Recurrent truncal dystonia (Pisa syndrome) due to donepezil — A case report

Mukku, Shiva Shanker Reddy; Achary, Umesh; Sivakumar, Palanimuthu T.; Varghese, Mathew

doi:10.1016/j.ajp.2018.05.003

Cited by 9 publications

(4 citation statements)

References 18 publications

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“…In most cases Pisa syndrome is reversible within a few days 21 to a few weeks, 20 as in our patient, of stopping treatment. Cases of partial improvement, 17 and non‐improvement, 24 even after stopping treatment, have been reported.…”

Section: Treatmentsupporting

confidence: 59%

“…The majority of patients with Pisa syndrome due to donepezil are female 15–20 . However, Pisa syndrome has been reported in male patients as well 17,21,22,23 . Concomitant use of antipsychotics increases the risk of Pisa syndrome 2,3,15,17 .…”

Section: Risk Factorsmentioning

confidence: 99%

“…[15][16][17][18][19][20] However, Pisa syndrome has been reported in male patients as well. 17,21,22,23 Concomitant use of antipsychotics increases the risk of Pisa syndrome. 2,3,15,17 Our patient had no history of antipsychotic treatment and was not on any other medication apart from donepezil, similar to other case reports of Pisa syndrome with donepezil.…”

Section: Risk Factorsmentioning

confidence: 99%

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Pisa syndrome secondary to donepezil

Waykar,

Jog,

Low

2023

Prog Neurol Psychiatry

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Pisa syndrome is characterised by a tonic flexion of the trunk to one side and a slight axial rotation in the sagittal plane. Recently more cases have been reported in Alzheimer's dementia and in patients treated with acetylcholinesterase inhibitor medication. Here the authors present a case of Pisa syndrome in an elderly lady treated with donepezil and highlight the importance of monitoring patients for side‐effects.

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Section: Treatmentsupporting

confidence: 59%

Section: Risk Factorsmentioning

confidence: 99%

Section: Risk Factorsmentioning

confidence: 99%

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Pisa syndrome secondary to donepezil

Waykar,

Jog,

Low

2023

Prog Neurol Psychiatry

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“…PS is observed in patients with neurodegenerative diseases, mainly Parkinson's disease [3]. PS is also considered as one of the rare types of tardive dystonias caused by drugs such as choline-esterase inhibitors (ChEIs) [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18], antipsychotics [19][20][21], antidepressants [22,23], lithium [24], and valproic acid [25]. However, the precise pathophysiology of PS has not yet been established.…”

Section: Introductionmentioning

confidence: 99%

Pisa syndrome induced by switching of a choline-esterase inhibitor treatment from donepezil to galantamine: a case report

et al. 2020

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Background: Pisa syndrome (PS) is characterized by an abnormally sustained posture, with flexion of the body and head to one side and slight rotation of the trunk. Although PS most commonly arises as an adverse effect of antipsychotic drugs, choline-esterase inhibitors (ChEIs) are also sometimes known to induce PS. Despite the fact that the precise mechanism remains unclear, cholinergic-dopaminergic imbalance has been considered as a possible pathophysiologic mechanism underlying the genesis of PS. Case presentation: We hereby report the case of a 60-year-old woman with Alzheimer's disease who presented with the signs of PS after her treatment was switched to galantamine, a type of ChEI, even though she had received donepezil, another type of ChEI, for 5 years without any complications. To the best of our knowledge, this is the first report of PS associated with treatment switch from one to another type of ChEI. Galantamine, but not other ChEIs, can enhance striatal dopamine release through allosteric modulation of the nicotinic acetylcholine receptor, and has weaker muscarinic effects than donepezil. Therefore, we propose two novel hypotheses to explain the development of PS, as follows; galantamine, which enhances dopamine release, can induce imbalance of dopamine levels in the striatum of patients with dementia, resulting in PS, and the weaker muscarinic effects of the drug could be one of the factors predisposing to the development of PS. Conclusion: The present case suggests that treatment with galantamine is associated with a higher risk of development of PS than that with other ChEIs, such as donepezil, despite the pharmacological profile of galantamine as a dopamine modulator. Also, this report provides novel insight into another plausible mechanism underlying the development of PS, besides cholinergic-dopaminergic imbalance, namely, dopamine imbalance in the striatum with muscarinic-nicotinic imbalance.

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Donepezil

2018

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Recurrent truncal dystonia (Pisa syndrome) due to donepezil — A case report

Cited by 9 publications

References 18 publications

Pisa syndrome secondary to donepezil

Pisa syndrome secondary to donepezil

Pisa syndrome induced by switching of a choline-esterase inhibitor treatment from donepezil to galantamine: a case report

Donepezil

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