Skip to main content
Have a personal or library account? Click to login
Effects of Focal Low-Energy Extracorporeal Shock Wave Treatment (ESWT) as an Add-On to Botulinum Toxin (BoNT) Injection on Pisa Syndrome in Parkinson’s Disease Cover

Effects of Focal Low-Energy Extracorporeal Shock Wave Treatment (ESWT) as an Add-On to Botulinum Toxin (BoNT) Injection on Pisa Syndrome in Parkinson’s Disease

Open Access
|Jun 2026

References

  1. Doherty KM, van de Warrenburg BP, Peralta MC, Silveira-Moriyama L, Azulay JP, Gershanik OS, et al. Postural deformities in Parkinson’s disease. Lancet Neurol [Internet]. 2011 Jun [cited 2025 Oct 4];10(6):538549. Available from: https://pubmed.ncbi.nlm.nih.gov/21514890/.
  2. Tinazzi M, Gandolfi M, Ceravolo R, Capecci M, Andrenelli E, Ceravolo MG, et al. Postural Abnormalities in Parkinson’s Disease: An Epidemiological and Clinical Multicenter Study. Mov Disord Clin Pract [Internet]. 2019 Sep 1 [cited 2026 Jan 31];6(7):576585. Available from: https://pubmed.ncbi.nlm.nih.gov/31538092/.
  3. Bonanni L, Thomas A, Varanese S, Scorrano V, Onofrj M. Botulinum toxin treatment of lateral axial dystonia in Parkinsonism. Mov Disord [Internet]. 2007 Oct 31 [cited 2025 Oct 4];22(14):20972103. Available from: https://pubmed.ncbi.nlm.nih.gov/17685467/.
  4. Barone P, Santangelo G, Amboni M, Pellecchia MT, Vitale C. Pisa syndrome in Parkinson’s disease and parkinsonism: clinical features, pathophysiology, and treatment [Internet]. The Lancet Neurology. Lancet Neurol. 2016 [cited 2025 Oct 4];15:10631074. Available from: https://pubmed.ncbi.nlm.nih.gov/27571158/.
  5. Tassorelli C, Furnari A, Buscone S, Alfonsi E, Pacchetti C, Zangaglia R, et al. Pisa syndrome in Parkinson’s disease: Clinical, electromyographic, and radiological characterization. Mov Disord. 2012 Feb;27(2):227235. DOI: 10.1002/mds.23930
  6. Tinazzi M, Fasano A, Geroin C, Morgante F, Ceravolo R, Rossi S, et al. Pisa syndrome in Parkinson disease. Neurology [Internet]. 2015 Nov 17 [cited 2026 Jan 31];85(20):17691779. Available from: https://pubmed.ncbi.nlm.nih.gov/26491088/.
  7. Tinazzi M, Juergenson I, Squintani G, Vattemi G, Montemezzi S, Censi D, et al. Pisa syndrome in Parkinson’s disease: An electrophysiological and imaging study. J Neurol [Internet]. 2013 Aug [cited 2025 Oct 4];260(8):21382148. Available from: https://pubmed.ncbi.nlm.nih.gov/23695587/.
  8. Geroin C, Squintani G, Morini A, Donato F, Smania N, Gandolfi M, et al. Pisa syndrome in Parkinson’s disease: Electromyographic quantification of paraspinal and non-paraspinal muscle activity. Funct Neurol [Internet]. 2017 Jul 1 [cited 2026 Feb 1];32(3):143151. Available from: https://europepmc.org/articles/PMC5726350.
  9. Gandolfi M, Artusi CA, Imbalzano G, Camozzi S, Crestani M, Lopiano L, et al. Botulinum Toxin for Axial Postural Abnormalities in Parkinson’s Disease: A Systematic Review [Internet]. Toxins (Basel). 2024 [cited 2026 Jan 31];16. Available from: https://pubmed.ncbi.nlm.nih.gov/38787080/.
  10. Ledda C, Panero E, Dimanico U, Parisi M, Gandolfi M, Tinazzi M, et al. Longitudinal Assessment of Botulinum Toxin Treatment for Lateral Trunk Flexion and Pisa Syndrome in Parkinson’s Disease: Real-life, Long-Term Study. Toxins [Internet]. 2023 Sep 11 [cited 2026 Jan 31];15(9):566. Available from: https://www.mdpi.com/2072-6651/15/9/566/htm.
  11. Tassorelli C, De Icco R, Alfonsi E, Bartolo M, Serrao M, Avenali M, et al. Botulinum toxin type A potentiates the effect of neuromotor rehabilitation of Pisa syndrome in Parkinson disease: a placebo controlled study. Parkinsonism Relat Disord [Internet]. 2014 Nov 1 [cited 2025 Oct 4];20(11):11401144. Available from: https://pubmed.ncbi.nlm.nih.gov/25175601/.
