Past Issues

Objective: We report a case of Pisa syndrome (pleurothotonus) after administration of rivastigmine. Case Report: A 77-year-old man with dementia was treated with rivastigmine. Once titration of the daily dose reached 9 mg, he developed Pisa syndrome, an involuntary movement disorder. Pisa syndrome subsided after reducing the rivastigmine dosage. Conclusion: Pisa Syndrome related to cholinesterase inhibitors has been well discussed. The currently available cholinesterase inhibitors for dementia treatment can induce Pisa syndrome. The emergence and resolution of Pisa syndrome in our patient correlated with the dose of rivastigmine. Most patients recover from Pisa syndrome once the cholinesterase inhibitors are discontinued. Administration of the minimally effective dose and close monitoring for movement disorders among patients on cholinesterase inhibitor therapy is recommended.