Geriatrics Gerontology & Palliative Nursing

Pisa syndrome is one of the abnormal postures. The term Pisa syndrome is defined as a lateral bending of a trunk. The mechanisms underlying Pisa syndrome have not been fully explained yet. It was originally considered as a consequence of treatment with antipsychotics which induce a cholinergic-dopaminergic imbalance. Subsequently, the term has been generally applied to trunk lateral deviation≥10°. Recently, it was reported that asymmetric functioning of basal ganglia could lead directly to asymmetric regulation of postural muscle tone related to a lateral deviation. We investigated the two schizophrenic patients. They developed Pisa syndrome while exposed to the long-term treatment with antipsychotics. In one case, 123I-FP-CIT dopamine transporter-single photon emission tomography imaging disclosed asymmetrical DAT uptake in the stiratum, which may be associated to asymmetric functioning of basal ganglia. Furthermore, it is possible that schizophrenic patients with Pisa syndrome developed the similar dysfunction of basal ganglia due to the exposure of long-term dopamine D2-receptor blockade. Because Pisa syndrome become irreversible condition in the advanced disease stages, early its recognition and the pharmacological adjustment especially the dosage of antipsychotic drugs should be important. Furthermore, postural deformities such as Pisa syndrome are frequent disabling complications of neurodegenerative diseases, especially Lewy body disease, frontotemporal dementia. The postural deformities have a multifactorial pathophysiology. Because the effects of levodopa treatment are limited, we have introduced botulinum toxin as therapeutic tool for the treatment of some neurological disorders. Botulinum toxin treatment resulted in significant improvement of the tension of muscles related to abnormal postures. We report these outcomes, including the pathogeny of Pisa syndrome and postural deformities this time.