title: Cholinergic-dopaminergic imbalance in Pisa syndrome.
abstract: Pisa syndrome is a rare type of truncal dystonia. Its development is associated commonly with neuroleptic treatment, but there are rare idiopathic cases or those related to neurodegenerative disorders. Recently, an association between cholinesterase inhibitors and Pisa syndrome has been described. The authors report two patients, one with Alzheimer's disease treated with risperidone and another with Parkinson's disease who presented this kind of dystonia after donepezil initiation. In the first patient the condition resolved after discontinuation of risperidone, and in the second one the condition resolved when donepezil was withdrawn. In patients with pharmacologic or degenerative dopaminergic neurotransmission disorders, cholinergic excess may induce this peculiar type of dystonia.
authors.affiliation: Department of Neurology, Hospital Universitario Doce de Octubre, Madrid, Spain. avgalende@yahoo.es
authors.forename: Alberto
authors.initials: A
authors.lastname: Villarejo
authors.forename: Ana
authors.initials: A
authors.lastname: Camacho
authors.forename: Rocío
authors.initials: R
authors.lastname: García-Ramos
authors.forename: Teresa
authors.initials: T
authors.lastname: Moreno
authors.forename: Marta
authors.initials: M
authors.lastname: Penas
authors.forename: Raúl
authors.initials: R
authors.lastname: Juntas
authors.forename: Juan
authors.initials: J
authors.lastname: Ruiz
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000188:drug therapy; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use; D002800:Cholinesterase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D000077265:Donepezil; D004409:Dyskinesia, Drug-Induced / Q000209:etiology* / Q000503:physiopathology; D004421:Dystonia / Q000139:chemically induced* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007189:Indans / Q000009:adverse effects / Q000627:therapeutic use; D010300:Parkinson Disease / Q000188:drug therapy; D010880:Piperidines / Q000009:adverse effects / Q000627:therapeutic use; D018967:Risperidone / Q000009:adverse effects / Q000627:therapeutic use; D013577:Syndrome; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents; D002800:Cholinesterase Inhibitors; D007189:Indans; D010880:Piperidines; D000077265:Donepezil; D018967:Risperidone