title: Reversible Valproate Induced Pisa Syndrome and Parkinsonism in a Neuro-Oncology Patient with Depression and Epilepsy.
abstract: Neurological and psychiatric conditions frequently overlap in neuro-oncology. This overlapping negatively affects patients' quality of life and decreases the ability of providers to manage specific symptoms by therapy modulation, especially when psychopharmacotherapy needs to be prescribed. We describe here a patient with recurrent brain tumor, symptomatic epilepsy and depression who developed Pisa syndrome and parkinsonism after several months of valproic acid use. An accurate recognition of symptoms and treatment side effect allowed an appropriate clinical approach so as to rapidly improve both movement disorder and depression without increasing the risk of developing seizure. This has improved the autonomy and quality of life in a patient with poor prognosis.
authors.affiliation: Department of Neuro-Oncology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Department of Psychiatry, Università degli Studi di Milano, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Botturi
authors.affiliation: Department of Neuro-Oncology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Silvani
authors.affiliation: Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy; Applied Research Unit for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Pravettoni
authors.affiliation: Department of Psychiatry, Università degli Studi di Milano, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Riccardo Augusto
authors.initials: RA
authors.lastname: Paoli
authors.affiliation: Department of Philosophy, Università degli Studi di Milano, Milan, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Lucchiari
keywords: Depression; Epilepsy; Neuro-oncology; Parkinsonism; Valproic acid