Pisa syndrome

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. 

Suzuki T, Hori T, Baba A, Abe S, Shiraishi H, Moroji T, Piletz JE. Effectiveness of anticholinergics and neuroleptic dose reduction on neuroleptic-induced pleurothotonus (the Pisa syndrome). J Clin Psychopharmacol 1999 19(3) 277-80. 

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. 

Jagadheesan K, Nizamie SH. Risperidone-induced Pisa syndrome. Aust N Z J Psychiatry 2002 36(1) 144. 

Harada K, Sasaki N, Ikeda H, Nakano N, Ozawa H, Saito T. Risperidone-induced Pisa syndrome. J Clin Psychiatry 2002 63(2) 166. 

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. 

Salazar Z, Tschopp L, Calandra C, Micheli F. Pisa syndrome and parkinsonism secondary to valproic acid in Huntington s disease. Mov Disord 2008 23(16) 2430-1. 

Pisa syndrome Pisa syndrome (PS) involves abnormal posturing, witii flexion of the body and head to one side and axial rotation of the trunk. PS occurs rarely during treatment with typical or atypical antipsychotics. One case had been reported in association with quetiapine [44 ] but none with sertraline. A severe case of PS appearing after administration of sertraline and quetiapine has now been reported [45 ]. 

Pisa syndrome Mirtazapine was associated with the development of a case of PS following a single dose [82 ]. 

Walder A, Greil W, Baumann P. Drug-induced Pisa syndrome rmder quetiapine. Prog Neuropsychopharmacol Biol Psychiatry... 

Perrone V, Antoniazzi S, Carnovale C, Clementi E, Radice S, Ba G, et al. A case of Pisa syndrome during sertraline and quetiapine treatment. 

Mendez Guerrero A, Llamas S, Murcia FJ, Ruiz J. Acute Pisa syndrome after administration of a single dose of mirtazapine. CUn Neurophar-macol2013 36(4) 133-4. 

Nervous system A randomised, double-blind, crossover study of 12 healthy adults with risperidone demonstrated significant dose-dependent effects on balance control. This effect was observed at low doses with no clinically detectable extrapyramidal symptoms [249 -]. Pisa syndrome is a dystonia affecting cervical and lumbar musculature that has been reported with risperidone, paliperidone and chlorpromazine. A case is presented of a 31-year-old male with MS and FDD who developed Pisa syndrome after chronic risperidone treatment showed improvement with lurasidone, but recurrence with chlorpromazine [250 ]. Another case in a 23-year-old female with history of seizure due to periventricular focal nodular heterotopia occurring 12 months after risperidone treatment she was eventually managed on olanzapine and baclofen PSI ]. A case of persistent Parkinsonism in an 84-year-old male after 5 months of risperidone (2 mg per day) is reported [252 ]. Other dystonic phenomena reported with risperidone include dislocation of the temporomandibular joint [253 ]. 

Kaufmann A, Boesch S, Fleischhacker WW, Hofer A. Management of a risperidone-induced tardive Pisa syndrome a case report. J Clin Psychopharmacol 2012 32(3) 418-20. 

Reinertsen, A. M. (1975) The Pisa syndrome. Disturbance of posture in elderly patients as a side effect to treatment with neuroleptic drugs (Norwegian). T. Norske Laegeforen., 95, 1212. 

Fox Rl, Luppi M, Pisa P, Kang HL (1992) Potential role of Epstein-Barr virus in Sjogren s syndrome and rheumatoid arthritis. J Rheumatol, 19 18-24. 

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