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Axial postural abnormalities (APAs), characterized by their frequency, disabling nature, and resistance to pharmacological treatments, significantly impact Parkinson's disease and atypical Parkinsonism patients. Despite advancements in diagnosing, assessing, and understanding their pathophysiology, managing these complications remains a significant challenge. Often underestimated by healthcare professionals, these disturbances can exacerbate disability. This systematic review assesses botulinum toxin treatments' effectiveness, alone and with rehabilitation, in addressing APAs in Parkinson's disease, utilizing MEDLINE (PubMed), Web of Science, and SCOPUS databases for source material. Of the 1087 records retrieved, 16 met the selection criteria. Most research has focused on botulinum toxin (BoNT) as the primary treatment for camptocormia and Pisa syndrome, utilizing mostly observational methods. Despite dose and injection site variations, a common strategy was using electromyography-guided injections, occasionally enhanced with ultrasound. Patients with Pisa syndrome notably saw consistent improvements in APAs and pain. However, studies on the combined effects of botulinum toxin and rehabilitation are limited, and antecollis is significantly under-researched. These findings recommend precise BoNT injections into hyperactive muscles in well-selected patients by skilled clinicians, avoiding compensatory muscles, and underscore the necessity of early rehabilitation. Rehabilitation is crucial in a multidisciplinary approach to managing APAs, highlighting the importance of a multidisciplinary team of experts.

Camptocormia is defined as an involuntary axial postural distortion of >45° flexion which occurs in the upright position, increases whilst walking and resolves when supine (Ashour and Jankovic, 2006). Unlike orthopaedic or age related kyphosis it is not a fixed structural deformity and produces kyphosis at predominantly lumbar and thoracic rather than cervical regions. Camptocormia has been reported due to a wide range of neurologic, psychiatric, muscular and orthopaedic conditions as well as rare reports of its emergence following the initiation of a number of medications (Finsterer and Strobl, 2010). Parkinson's disease (PD) includes prominent motor features of bradykinesia, rigidity and reduced postural balance responses in all those affected with this disease, but can also cause a range of other motor and non-motor features. Camptocormia is reported in a minority of patients with PD, and it is usually associated with longer disease duration and greater disease burden (Tiple et al., 2009). The aetiology of camptocormia in PD is debated, and responses to treatment have been generally poor and variable between studies. Recent studies have suggested the use of botulinum toxin may improve posture in some affected individuals., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Parkinson's disease (PD) is the most frequent among a broad spectrum of neurologic etiologies of саmptocormia. Camptocormia (CC) is characterized by an abnormal posture with involuntary forward flexion of the trunk, which appears in erect position, increases during prolonged standing or walking, and abates in supine position. CC leads to malposition, increasing postural instability and risk of falling. Treatment of CC in PD includes adjustment of antiparkinsonian medication, injections of botulinum toxin and orthopedical interventions. In this study, CC occurred in sitting position in 62.9% patients and in vertical position in 30% patients, however it disappeared in all patients in a dorsal position. CC was observed throughout the day in 77.1% patients. In 78.6% of PD patients with CC, the pose changed and encouraged with the various factors including weariness and stress; 37.1% patients used a walking stick; 5.7% used a walking aid. CC was accompanied with the painful syndrome in the majority of patients (88.6%). Moreover, 66% of patients had a history of vertebrogenic disorders. The association between CC and the start of dopaminergic treatment was found in 25.7% of patients.