Department of Pharmacy, Center for Behavioral Medicine, Kansas City, MO.
Ann Pharmacother. 2013 Sep;47(9):1223-8. doi: 10.1177/1060028013503132.
To report a case of risperidone-induced Pisa syndrome in a patient with multiple sclerosis (MS) that resolved with lurasidone, recurred with chlorpromazine, and was complicated by possible drug-drug interactions.
A 31-year-old white male with MS developed Pisa syndrome after years of treatment with risperidone at varying doses for behavioral symptoms associated with pervasive developmental disorder. The patient experienced improvement in symptoms after treatment was switched to lurasidone; however, due to psychiatric decompensation, a switch to chlorpromazine was made and Pisa syndrome recurred. To maintain control of the patient's behavioral symptoms, chlorpromazine was not discontinued.
Pisa syndrome is a rare adverse drug reaction induced most often by neuroleptic medications. The reaction is characterized by dystonia affecting cervical and lumbar musculature, resulting in flexion of the head and body to one side with axial rotation of the trunk. The etiology is believed to involve a dopaminergic-cholinergic imbalance. Most practitioners are not familiar with this syndrome, and it has not been reported previously in a patient with MS. Definitive diagnostic criteria and treatment have not been established. We identified 15 case reports involving risperidone, paliperidone, chlorpromazine, clomipramine, or valproic acid. The time to development of Pisa syndrome, patient demographics, dosing and titration of causative medications, approach to treatment, and resolution of Pisa syndrome varied widely in these reports. Dystonia in MS often presents differently than Pisa syndrome. The Naranjo probability scale indicated a probable relationship between either risperidone or chlorpromazine in each instance of Pisa syndrome in our patient.
Pisa syndrome is a rare adverse drug reaction associated with neuroleptic medications. Our report highlights the importance of identifying this uncommon type of dystonia in order to consider modification of the medication regimen when appropriate.
报告 1 例多发性硬化症（MS）患者因利培酮引起的 Pisa 综合征，该综合征经氯丙嗪治疗后复发，并可能发生药物相互作用。
1 名 31 岁白人男性，因广泛发育障碍相关行为症状，在服用不同剂量利培酮数年后面临 Pisa 综合征。改用鲁拉西酮治疗后，患者症状改善；然而，由于精神科病情恶化，改用氯丙嗪后， Pisa 综合征再次出现。为了控制患者的行为症状，未停用氯丙嗪。
Pisa 综合征是一种罕见的药物不良反应，最常由神经安定药引起。该反应的特征是影响颈肌和腰肌的张力障碍，导致头部和身体向一侧弯曲，脊柱轴向旋转。其病因被认为与多巴胺-胆碱能失衡有关。大多数医生对此综合征并不熟悉，且以前在 MS 患者中也未报道过。目前尚未建立明确的诊断标准和治疗方法。我们共识别出 15 例涉及利培酮、帕利哌酮、氯丙嗪、氯米帕明或丙戊酸的病例报告。这些报告中，Pisa 综合征的发病时间、患者人口统计学特征、致病药物的剂量和滴定、治疗方法和 Pisa 综合征的缓解情况差异很大。MS 中的张力障碍与 Pisa 综合征的表现不同。Naranjo 概率量表表明，在我们患者的每例 Pisa 综合征中，利培酮或氯丙嗪均与该综合征具有可能的相关性。
Pisa 综合征是一种罕见的与神经安定药相关的药物不良反应。我们的报告强调了识别这种不常见类型的张力障碍的重要性，以便在适当情况下考虑修改药物治疗方案。
