Pisa syndrome in Parkinson's disease: diagnostic and management challenges

Figures & data

Table 1 Causes of Pisa syndrome

Drugs

Antipsychotics (typical and atypical)

Tricyclic antidepressants

Selective serotonin reuptake inhibitors

Antiemetics

Lithium

Benzodiazepines

Cholinesterase inhibitors

Valproic acid

Levodopa combinations (eg, levodopa/carbidopa, levodopa/benserazide,

levodopa/carbidopa/entacapone)

Ergot derivative–pergolide

Nonergot derivatives–pramipexole and ropinirole

Monoamine oxidase-B inhibitor–rasagiline

Neurodegenerative diseases

Parkinson’s disease

Multiple system atrophy

Progressive supranuclear palsy

Huntington’s disease

Alzheimer’s disease

Lewy body dementia

Other

Normotensive hydrocephalus

Subdural hematoma

Subacute sclerosing panencephalitis

Idiopathic form

Figure 1 Pathophysiological mechanisms responsible for development of Pisa syndrome in Parkinson’s disease.

Figure 2 Treatment algorithm for Pisa syndrome in Parkinson’s disease.

Abbreviations: PS, Pisa syndrome; PD, Parkinson’s disease; DBS, deep brain stimulation.