Table 1
Summary of finding in the reported manuscripts on treatment of camptocormia with botulinum neurotoxins.
| AUTHORS AND DATE | #PTS | MUSCLE(S) INJECTED | TYPE OF TOXIN | DOSE IN UNITS | ASSESSMENT | RESULTS | SIDE EFFECTS |
|---|---|---|---|---|---|---|---|
| Azher & Jankovic, 2005 [5] | 9 | Rectus abdominis (bilateral) | onaA | 300–600 per treatment visit | Clinical: posture (degree of trunk flexion); Functional improvement; UPDRS (for PD pts); Video documentation | 4 patients showed moderate to marked improvement (lasting 8–16 weeks), while remaining 5 patients had no significant improvement | Not mentioned |
| Von Coelln et al, 2008 [14] | 4 | Psoas major: Two patients bilateral. Two patients unilateral | aboA | Initial: 500 per side, Maximum: 1,500 per side | Clinical exam; Patient subjective reporting; Objective posture measure (height) | Temporary improvement with functional gain (1 patient); Worsening of posture and general condition (1 patient). Overall, no significant benefit. | Mild hip flexor weakness and transient local itching at injection site (1 patient), mild transient functional impairment (1 patient) |
| Colosimo and Salvatori, 2009 [15] | 2 | Ileopsoas (bilateral), rectus abdominis (bilateral) | onaA | Iliopsoas: 300; rectus abdominis: 200 | Clinical: objective and subjective assessment of posture | No objective or subjective improvement. | Not mentioned |
| Fietzek et al, 2009 [16] | 10 | Rectus abdominis (bilateral), Iliopsoas (bilateral) | Inco-A | 100–300 U | UPDRS, Times Up & Go, Goal Attainment Scaling | No significant improvement | Mild muscle soreness at injection site (2 patients) |
| Wijemanne et al, 2014 [17] | 1 | Initially: Rectus abdominis (bilateral)Subsequently: External oblique (L) and Rectus abdominis | onaA | Initially, 200 into each rectus with additional injection of 200 into each external oblique two months later | Degree of trunk flexion; ability to lie flat; functional ability; MDS-UPDRS III scores (ON vs OFF); EMG; CT (to assess muscle anatomy and physiology) | Limited improvement initially but marked improvement following second treatment with additional external oblique injection. Benefits were sustained over 18 months with repeated injections. | None mentioned |
| Matsumoto et al, 2018 [18] | 1 | Right lumbar paraspinal muscles (L2-L4) | onaA | Initial: 20 Repeat injection one month later: 30 | Posture and pain; posture X-ray (before and after); CT (assessed muscle volume; EMG | camptocormia and Pisa syndrome improved with reduction in abdominal pain. | None |
| Todo et al, 2018 [19] | 6 | External oblique (bilateral) | onaA | 75–90 per side; 150–180 per patient | CC angle; Subjective symptom relief, Pain (VAS), Functional measures | Significant improvement of CC angle in all pts (Median 38° → 18°), 4 of 6 patients reported pain relief and increased gait speed and stride | None |
| Jabbari, 2022 [20] | 3 | Rectus abdominis and external oblique bilaterally | onaA | 200 per side into rectus abdominis; 150 per side into external oblique | Abdominal Pain measured by VAS; Improvement of posture measured by CC angle, treatment combined with physiotherapy | Significant improvement of CC angle in all 3; Significant pain improvement in one: VAS score dropped from 8 to 2 | None |
| De Monte et al, 2026 [21] | 1 | Rectus abdominis (bilateral) External oblique (bilateral) | onaA | Rectus abdominis: 30 per side; External oblique: 50 per side | UMSARS Part II; Timed Up and Go; 10-Meter Walk Test; Wearable sensor gait analysis; EMG; Static posturography | Posture score, walking velocity, and step length all improved. BoNT treatment was superior to spinal stimulation. | None |
[i] CC: Camptocormia; OnaA: onabutulinumtoxinA (Botox); aboA: abobotulinumtoxinA (dysport); GAS: goal attainment scaling; VAS: Visual Analogue Scale; UPDRS: Unified Parkinson Disease Rating Scale; UMSRS: Unified Multiple System Atrophy Rating Scale.
Figure 1
Points of botulinum neurotoxin (botox) injection into the rectus abdominis and external oblique muscles in a 46 years-old, muscular man with several years of severe camptocormia [20]. Injections were bilateral, 40units/point for RA and 30 units/point for EO. Drawing curtesy of Damoun Safarpour, M.D.