Flexion dystonia

The extreme form of the motor syndrome is instructive, just as the extreme form of mental deficiency in cretinism is instructive because it produces an autistic state (implicating the limbic system). The severe form of motoric dysfunction (which does not necessarily run parallel to the mental dysfunction) is characterized by marked flexion dystonia and by release of "thalamic postures." These are obligatory and stereotyped... 

Pleurothotonus (Pisa syndrome) is a special form of tardive dystonia that involves tonic flexion of the trunk to one side accompanied by slight backward rotation, in the absence of other dystonic symptoms. However, it can also occur immediately after the administration of neuroleptic drugs (SED-13,123). Nine of twenty patients (mean age 40 years) who developed Pisa syndrome while taking neuroleptic drugs (mean duration 12 years) improved within 3 weeks of treatment with trihexyphenidyl 12 mg/day (330). Reduction or withdrawal of the daily dose of the neuroleptic drugs was beneficial to the remaining patients. 

Pisa syndrome, a tardive axial dystonia with flexion of the trunk towards one side, is a rare reaction that occurs during treatment with neuroleptic drugs (SED-14, 146 SEDA-24, 57). Two cases related to risperidone have been published. 

One patient with Huntington s disease developed both parkinsonism and Pisa syndrome secondary to valproic add [359 ]. Pisa syndrome is an uncommon type of truncal dystonia manifested by persistent lateral flexion of the trunk. 

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