Pisa Syndrome Secondary to Drugs: A Scope Review

Author:

Pitton Rissardo Jamir1ORCID,Murtaza Vora Nilofar2,Danaf Naseeb3ORCID,Ramesh Saivignesh2,Shariff Sanobar4ORCID,Fornari Caprara Ana Letícia1ORCID

Affiliation:

1. Neurology Department, Cooper University Hospital, Camden, NJ 08103, USA

2. Medicine Department, Terna Speciality Hospital and Research Centre, Navi Mumbai 400706, India

3. Medicine Department, Lebanese University, Hadath RGHC+4PR, Lebanon

4. Faculty of General Medicine, Yerevan State Medical University, Yerevan 0025, Armenia

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.

Publisher

MDPI AG

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