Orientation in space and perception of earth-verticality in patients with Parkinson`s disease and Pisa syndrome.

在这项研究中，我们计划调查帕金森病（PD）和比萨综合征（PS）患者的空间定向。空间定向涉及视觉、躯体感觉和前庭系统。地球垂直度的感知可以通过确定主观视觉垂直（SVV）来研究。当向一侧倾斜>60°时，在正常受试者中诱导SVV倾斜（A效应）。垂直感改变也是眼倾斜反应（OTR）的标志，这是一种由内耳和内侧纵束（riMLF）之间的耳石通路病变引起的综合征。其特征在于SVV的偏差，头部倾斜，眼球扭转和偏斜偏差。PD包括知觉缺陷，包括视觉、前庭和本体感受信息处理。异常轴位也是PD的常见表现。一种这样的姿势障碍是PS，其特征在于脊柱的侧屈。初步结果显示PS患者的SVV倾斜。尚不清楚PS中的SVV倾斜是否是由于A效应（考虑到这些患者的内滚平面偏差）或由于原发性感知功能障碍所致。PS可能是耳石不平衡或riMLF不对称参与的表现吗？身体图式知觉和躯体感觉信息整合的改变是否将OTR的经典特征改变为身体侧向偏离？多巴胺能药物如何影响这些躯体感觉和知觉缺陷？我们计划在阿根廷布宜诺斯艾利斯Favaloro基金会神经科学研究所收集PD/PS人群的人口统计学和临床数据。将研究这些患者的OTR体征，并通过测定不同程度身体倾斜（有和无多巴胺能刺激）的SVV检查A效应，并与无PS的PD患者、非PS引起的侧偏PD患者和健康受试者进行比较。

With this study we plan to investigate orientation in space in patients with Parkinsons disease (PD) and Pisa syndrome (PS). Orientation in space involves the visual, somatosensory and vestibular system. Perception of earth-verticality can be investigated by determining the subjective visual vertical (SVV). SVV tilts are induced in normal subjects when tilted >60° to one side (A effect). Altered verticality perception is also the hallmark of the ocular tilt reaction (OTR), a syndrome caused by lesions of the otolithic pathway between the inner ear and the medial longitudinal fasciculus (riMLF). It is characterized by deviation of the SVV, head tilt, ocular torsion and skew deviation. PD encompasses perceptual deficits including visual, vestibular and proprioceptive information processing. Abnormal axial postures are also frequent findings in PD. One such disorder of posture is PS, characterized by lateral flexion of the spine. Preliminary results show an SVV tilt in PS patients. It is unknown if this SVV tilt in PS is due to the A-effect, given the inner roll-plane deviation of these patients or due to a primary perceptual dysfunction. Could PS be a manifestation of otolithic imbalance or of an asymmetric involvement of the riMLF? Do the alterations in perception of body schema and in the integration of somatosensory information change the OTR classic features to a body lateral deviation? How does dopaminergic medication affect these somatosensory and perceptual deficits? We plan to collect demographic and clinical data of the PD/PS population at the Institute of Neurosciences of the Favaloro Foundation, Buenos Aires, Argentina. These patients will be investigated for signs of an OTR, and the A-effect will be examined by determining the SVV in different degrees of body tilt (with and without dopaminergic stimulation) and compared to PD-patients without PS, PD-patients with lateral deviation not caused by PS, and healthy subjects.