Parkinson's Disease Bradykinesia, Forward Posture, and Drug-Induced Pisa Syndrome Alleviated With Traditional Japanese Acupuncture: A Case Report

Parkinson's disease (PD) is a common progressive neurodegenerative disease. The management of PD including Pisa syndrome (PS), a postural deformity in PD characterized by reversible lateral bending of the trunk on the side, is often challenging. Recently, acupuncture has been a recognized intervention for treating motor or non-motor symptoms in PD management. However, very few of these studies or cases have been reported from Japan. A 58-year-old man with a four-year history of PD (Hoehn and Yahr Scale: Stage 2) presented to the acupuncture department of our hospital with dysphasia, bradykinesia, forward posture, and newly appeared right-side bending of the trunk after he increased the dose of rotigotine delivered via skin patches six months earlier. There was no change in the right-sided bending of the trunk two months after the withdrawal of the dopaminergic agents. A traditional Japanese acupuncture and moxibustion treatment, Hokushin-kai, was started. According to the Oriental medical diagnosis, he was categorized with "liver depression," "kidney deficiency," and "dampness" patterns. The treatment was administered once a week, and only one or two needles were used. The acupoints, such as Ququan (LR8) or Houxi (SI3), were selected according to the Oriental medical diagnosis and the findings of the acupoint examination. At first, the Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) score was 34 points, and the Parkinson's Disease Questionnaire (PDQ-39) score was 42 points; the Cobb angle was 45°. After 10 weeks, he could walk smoothly and almost upright. MDS-UPDRS-3 and PDQ-39 scores improved to 12 points and 34 points, respectively, while the Cobb angle improved to 32°. Changes (improvements) in his gait and posture are shown in the videos included in this case report. We present a case of PD bradykinesia, forward posture, and drug-induced PS alleviated with traditional Japanese acupuncture. This case report suggests that acupuncture using this Japanese method would achieve similar efficacies to those achieved in conventional case reports or clinical trials, and it could be one of the optional treatments available for PD. Further studies, such as the long-term effect of acupuncture on PD patients or improved outcomes of PD patients with early-phase intervention, are required.