  12. Argenziano G, Squintani G, Camozzi S, Di Vico I, Gandolfi M, Artusi CA, et al. Clinical Algorithm-Guided Approach to Botulinum Toxin Type A Treatment for Axial Postural Abnormalities in Parkinson’s Disease. Mov Disord Clin Pract [Internet]. 2025 [cited 2026 Jan 31]; Available from: https://pubmed.ncbi.nlm.nih.gov/41189548/.
  13. Bartolo M, Serrao M, Tassorelli C, Don R, Ranavolo A, Draicchio F, et al. Four-week trunk-specific rehabilitation treatment improves lateral trunk flexion in Parkinson’s disease. Mov Disord [Internet]. 2010 Feb 15 [cited 2026 Jan 31];25(3):325331. Available from: https://onlinelibrary.wiley.com/doi/full/10.1002/mds.23007.
  14. Capecci M, Serpicelli C, Fiorentini L, Censi G, Ferretti M, Orni C, et al. Postural rehabilitation and Kinesio taping for axial postural disorders in Parkinson’s disease. Arch Phys Med Rehabil [Internet]. 2014 [cited 2025 Oct 4];95(6):10671075. Available from: https://pubmed.ncbi.nlm.nih.gov/24508531/.
  15. Lena F, Iezzi E, Etoom M, Santilli M, Centonze D, Foti C, et al. Effects of postural exercises in patients with Parkinson’s disease and Pisa syndrome: A pilot study. NeuroRehabilitation. 2017;41(2):423428. DOI: 10.3233/NRE-162033
  16. Volpe D, Giantin MG, Manuela P, Filippetto C, Pelosin E, Abbruzzese G, et al. Water-based vs. non-water-based physiotherapy for rehabilitation of postural deformities in Parkinson’s disease: A randomized controlled pilot study. Clin Rehabil [Internet]. 2017 Aug 1 [cited 2026 Jan 31];31(8):11071115. Available from: https://journals.sagepub.com/doi/10.1177/0269215516664122.
  17. Manganotti P, Amelio E. Long-term effect of shock wave therapy on upper limb hypertonia in patients affected by stroke. Stroke [Internet]. 2005 Sep [cited 2026 Jan 31];36(9):19671971. Available from: https://pubmed.ncbi.nlm.nih.gov/16109905/.
  18. Trompetto C, Avanzino L, Bove M, Marinelli L, Molfetta L, Trentini R, et al. External shock waves therapy in dystonia: Preliminary results. Eur J Neurol [Internet]. 2009 Apr [cited 2026 Jan 31];16(4):517521. Available from: https://pubmed.ncbi.nlm.nih.gov/19187259/.
  19. Kenmoku T, Nemoto N, Iwakura N, Ochiai N, Uchida K, Saisu T, et al. Extracorporeal shock wave treatment can selectively destroy end plates in neuromuscular junctions. Muscle and Nerve [Internet]. 2018 Mar 1 [cited 2026 Jan 31];57(3):466472. Available from: https://pubmed.ncbi.nlm.nih.gov/28759703/.
  20. Opara J, Taradaj J, Walewicz K, Rosińczuk J, Dymarek R. The Current State of Knowledge on the Clinical and Methodological Aspects of Extracorporeal Shock Waves Therapy in the Management of Post-Stroke Spasticity-Overview of 20 Years of Experiences. J Clin Med [Internet]. 2021 Jan 2 [cited 2026 Jan 31];10(2):129. Available from: https://pubmed.ncbi.nlm.nih.gov/33445623/.
  21. Postuma RB, Berg D, Stern M, Poewe W, Olanow CW, Oertel W, et al. MDS clinical diagnostic criteria for Parkinson’s disease [Internet]. Mov Disord. 2015 [cited 2026 Jan 31];30:15911601. Available from: https://pubmed.ncbi.nlm.nih.gov/26474316/.
  22. Hoehn MM, Yahr MD. Parkinsonism: Onset, progression, and mortality. Neurology [Internet]. 1967 [cited 2026 Jan 31];17(5):427442. Available from: https://pubmed.ncbi.nlm.nih.gov/6067254/.
  23. Goetz CG, Tilley BC, Shaftman SR, Stebbins GT, Fahn S, Martinez-Martin P, et al. Movement Disorder Society-Sponsored Revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS): Scale presentation and clinimetric testing results. Mov Disord [Internet]. 2008 Nov 15 [cited 2026 Jan 31];23(15):21292170. Available from: https://pubmed.ncbi.nlm.nih.gov/19025984/.
