Nervenheilkunde 2015; 34(03): 138-143
DOI: 10.1055/s-0038-1627566
Schattauer GmbH

Kamptokormie, Anterocollis und Pisa-Syndrom bei Parkinson

Fokus Physiotherapie: Erscheinungsbild und InterventionCamptocormia, Pisa syndrome and anterocollis in Parkinson’s disease
F. E. Schroeteler
1   Abteilung Neurologie und klinische Neurophysiologie, Zentrum für Parkinson-Syndrome und Bewegungsstörungen, Schön Klinik, München Schwabing
› Author Affiliations
Further Information

Publication History

eingegangen am: 17 December 2014

angenommen am: 17 December 2014

Publication Date:
22 January 2018 (online)


Kamptokormie, Anterocollis und Pisa-Syndrom sind selten auftretende Plussymptome im Krankheitsverlauf des idiopathischen Parkinson-Syndroms und bei atypischen Formen. Sie unterscheiden sich von der klassischen Beugehaltung bei Parkinson vor allem dadurch, dass sie in Rückenlage spontan und zumeist vollständig aufgehoben sind. Die Ätiologie ist nicht abschließend geklärt. Schwere axiale Fehlhaltungen unterliegen dringendem therapeutischen Handlungsbedarf, denn sie erschweren die motorische Selbstständigkeit, erhöhen die Sturzgefahr, stigmatisieren und verursachen teilweise erhebliche Rückenschmerzen. Klinische Verbesserungen dieser Fehlhaltungen lassen sich durch muskuläres Krafttraining der Rücken-, bzw. Nacken-oder Hüftextensoren erreichen. Tendenziell ist dies in Kombination mit einem aktiven, propriozeptiven Training für die eigene Vertikalisierung noch effektiver.


Postural deformities in Parkinson’s disease (PD) as camptocormia, Pisa syndrome and anterocollis are high disabling, rare symptoms both in late PD stages and in atypical Parkinson syndromes. The pathogenesis of these disorders is discussed controversially. Their postures differ most notably from the typical stooped posture in PD as they abate in supine position. They raise the risk of falls, border the independent mobility, stigmatize and cause serious back pain in the vertical position. Physiotherapeutic strength training of the back, respectively neck or hip extensors, shows clinical improvements, tending to be even more effective when combined with an active perceptional training for the straighten up process.

