Session Information
Date: Wednesday, June 22, 2016
Session Title: Phenomenology and clinical assessment of movement disorders
Session Time: 12:00pm-1:30pm
Location: Exhibit Hall located in Hall B, Level 2
Objective: We report on a patient who presented a reversible Pisa syndrome without any dopaminergic treatment at onset and before diagnosis of Parkinson’s disease (PD).
Background: The term Pisa Syndrome is used to indicate a tonic lateral flexion of the trunk often associated with slight spinal rotation along the sagittal plane, described by Ekbom for the first time in 1972 in a group of patients on neuroleptic drugs. Pisa Syndrome has also been reported in idiopathic PD patients on dopaminergic drugs.
Methods: We described clinical manifestations and neuroimaging of a drug-naive PD patient who developed reversible Pisa syndrome and the response to dopaminergic treatment.
Results: A 81-year-old woman presented with a 1-year history of bilateral resting tremor, more evident to the right side, and contralateral rigidity and mild slowness with poverty of movement at left upper arm. At the neurological examination, she presented a moderate lateral flexion to the right side alleviated completely by passive mobilization or on lying supine, compatible with a diagnosis of Pisa syndrome. Although the lateral flexion of the trunk was evident, she had not insight about her postural disorder. A previous video, registered about a year before, did not showed evident lateral flexion of the trunk. Brain MRI was normal, while [123I]FP-CIT-SPECT showed a marked reduction of tracer uptake mainly involving the putamen of the right side. She was then treated initially with levodopa/benserazide (400/100 mg/day) with beneficial effects on motor rigidity and tremor, and satisfactory improvement of the lateral flexion of the trunk.
Conclusions: Pisa syndrome may be present at the onset of PD and in addition to cardinal motor symptoms, classically individuated at first examination. In this case, the same response to dopaminergic treatment and the clear asymmetry of dopaminergic denervation as showed in the brain [123I]FP-CIT-SPECT suggests a mechanism of dopaminergic unbalance as a probable key factor.
To cite this abstract in AMA style:
P. Solla, A. Cannas, M.M. Mascia, M. Mancino, D. Picciau, R. Farris, G. Orofino, L. Cugusi, L. Polizzi, F. Marrosu. Pisa syndrome in a drug-naive Parkinson’s disease patient [abstract]. Mov Disord. 2016; 31 (suppl 2). https://www.mdsabstracts.org/abstract/pisa-syndrome-in-a-drug-naive-parkinsons-disease-patient/. Accessed June 14, 2025.« Back to 2016 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/pisa-syndrome-in-a-drug-naive-parkinsons-disease-patient/