Pisa Syndrome Due to a Cholinesterase Inhibitor (Donepezil): A Case Report

Letter to the Editor

Sir: Ekbom et al. reported on 3 elderly women who exhibited tonic lateral flexion accompanied by slight rotation of the trunk that increased while they were walking. They considered this peculiar body posture to be a new type of dystonic reaction to antipsychotics and called it Pisa syndrome. Reports on the clinical characteristics of Pisa syndrome have been accumulating in the literature. Originally, the syndrome seemed to be exclusively a side effect of long-term neuroleptic medication. Although dopaminergic dysfunction has been implicated in this syndrome, the involvement of other neurotransmitters has also been suggested. We report development of Pisa syndrome in a patient taking a novel cholinesterase-inhibiting, cognition-enhancing agent, donepezil.