Parkinson’s disease-associated camptocormia: biopsy-confirmed focal myositis and treatment options
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND: The etiology of the disabling symptom camptocormia/dropped head in Parkinson's disease (PD) is still debated. Many PD patients develop involuntary flexion of the spine in an upright position that does not respond to dopaminergic treatment. OBJECTIVES: To study the histopathology of paraspinal muscles in PD-associated camptocormia with potential consequences for therapy. METHODS: We report a cohort of 66 patients with PD (mean age 68.4 ± 8.1 years) and associated camptocormia according to consensus criteria. Paravertebral muscle biopsy was performed in all patients with consecutive histopathological analysis. RESULTS: Forty-two patients (64%) showed inflammatory myositis in the paravertebral muscles with features of T-cell dominant myositis with additional necrosis, in addition to moderate myopathic changes. Thirty-four of these 42 patients with myositis received immunosuppression according to general clinical guidelines for myositis (i.e., prednisolone, often followed by azathioprine) in addition to PD medication. Twenty-three/34 patients (68%) on prednisolone showed a partial or complete improvement of the muscle weakness. This effect persisted after switching from prednisolone to the long-term immunosuppressant. Three/34 patients were lost to follow-up, and 8/34 did not improve. CONCLUSIONS: In this cohort of PD patients with camptocormia, muscle biopsy demonstrated local myositis in addition to myopathic changes in 64% of the cases. About two-thirds of these patients benefited from prednisolone therapy, as a symptomatic therapeutic option for muscle weakness. We recommend a histological work-up of the clinical diagnosis PD-associated camptocormia given that effective therapeutic options are available.
Source: Journal of Neurology
Institution: University Hospital Ulm
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,790
OpenAlex ID: W4415482131