in athletes: role and clinical relevance of MR imaging and ultrasound. Insights Imaging 3:591–601
Tomasova Studynkova J, Charvat F, Jarosova K, Vencovsky J (2007) The role of MRI in the assessment of polymyositis and dermatomyositis. Rheumatology (Oxford) 46:1174–1179
Wunderlich S, Csoti I, Reiners K, Gunthner-Lengsfeld T, Schneider C, Becker G, Naumann M (2002) Camptocormia in Parkinson’s disease mimicked by focal myositis of the paraspinal muscles. Mov Disord 17:598–600
Charpentier P, Dauphin A, Stojkovic T, Cotten A, Hurtevent JF, Maurage CA, Thevenon A, Destee A, Defebvre L (2005) Parkinson’s disease, progressive lumbar kyphosis and focal paraspinal myositis. Rev Neurol (Paris) 161:459–463
Dietz V (2002) Proprioception and locomotor disorders. Nat Rev Neurosci 3:781–790
Asahi T, Taguchi Y, Hayashi N, Hamada H, Dougu N, Takashima S, Tanaka K, Endo S (2011) Bilateral subthalamic deep brain stimulation for camptocormia associated with Parkinson’s disease. Stereotact Funct Neurosurg 89:173–177
Capelle HH, Schrader C, Blahak C, Fogel W, Kinfe TM, Baezner H, Krauss JK (2011) Deep brain stimulation for camptocormia in dystonia and Parkinson’s disease. J Neurol 258:96–103
Schulz-Schaeffer WJ, Margraf NG, Munser S, Wrede A, Buhmann C, Deuschl G, Oehlwein C (2015) Effect of neurostimulation on camptocormia in Parkinson’s disease depends on symptom duration. Mov Disord (epub ahead of print)
Spuler S, Krug H, Klein C, Medialdea IC, Jakob W, Ebersbach G, Gruber D, Hoffmann KT, Trottenberg T, Kupsch A (2010) Myopathy causing camptocormia in idiopathic Parkinson’s disease: a multidisciplinary approach. Mov Disord 25:552–559
Acknowledgments
The authors express their deep thanks to Sari Munser for her valuable help in gathering the data of this study, and Klarissa Hanja Stürner and Walter J. Schulz-Schaeffer for very helpful discussion of the manuscript. The study was supported by a grant from the Medical Faculty of the Christian-Albrechts University of Kiel.
Conflicts of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Additional information
N. G. Margraf and A. Rohr contributed equally to the manuscript.
Rights and permissions
About this article
Cite this article
Margraf, N.G., Rohr, A., Granert, O. et al. MRI of lumbar trunk muscles in patients with Parkinson’s disease and camptocormia. J Neurol 262, 1655–1664 (2015). https://doi.org/10.1007/s00415-015-7726-3
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00415-015-7726-3