Article type: Literature Review
Article title: Pisa Syndrome Secondary to Drugs: A Scope Review
Journal: Geriatrics
Year: 2024
Authors: Jamir Pitton Rissardo, Nilofar Murtaza Vora, Naseeb Danaf, Saivignesh Ramesh, Sanobar Shariff, and Ana LetÃcia Fornari Caprara
E-mail: jamirrissardo@gmail.com
ABSTRACT
Background: Pisa syndrome, also known as pleurothotonus, is a neurological condition characterized by more than ten degrees of constant lateral curvature of the spine when upright. In this way, the present manuscript aims to systematically review Pisa syndrome secondary to drugs. Methods: Two reviewers identified and assessed relevant reports in six databases without language restriction between January 1990 and June 2024. Results: The prevalence of Pisa syndrome varied from 0.037 to 9.3%. We found 109 articles containing 191 cases of drug-induced Pisa syndrome reported in the literature. The mean and median ages were 59.70 (SD = 19.02) and 67 (range = 12–98 years). The most prevalent sex was female, 56.91% (107/188). The most frequent medications associated with Pisa syndrome were acetylcholinesterase inhibitors in 87 individuals. Of 112 individuals in which the onset time from the medication to the movement disorder occurrence was reported, 59 took place within a month. In this way, a return to baseline was observed in 45.50% of the cases, and partial recovery was observed in 14.28%. Conclusion: We proposed new diagnostic criteria for Pisa syndrome based on previous findings in the literature. Moreover, multiple mechanisms are probably involved in balance control and the development of lateral trunk flexions.
Keywords: pisa syndrome; pleurothotonus; dystonia; tardive dyskinesia; extrapyramidal symptom; drug induced; movement disorder
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DOI
Citation
Pitton Rissardo J, Murtaza Vora N, Danaf N, Ramesh S, Shariff S, Fornari Caprara AL. Pisa Syndrome Secondary to Drugs: A Scope Review. Geriatrics. 2024; 9(4):100.
Figure 1. Pisa syndrome is characterized by more than ten degrees of constant lateral curvature of the spine when upright, without any evident rotation of the spinal bones, resembling the posture of the Leaning Tower of Pisa.
Figure 2. Flowchart of the screening process.
Figure 3. Pathophysiology of drug-induced Pisa syndrome. The motor function is represented, and possible hypotheses from the literature regarding specific structures of this pathway are referenced. Abbreviations: ACh, acetylcholine; DA, dopamine; Gaba, Gamma-aminobutyric acid; GLU, glutamate.
Figure 4. Clinical management of drug-induced Pisa syndrome based on the clinical assessment of the symptom’s severity.
Table 1. FreeText and MeSH search terms in the US National Library of Medicine.
Table 2. Prevalence of drug-induced Pisa syndrome in different studies.
Table 3. Literature review of the cases of Pisa syndrome secondary to drugs.
Table 4. Drug-induced Pisa syndrome, according to the drug classes.
Table 6. The time between movement disorder onset and recovery of different classes of drugs associated with Pisa syndrome.