PISA SYNDROME UNDER CLOZAPINE THERAPY

Neuroleptic therapy frequently induces undesirable extrapyramidal side effects. The Pisa syndrome is a rare extrapyramidal side effect cause d by neuroleptic treatment. Twisting and bending to one side of the up per thorax, the neck and the head are its typical symptoms. These symp toms mainly develop in elderly patients with a history of neuroleptic treatment. To our knowledge there have been no reports of Pisa syndrom e occuring during therapy with clozapine - an atypical neuroleptic dru g with no major extrapyramidal side effects. We report on 4 female pat ients suffering from a chronic schizophrenic and/or depressive conditi on and having been on a long-term neuroleptic treatment. These patient s developed a dystonia equivalent to the Pisa syndrome during an acute clozapine therapy. All four women had signs of marked brain atrophy, two of them also showing tardive dyskinesia already prior to the treat ment with clozapine. The etiology of the Pisa syndrome is discussed wi th respect to discontinuation of treatment with classic neuroleptics, coinciding with the beginning of the clozapine therapy, clinical pheno menology, history of medication, course of treatment, and results of c ranial computer tomography.