{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T02:43:59Z","timestamp":1780627439892,"version":"3.54.1"},"reference-count":53,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T00:00:00Z","timestamp":1762300800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T00:00:00Z","timestamp":1762300800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["movementdisorders.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Movement Disord Clin Pract"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Axial postural abnormalities (APAs) are common, disabling complications of Parkinson's disease (PD) with unclear pathophysiology. The presence of hyperactivity in multiple trunk muscles supports the use of botulinum toxin (BTA). However, its application is complex, due to the lack of standardized clinical and electrophysiological approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate BTA injections effectiveness using a clinical algorithm that integrates trunk angle severity and electromyography (EMG)\u2010detected muscle hyperactivity in patients with APAs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This is prospective, open\u2010label, pilot study. A novel decisional algorithm guided muscle selection, based on the bending degree and EMG findings. PD patients with different APAs underwent trunk angle measurement and EMG polygraphy of axial muscles in the standing position and during trunk activation. Primary outcome was the change in trunk misalignment measured before and one month after BTA injection. Secondary outcomes were the Clinical Global Impression of Change\u2010Improvement (CGI\u2010pain and CGI\u2010posture) and the Numeric Rating Scale (NRS) for pain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 52 PD patients, 20(38.5%) were eligible for treatment. At one\u2010month follow\u2010up, lateral trunk flexion (LTF) improved [LTF angle from 11.5 (CI 7.1\u201315.9) to 9.9, (CI 5.2\u201314.7)\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.013], while anterior trunk flexion (ATF) did not (thoracic fulcrum ATF from 41.4 to 40.6,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&gt;\u20090.05; lumbar fulcrum ATF from 25.7 to 24.5,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&gt;\u20090.05). CGI\u2010posture improved in 45% of cases, CGI\u2010pain improved in 50% of cases, and NRS decreased from 6.3 to 4.8 (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.010).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A clinical and neurophysiological algorithm integrating measures of trunk bending and EMG\u2010detected muscle hyperactivity can optimize BTA treatment for APAs in PD, improving motor\/ non\u2010motor outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/mdc3.70408","type":"journal-article","created":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T09:28:44Z","timestamp":1762334924000},"page":"985-995","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical Algorithm\u2010Guided Approach to Botulinum Toxin Type A Treatment for Axial Postural Abnormalities in Parkinson's Disease"],"prefix":"10.1002","volume":"13","author":[{"given":"Giacomo","family":"Argenziano","sequence":"first","affiliation":[{"name":"Neurology Unit, Neuromotor and Rehabilitation Department Azienda USL\u2010IRCCS Reggio Emilia  Reggio Emilia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanna","family":"Squintani","sequence":"additional","affiliation":[{"name":"Neurology and Neurophysiology Unit, Azienda Ospedaliera Universitaria Integrata  Verona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serena","family":"Camozzi","sequence":"additional","affiliation":[{"name":"Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences University of Verona  Verona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilaria","family":"Di Vico","sequence":"additional","affiliation":[{"name":"Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences University of Verona  Verona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0877-4807","authenticated-orcid":false,"given":"Marialuisa","family":"Gandolfi","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Biomedicine and Movement Sciences University of Verona  Verona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8579-3772","authenticated-orcid":false,"given":"Carlo Alberto","family":"Artusi","sequence":"additional","affiliation":[{"name":"Department of Neuroscience \u201cRita Levi Montalcini\u201d University of Turin  Turin Italy"},{"name":"Neurology 2 Unit, A.O.U. 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