Journal of Neurology

, Volume 253, Supplement 7, pp vii17–vii20 | Cite as

Lateral flexion in Parkinson’s disease and Pisa syndrome



Various types of abnormal posture are observed in Parkinson’s disease (PD). Lateral flexion is very common and frequent among them. The clinical characteristics of lateral flexion in PD vary and are classified into two types, the chronic and subchronic types. The chronic type of lateral flexion in PD appears subclinically and worsens, which is related to the laterality of parkinsonian symptoms and the progression of the disease. The subchronic type of lateral flexion in PD develops subacutely and worsens rapidly in several months. An atypical and rare type of tonic truncal dystonia, Pisa syndrome, may be induced following the intake of neuroleptics. The clinical features of the subchronic type of lateral flexion in PD are similar to those of Pisa syndrome. Differences between lateral flexion in PD and Pisa syndrome are described.

Key words

Parkinson’s disease lateral flexion posture Pisa syndrome dopamine agonist oblique sign 


  1. 1.
    Duvoisin RC, Marsden CD (1975) Note on the scoliosis of Parkinsonism. J Neurol Neurosurg Psychiatry 38(8):787–793PubMedGoogle Scholar
  2. 2.
    Marsden CD, Duvoisin R (1980) Scoliosis and Parkinson’s disease. Arch Neurol 37(4):253–254PubMedGoogle Scholar
  3. 3.
    Furukawa T (1986) The oblique signs of Parkinsonism. Neurol Med 25:11–13Google Scholar
  4. 4.
    Furukawa T, Okiyama R, Tsukagoshi H (1989) Oblique sign of Parkisonism. Clin Neurol 29:1603Google Scholar
  5. 5.
    Furukawa T (2001) Body schema. Neurol Med 54:472–478Google Scholar
  6. 6.
    DLee AC, Harris JP, Atkinson EA, Fowler MS (2001) Disruption of estimation of body-scaled aperture width in Hemiparkinson’s disease. Neuropsychologia 39(10):1097–1104CrossRefGoogle Scholar
  7. 7.
    DProctor F, Riklan M, Cooper IS et al. (1964) Judgment of visual and postural vertical by parkinsonian patients. Neurology 14:287–293Google Scholar
  8. 8.
    Ekbom K, Lindholm H, Ljungberg L (1972) New dystonic syndrome associated with butyrophenone therapy. Z Neurol 202(2):94–103PubMedCrossRefGoogle Scholar
  9. 9.
    Yassa R, Nastase C, Cvejic J et al. (1991) The Pisa syndrome (or pleurothotonus): prevalence in a psychogeriatric population. Biol Psychiatry 29(9):942–945PubMedCrossRefGoogle Scholar
  10. 10.
    Stubner S, Padberg F, Grohmann R et al. (2000) Pisa syndrome (pleurothotonus): report of a multicenter drug safety surveillance project. J Clin Psychiatry 61(8):569–574PubMedGoogle Scholar
  11. 11.
    Suzuki T, Matsuzaka H (2002) Druginduced Pisa syndrome (pleurothotonus): epidemiology and management. CNS Drugs 16(3):165–174PubMedCrossRefGoogle Scholar
  12. 12.
    Suzuki T, Hori T, Baba A et al. (1999) Effectiveness of anticholinergics and neuroleptic dose reduction on neuroleptic-induced pleurothotonus (the Pisa syndrome). J Clin Psychopharm 19(3):277–280CrossRefGoogle Scholar
  13. 13.
    Villarejo A, Camacho A, Garcia-Ramos R et al. (2003) Cholinergic-dopaminergic imbalance in Pisa syndrome. Clin Neuropharmacol 26(3):119–121PubMedCrossRefGoogle Scholar
  14. 14.
    Cannas A, Solla P, Floris G et al. (2005) Reversible Pisa syndrome in Parkinson’s disease during treatment with Pergolide: a case report. Clin Neuropharm 28(5):252CrossRefGoogle Scholar
  15. 15.
    Gambarin M, Antonini A, Moretto G et al. (2006) Pisa syndrome without neuroleptic exposure in a patient with Parkinson’s disease: case report. Mov Disord 21(2):270–273PubMedCrossRefGoogle Scholar
  16. 16.
    Herrera-Marschitz M, Utsumi H, Ungerstedt U (1990) Scoliosis in rats with experimentally-induced hemi-parkinsonism: dependence upon striatal dopamine denervation. J Neurol Neurosurg Psychiatry 53(1):39–43PubMedCrossRefGoogle Scholar

Copyright information

© Steinkopff-Verlag 2006

Authors and Affiliations

  1. 1.Department of NeurologyTokyo Metropolitan Neurological HospitalTokyo, 184-0032Japan

Personalised recommendations