  24. Peto V, Jenkinson C, Fitzpatrick R. PDQ-39: A review of the development, validation and application of a Parkinson’s Disease quality of life questionnaire and its associated measures. Supplement [Internet]. J Neurol; 1998 [cited 2026 Jan 31]. Available from: https://pubmed.ncbi.nlm.nih.gov/9617716/.
  25. Scott W, McCracken LM. Patients’ impression of change following treatment for chronic pain: Global, specific, a single dimension, or many? J Pain [Internet]. 2015 Jun 1 [cited 2026 Jan 31];16(6):518526. Available from: https://www.jpain.org/action/showFullText?pii=S1526590015005441.
  26. Duan H, Lian Y, Jing Y, Xing J, Li Z. Research progress in extracorporeal shock wave therapy for upper limb spasticity after stroke. Front Neurol. 2023 Feb 9;14:1121026. DOI: 10.3389/fneur.2023.1121026
  27. Otero-Luis I, Cavero-Redondo I, Álvarez-Bueno C, Martinez-Rodrigo A, Pascual-Morena C, Moreno-Herráiz N, et al. Effectiveness of Extracorporeal Shock Wave Therapy in Treatment of Spasticity of Different Aetiologies: A Systematic Review and Meta-Analysis. J Clin Med [Internet]. 2024 Mar 1 [cited 2025 Dec 8];13(5):1323. Available from: https://www.mdpi.com/2077-0383/13/5/1323/htm.
  28. Mihai EE, Popescu MN, Iliescu AN, Berteanu M. A systematic review on extracorporeal shock wave therapy and botulinum toxin for spasticity treatment: a comparison on efficacy [Internet]. Eur J Phys Rehabil Med; 2022 [cited 2026 Jan 31];58:565574. Available from: https://pubmed.ncbi.nlm.nih.gov/35412036/.
  29. Santamato A, Notarnicola A, Panza F, Ranieri M, Micello MF, Manganotti P, et al. SBOTE study: extracorporeal shock wave therapy versus electrical stimulation after botulinum toxin type a injection for post-stroke spasticity-a prospective randomized trial. Ultrasound Med Biol [Internet]. 2013 [cited 2025 Dec 8];39(2):283291. Available from: https://pubmed.ncbi.nlm.nih.gov/23245824/.
  30. Ryskalin L, Morucci G, Natale G, Soldani P, Gesi M. Molecular Mechanisms Underlying the Pain-Relieving Effects of Extracorporeal Shock Wave Therapy: A Focus on Fascia Nociceptors [Internet]. Life (Basel). 2022 [cited 2026 Jan 31];12. Available from: https://pubmed.ncbi.nlm.nih.gov/35629410/.
  31. Mariotto S, de Prati A, Cavalieri E, Amelio E, Marlinghaus E, Suzuki H. Extracorporeal Shock Wave Therapy in Inflammatory Diseases: Molecular Mechanism that Triggers Anti-Inflammatory Action. Curr Med Chem [Internet]. 2009 Jul 2 [cited 2026 Feb 1];16(19):23662372. Available from: https://pubmed.ncbi.nlm.nih.gov/19601786/.
  32. Reilly JM, Bluman E, Tenforde AS. Effect of Shockwave Treatment for Management of Upper and Lower Extremity Musculoskeletal Conditions: A Narrative Review [Internet]. PM R. 2018 [cited 2026 Feb 1];10:13851403. Available from: https://pubmed.ncbi.nlm.nih.gov/29775801/.
  33. Starosta M, Marek K, Redlicka J, Miller E. Extracorporeal Shockwave Treatment as Additional Therapy in Patients with Post-Stroke Spasticity of Upper Limb—A Narrative Review [Internet]. J Clin Med. 2024 [cited 2026 Feb 1];13. Available from: https://pubmed.ncbi.nlm.nih.gov/38610782/.
DOI: https://doi.org/10.5334/tohm.1201 | Journal eISSN: 2160-8288
Language: English
Page range: 37 - 37
Submitted on: Mar 12, 2026
Accepted on: May 21, 2026
Published on: Jun 4, 2026
Published by: Ubiquity Press
In partnership with: Paradigm Publishing Services
Publication frequency: 1 issue per year

© 2026 Paolo Manganotti, Tiziana Maria Isabella Lombardo, Valentina Cenacchi, Mauro Catalan, Giulia Bellavita, Valentina Tommasini, Arianna Sartori, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.