Pisa Syndrome

Michel, Sáenz Farret; Oscar, Arias Carrión; Correa, Thalia Estefania Sánchez; Alejandro, Pellene Luis; Micheli, Federico

doi:10.1097/wnf.0000000000000092

Cited by 22 publications

(10 citation statements)

References 60 publications

(69 reference statements)

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“…Because PD without Pisa syndrome also had deficiencies in postural verticality compared to healthy controls [ 132 , 136 - 138 ], mismatch between proprioception and vestibular gravitation in PD may alter subjective postural verticality, resulting in Pisa syndrome. Alternatively, asymmetry of the basal ganglia output, which is due to cholinergic-dopaminergic imbalance in the striatum [ 134 , 139 , 140 ] or disturbance of the pallidal output [ 141 , 142 ], may also elicit left-right disproportion of the thalamocortical processing of vestibular information.…”

Section: Higher-order Regulation Of Posture-gait Controlmentioning

confidence: 99%

Functional Neuroanatomy for Posture and Gait Control

Takakusaki¹

2017

JMD

633

545

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Here we argue functional neuroanatomy for posture-gait control. Multi-sensory information such as somatosensory, visual and vestibular sensation act on various areas of the brain so that adaptable posture-gait control can be achieved. Automatic process of gait, which is steady-state stepping movements associating with postural reflexes including headeye coordination accompanied by appropriate alignment of body segments and optimal level of postural muscle tone, is mediated by the descending pathways from the brainstem to the spinal cord. Particularly, reticulospinal pathways arising from the lateral part of the mesopontine tegmentum and spinal locomotor network contribute to this process. On the other hand, walking in unfamiliar circumstance requires cognitive process of postural control, which depends on knowledges of self-body, such as body schema and body motion in space. The cognitive information is produced at the temporoparietal association cortex, and is fundamental to sustention of vertical posture and construction of motor programs. The programs in the motor cortical areas run to execute anticipatory postural adjustment that is optimal for achievement of goal-directed movements. The basal ganglia and cerebellum may affect both the automatic and cognitive processes of posturegait control through reciprocal connections with the brainstem and cerebral cortex, respectively. Consequently, impairments in cognitive function by damages in the cerebral cortex, basal ganglia and cerebellum may disturb posture-gait control, resulting in falling.

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Section: Higher-order Regulation Of Posture-gait Controlmentioning

confidence: 99%

Functional Neuroanatomy for Posture and Gait Control

Takakusaki¹

2017

JMD

633

545

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“…According to the reviews, 1,14 for the treatment of PS, anticholinergics or stopping the offending drugs is a useful strategy. If antipsychotics must be maintained, clozapine may be an alternative 14 .…”

Section: Discussionmentioning

confidence: 99%

Brexpiprazole-Associated Pisa Syndrome (Pleurothotonus) in a Patient With Dementia

et al. 2022

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ObjectivesThe aims of the study were to report brexpiprazole-induced Pisa syndrome (PS) in a patient with Alzheimer disease and to discuss the pathophysiology and the treatment of PS.MethodsWe report a 71-year-old female patient with Alzheimer disease. After 2 months medication of brexpiprazole, she presented PS. By switching to quetiapine, the symptom was ameliorated; however, transient acute dystonia was occurred.ConclusionsDrug-induced PS may be associated with dopamine-acetylcholine imbalance. This imbalance causes the dysfunction of the cortex and basal ganglia and the dysfunction of sensory and somatosensory system. Stopping the offending drugs is a choice for the treatment of PS. This is the first report of PS-induced brexpiprazole.

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“…Alternatively, it is possible that asymmetry in pallidal output elicits an imbalance of the thalamocortical processing of vestibular graviception 114,115 . In any case, dysregulation of cholinergic actions at cortical and subcortical structures may exist in the background 7,111,116 …”

Section: Pathophysiological Mechanisms Of the Posture‐gait Disturbanc...mentioning

confidence: 99%

Neurophysiological mechanisms of gait disturbance in advanced Parkinson's disease patients

Takakusaki

Takahashi

Noguchi

et al. 2022

Neurology & Clinical Neurosc

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This review considers pathophysiological mechanisms of posture-gait disturbances in Parkinson's disease (PD). Clinical studies have shown that posture-gait disturbance attributes to the dysfunction of the whole neuraxis in addition to the musculoskeletal system. The cerebral cortex, basal ganglia (BG), cerebellum, brainstem, and spinal cord temporally and spatially integrate and coordinate multisensory feedback and efferent copies of the motor command. Therefore, the extensive repertoire of voluntary movements can be coupled with anticipatory and reactive postural adjustments to provide the framework for supporting and stabilizing the goal-directed gait activity. Redundancies in the system allow adaptation and compensation through reward-oriented and error-based learning processes implemented through the BG and cerebellar pathways, respectively.However, the impairment of these systems in PD may considerably compromise the capacity to adapt and lead to maladaptive changes impairing posture-gait control. When these impairments occur, the risk of falls can significantly increase, and interventions are required to reduce morbidity. The damage in dopamine (DA) neurons is the primary cause of PD. Insufficient DA supply in the striatum disturbs the operation of intrinsic networks in the BG. This also pathologically increases GABAergic BG output to the cerebral cortex and brainstem, resulting in functional disconnection of other structures from the BG. The disconnection makes PD patients disable to achieve habitually acquired automatized gait control. Moreover, Lewy body degeneration in most brain areas, particularly in cholinergic and other monoaminergic systems vulnerable to neurodegeneration, further disturbs posture-gait control and alters non-motor symptoms of PD.

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Pisa Syndrome

Cited by 22 publications

References 60 publications

Functional Neuroanatomy for Posture and Gait Control

Functional Neuroanatomy for Posture and Gait Control

Brexpiprazole-Associated Pisa Syndrome (Pleurothotonus) in a Patient With Dementia

Neurophysiological mechanisms of gait disturbance in advanced Parkinson's disease patients

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