Ueda Akihiro, Komatsu Kenichi, Takahashi Makio
Department of Neurology, Kitano Hospital, Tazuke Kofukai Medical Research Institute.
Rinsho Shinkeigaku. 2023 Feb 25;63(2):85-91. doi: 10.5692/clinicalneurol.cn-001792. Epub 2023 Jan 31.
Patient 1, an 80-year-old woman with Alzheimer's disease, had been taking donepezil 5 mg for 2 years. Donepezil was increased to 10 mg, and 2 months later, the patient developed dropped head syndrome. MRI and needle EMG abnormality of the neck extensor muscles suggested focal myopathy, but the symptom disappeared within 2 months by discontinuing donepezil. Patient 2, a 78-year-old man with Lewy body dementia, had been taking levodopa and pramipexole (PPX). One month after tapering levodopa, donepezil 3 mg was introduced, and Pisa syndrome (bending of the trunk to the right anterior direction) developed 10 days later. Donepezil and PPX were discontinued and levodopa was increased. Within 5 months, his posture had almost recovered. Cholinesterase inhibitors can induce abnormal posture of the trunk, and clinicians should be aware of this uncommon but important side effect.
病例1，一名80岁患阿尔茨海默病的女性，服用5毫克多奈哌齐已2年。多奈哌齐剂量增至10毫克，2个月后，该患者出现垂头综合征。颈部伸肌的MRI和针极肌电图异常提示局灶性肌病，但通过停用多奈哌齐，症状在2个月内消失。病例2，一名78岁患路易体痴呆的男性，一直在服用左旋多巴和普拉克索（PPX）。在逐渐减少左旋多巴剂量1个月后，开始服用3毫克多奈哌齐，10天后出现比萨综合征（躯干向右前方弯曲）。停用多奈哌齐和PPX，并增加左旋多巴剂量。5个月内，他的姿势几乎恢复正常。胆碱酯酶抑制剂可诱发躯干异常姿势，临床医生应意识到这种罕见但重要的副作用。