  • Literatur

  • 1 Azher SN, Jankovic J. Camptocormia: pathogenesis, classification, and response to therapy. Neurology 2005; 65 (03) 355-9.
  • 2 Djaldetti R, Mosberg-Galili R, Sroka H, Merims D, Melamed E. Camptocormia (bent spine) in patients with Parkinson’s disease – characterization and possible pathogenesis of an unusual phenomenon. Mov Disord 1999; 14 (03) 443-7.
  • 3 Margraf NG. et al. Camptocormia in idiopathic Parkinson’s disease: a focal myopathy of the paravertebral muscles. Mov Disord Off J Mov Disord Soc 2010; 25 (05) 542-51.
  • 4 Souques A. Rosanoff-Saloff La camptocormie; incurvation du tronc, consécutive aux traumatismes du dos et des lombes; considerations morphologiques. Rev Neurol 1914–1915; 28: 937-9.
  • 5 Bloch F. et al. Parkinson’s disease with camptocormia. J Neurol Neurosurg Psychiatry 2006; 77 (11) 1223-8.
  • 6 Lepoutre AC. et al. A specific clinical pattern of camptocormia in Parkinson’s disease. J Neurol Neurosurg Psychiatry 2006; 77 (11) 1229-34.
  • 7 Gdynia HJ. et al. Histopathological analysis of skeletal muscle in patients with Parkinson’s disease and “dropped head”/’bent spine’ syndrome. Parkinsonism Relat Disord 2009; 15 (09) 633-9.
  • 8 Laroche M, Delisle MB, Aziza R, Lagarrigue J, Mazieres B. Is camptocormia a primary muscular disease?. Spine 1995; 20 (09) 1011-6.
  • 9 Margraf N, Deuschl G. Kamptokormie bei Morbus Parkinson. Aktuelle Neurol 2010; 37 (07) 319-26.
  • 10 Jankovic J. Camptocormia, head drop and other bent spine syndromes: heterogeneous etiology and pathogenesis of Parkinsonian deformities. Mov Disord Off J Mov Disord Soc 2010; 25 (05) 527-8.
  • 11 Spuler S. et al. Myopathy causing camptocormia in idiopathic Parkinson’s disease: a multidisciplinary approach. Mov Disord Off J Mov Disord Soc 2010; 25 (05) 552-9.
  • 12 Tiple D. et al. Camptocormia in Parkinson disease: an epidemiological and clinical study. J Neurol Neurosurg Psychiatry 2009; 80 (02) 145-8.
  • 13 Furusawa Y, Mukai Y, Kobayashi Y, Sakamoto T, Murata M. Role of the external oblique muscle in upper camptocormia for patients with Parkinson’s disease. Mov Disord Off J Mov Disord Soc 2012; 27 (06) 802-3.
  • 14 Ekbom K, Lindholm H, Ljungberg L. New dystonic syndrome associated with butyrophenone therapy. Z für Neurol 1972; 202 (02) 94-103.
  • 15 Suzuki T, Matsuzaka H. Drug-induced Pisa syndrome (pleurothotonus): epidemiology and management. CNS Drugs 2002; 16 (03) 165-74.
  • 16 Slawek J, Derejko M, Lass P, Dubaniewicz M. Camptocormia or Pisa syndrome in multiple system atrophy. Clin Neurol Neurosurg 2006; 108 (07) 699-704.
  • 17 Bonanni L, Thomas A, Varanese S, Scorrano V, Onofrj M. Botulinum toxin treatment of lateral axial dystonia in Parkinsonism. Mov Disord Off J Mov Disord Soc 2007; 22 (14) 2097-103.
  • 18 Doherty KM. et al. Postural deformities in Parkinson’s disease. Lancet Neurol 2011; 10 (06) 538-49.
  • 19 Tassorelli C. et al. Pisa syndrome in Parkinson’s disease: Clinical, electromyographic, and radiological characterization. Mov Disord Off J Mov Disord Soc. 2011
  • 20 Castrioto A, Piscicelli C, Pérennou D, Krack P, Debû B. The pathogenesis of Pisa syndrome in Parkinson’s disease. Mov Disord Off J Mov Disord Soc 2014; 29 (09) 1100-7.
  • 21 Papapetropoulos S, Tuchman A, Sengun C, Russell A, Mitsi G, Singer C. Anterocollis: clinical features and treatment options. Med Sci Monit Int Med J Exp Clin Res 2008; 14 (09) CR427-30.
  • 22 Kastrup A, Gdynia HJ, Nägele T, Riecker A. Dropped-head syndrome due to steroid responsive focal myositis: a case report and review of the literature. J Neurol Sci 2008; 267 (1–2): 162-5.
  • 23 Ashour R, Jankovic J. Joint and skeletal deformities in Parkinson’s disease, multiple system atrophy, and progressive supranuclear palsy. Mov Disord Off J Mov Disord Soc 2006; 21 (11) 1856-63.
  • 24 Panchoa Mde Sèze, Guillaud E, Slugacz L, Cazalets JR. An examination of camptocormia assessment by dynamic quantification of sagittal posture. J Rehabil Med 2014; 29 September; E-Pub.
  • 25 Schroeteler F, Fietzek U, Ziegler K, Orthober L, Ceballos-Baumann A. Die Hüftbeugung ist stärkster Faktor für den Körpergrößenverlust durch Kamptokormie bei Parkinson-Syndromen. Abstractband. 85. DGN-Kongress Hamburg. 2012
  • 26 Fietzek UM, Schroeteler FE, Ceballos-Baumann A. Kamptokormie. Nervenheilkunde 2010; 29 (12) 812-4.
  • 27 Reese R, Knudsen K, Falk D, Mehdorn HM, Deuschl G, Volkmann J. Motor outcome of dystonic camptocormia treated with pallidal neurostimulation. Parkinsonism Relat Disord 2014; 20 (02) 176-9.
  • 28 Siewe J. et al. [Complication analysis of spinal interventions in adult central movement disorders and scoliosis]. Z für Orthop Unfallchirurgie 2013; 151 (05) 454-62.
  • 29 Peek AC, Quinn N, Casey ATH, Etherington G. Thoracolumbar spinal fixation for camptocormia in Parkinson’s disease. J Neurol Neurosurg Psychiatry 2009; 80 (11) 1275-8.
  • 30 Goodwin VA, Richards SH, Taylor RS, Taylor AH, Campbell JL. The effectiveness of exercise interventions for people with Parkinson’s disease: a systematic review and meta-analysis. Mov Disord Off J Mov Disord Soc 2008; 23 (05) 631-40.
  • 31 Tomlinson CL. et al. Physiotherapy versus placebo or no intervention in Parkinson’s disease. Cochrane Database Syst Rev 2013; 09: CD002817.
  • 32 Farley BG, Koshland GF. Training BIG to move faster: the application of the speed-amplitude relation as a rehabilitation strategy for people with Parkinson’s disease. Exp Brain Res 2005; 167 (03) 462-7.
  • 33 Ridgel AL, Vitek JL, Alberts JL. Forced, not voluntary, exercise improves motor function in Parkinson’s disease patients. Neurorehabil Neural Repair 2009; 23 (06) 600-8.
  • 34 Ebersbach G. et al. Comparing exercise in Parkinson’s disease – the Berlin LSVT®BIG study. Mov Disord Off J Mov Disord Soc 2010; 25 (12) 1902-8.
  • 35 Frazzitta G. et al. Intensive rehabilitation treatment in early Parkinson’s disease: a randomized pilot study with a 2-year follow-up. Neurorehabil Neural Repair. 2014 18 Juli; E-Pub.
  • 36 Viliani T. Effects of physical training on straightening-up processes in patients with Parkinson’s disease. Disabil Rehabil 1999; 21 (02) 68-73.
  • 37 Bridgewater KJ, Sharpe MH. Trunk muscle performance in early Parkinson’s disease. Phys Ther 1998; 78 (06) 566-76.
  • 38 Corcos DM. et al. A two-year randomized controlled trial of progressive resistance exercise for Parkinson’s disease: Progressive Resistance Exercise in PD. Mov Disord 2013; 28 (09) 1230-40.
  • 39 Bartolo M. et al. Four-week trunk-specific rehabilitation treatment improves lateral trunk flexion in Parkinson’s disease. Mov Disord Off J Mov Disord Soc 2010; 25 (03) 325-31.
  • 40 Schroeteler FE, Fietzek UM, Ziegler K, Ceballos-Baumann AO. Upright posture in parkinsonian camptocormia using a high-frame walker with forearm support. Mov Disord Off J Mov Disord Soc 2011; 26 (08) 1560-1.
  • 41 Capecci M. et al. Postural rehabilitation and Kinesio taping for axial postural disorders in Parkinson’s disease. Arch Phys Med Rehabil 2014; 95 (06) 1067-75.