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<p>Dystonia (specially Pisa syndrome) is an infrequent adverse effect of anticholinesterase drugs. We report a patient who develop an acute dystonic reaction after treatment with rivastigmine and a narrative review of the previous literature regarding this issue. Anticholinesterase drugs can produce both acute dystonic reactions and tardive dystonia (some begin up to 4 years after the start of treatment). The drug most frequently implicated was donepezil. Slightly more than a third of cases had concomitant treatment with antipsychotics. The most common type of dystonia induced by these drugs is Pisa syndrome, followed by cervical dystonia. Most dystonic episodes caused by anticholinesterases resolve after drug withdrawal. Although the pathophysiology is not well understood, the most plausible hypothesis suggested is its relationship with an acetylcholine/dopamine imbalance.</p>

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Dystonia induced by anticholinesterase drugs: case report and literature review

  • 期刊论文

  • 发表日期：

    2026年3月30日

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  • Hortensia Alonso-Navarro,
  • Silvina Espada-Rubio,
  • Miguel Ángel Martín-Gómez,
  • Paula Salgado-Cámara,
  • Margarita Arroyo-Solera,
  • Alba Cárcamo Fonfría,
  • Félix Javier Jiménez-Jiménez

摘要

Dystonia (specially Pisa syndrome) is an infrequent adverse effect of anticholinesterase drugs. We report a patient who develop an acute dystonic reaction after treatment with rivastigmine and a narrative review of the previous literature regarding this issue. Anticholinesterase drugs can produce both acute dystonic reactions and tardive dystonia (some begin up to 4 years after the start of treatment). The drug most frequently implicated was donepezil. Slightly more than a third of cases had concomitant treatment with antipsychotics. The most common type of dystonia induced by these drugs is Pisa syndrome, followed by cervical dystonia. Most dystonic episodes caused by anticholinesterases resolve after drug withdrawal. Although the pathophysiology is not well understood, the most plausible hypothesis suggested is its relationship with an acetylcholine/dopamine imbalance.