Effectiveness of Anticholinergics and Neuroleptic Dose Reduction on Neuroleptic-Induced Pleurothotonus (the Pisa Syndrome)

Suzuki, Tomohiko; Hori, Takafumi; Baba, Atsuomi; Abe, Shuzo; Shiraishi, Hiroyasu; Moroji, T; Piletz, John E.

doi:10.1097/00004714-199906000-00017

Cited by 28 publications

(19 citation statements)

References 16 publications

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“…Suzuki et al [12] studied the clinical characteristics of 24 patients with drug-induced Pisa syndrome, which included responders and nonresponders to anticholinergic drugs. However, no significant differences in gender, age, psychiatric diagnosis, direction of extrapyramidal symptoms, or organic brain changes were noted between the responders and nonresponders.…”

Section: Pisa Syndromementioning

confidence: 99%

Lateral flexion in Parkinson’s disease and Pisa syndrome

Yokochi

2006

J Neurol

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Various types of abnormal posture are observed in Parkinson's disease (PD). Lateral flexion is very common and frequent among them. The clinical characteristics of lateral flexion in PD vary and are classified into two types, the chronic and subchronic types. The chronic type of lateral flexion in PD appears subclinically and worsens, which is related to the laterality of parkinsonian symptoms and the progression of the disease. The subchronic type of lateral flexion in PD develops subacutely and worsens rapidly in several months. An atypical and rare type of tonic truncal dystonia, Pisa syndrome, may be induced following the intake of neuroleptics. The clinical features of the subchronic type of lateral flexion in PD are similar to those of Pisa syndrome. Differences between lateral flexion in PD and Pisa syndrome are described.

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Section: Pisa Syndromementioning

confidence: 99%

Lateral flexion in Parkinson’s disease and Pisa syndrome

Yokochi

2006

J Neurol

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“…41 The latter patients have been associated with recent exposure to antipsychotics and benefited the most from anticholinergic treatment when compared with those with chronic exposure whose onset of the syndrome is insidious and less responsive to anticholinergic treatment. 3,42,43 This has led some authors to suggest classifying PS as acute and with tardive forms. 44 Because of the clear improvement in patients in whom the PS develops subacutely, the time of evolution should be taken into account for PS management.…”

Section: Clinical Manifestationsmentioning

confidence: 99%

“…54 Anticholinergics have been effective mainly in patients with an acute onset of the syndrome after a brief exposure to antipsychotics, whereas in those with an insidious onset after prolonged exposure, the response has been less satisfactory. 3,42,43 Bonanni et al 39 performed a crossover clinical trial with botulinum toxin A or placebo in paraspinal muscles of 9 patients with levodopa responding to parkinsonism and PS. Six of them showed an improvement of between 50% and 87.5% of the lateral flexion and an average of 4 points on the disability scale trunk dystonia.…”

Section: Treatmentmentioning

confidence: 99%

Pisa Syndrome

Michel¹,

Oscar²,

Correa³

et al. 2015

Clinical Neuropharmacology

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Lateral trunk flexion is often seen in patients with Parkinson disease, sometimes coming on as a subacute phenomenon associated with medication adjustments, and in others with gradual onset that seems related to a neurodegenerative process related to the evolution of the disease.Either acute or subacute presentations seem to be pure abnormalities in the coronal plane and are usually reversible. However, a chronic form occurs often in a combined fashion with anteroposterior flexion (camptocormia), improves only partially, remains stable, or even worsens over time.The acute/subacute phenotype is the condition originally named as Pisa syndrome (PS).The pathophysiology of PS remains poorly understood, and a cholinergic-dopaminergic imbalance has been suggested as being involved in the cause of this disorder. The role of other neurotransmitters and how they become dysfunctional in PS remains to be elucidated.Specific treatments, other than discontinuing the medications responsible for the disorder, whenever possible, are undeveloped because of the unknown etiology.

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“…Ursprünglich handelt es sich jedoch um eine Symptomatik, die durch Psychopharmaka hervorgerufen wird. Es wurde unter anderem über Medikamente aus bekannten Substanzgruppen wie den typischen und atypischen Antipsychotika, den trizyklischen Antidepressiva und den selektiven Serotonin-Wiederaufnahmehemmern berichtet [7,[16][17][18][19][20]. Auch sind Fälle durch Cholinesterase-Inhibitoren (Medikamente gegen Morbus Alzheimer), Antiemetika oder ohne vorherige Medikation beschrieben (idiopathisches Pisa-Syndrom) [21,22].…”

Section: Pisa-syndromunclassified

“…Oftmals ist bereits das Absetzen der Psychopharmaka bei der Behandlung erfolgreich. Ein Teil der Patienten spricht auf Anticholinergika an [19]. In Fallbeschreibungen waren akut aufgetretene Hemidystonien mit Laterocollis verursacht durch Clozapin nach Absetzen völlig regredient [18].…”

Section: Pisa-syndromunclassified

Komplikationsanalyse von spinalen Eingriffen bei adulten zentralen Bewegungsstörungen und Skoliosen

et al. 2013

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In patients suffering from Parkinson's disease, even minor surgical interventions can lead to instability of whole spine segments or even the entire spine. Implant loosening, adjacent segment instability, general perioperative complications, and progressive malposture due to disease progress can bring forth disastrous treatment courses. Spinal fixation should be performed long-segmented in combination with ventral stabilisation. Due to osteoporosis, pedicle screw cement augmentation is recommended in this collective. If the diagnosis of Pisa syndrome is established, an optimised preoperative preparation should be initiated in close cooperation with neurologists. In many cases medical therapy is sufficient and surgical interventions can be avoided.

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Effectiveness of Anticholinergics and Neuroleptic Dose Reduction on Neuroleptic-Induced Pleurothotonus (the Pisa Syndrome)

Cited by 28 publications

References 16 publications

Lateral flexion in Parkinson’s disease and Pisa syndrome

Lateral flexion in Parkinson’s disease and Pisa syndrome

Pisa Syndrome

Komplikationsanalyse von spinalen Eingriffen bei adulten zentralen Bewegungsstörungen und Skoliosen

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