Pramipexole, posture, Pisa syndrome

My wife suddenly developed a severe and painful stoop forwards and towards her more Parkinson’s-affected side, less than 2 years after diagnosis. It was two months before she was seen by her Parkinson’s specialist (who said it was Pisa syndrome) and I had chanced upon papers online describing a small number of cases where this had appeared as a side effect of dopamine agonists such as Pramipexole, possibly reversible if caught in time. Three months had passed from the postural change to the time the specialist had been persuaded and the drug had been reduced and stopped. The pain has largely gone, but her posture has not recovered.

Neither the drug company (Teva) package leaflet, the NHS Health A-Z website nor NICE guidelines mention this danger. Our GP and the Parkinson’s specialist seem both to have been unaware of it. And yet US websites Medline Plus, WebMDRxList,, Healthline & emedicinehealth, as well as Australian site News Medical all emphasize this postural change while taking Pramipexole as something requiring immediate medical attention.

Today an x-ray showed a compressive fracture in one of my wife’s vertebrae, probably a result of osteoporosis. So this is a more likely cause of the postural change than a drug side effect.

Still the fact remains that many foreign information sources warn about this possible risk while UK ones do not.

Hello, I too am on pramipexole, the parkinson’s consultant I saw said I have a stoop, but I Don,‘t notice anything different as to the way I walk, I’ ll ask my wife to watch me walk in the future, then I can raise the issue with my consultant about pramipexole and people getting a stoop, bye.

I too take pramipexole and recently noticed it mentioned the stoop etc in the leaflet in with the tablets. I have Camptocormia which it states can be a problem when taking pramipexole. I mentioned my stoop to the Neurologist last time I saw him and he said Botox injections would have helped in the earlier stages but it is far to late now. By the way when I brought this subject up with another Neurologist , he told me the symptoms I had were nothing to do with PD and promptly filed my notes away so I never saw anyone for around 6/7 years. Nice one……… I have had PD since 2007 and can cope with my other symptoms. Although have recently started with ‘warm glows’ which I am told is a side affect of my pills will bring that up on m next visit.

Hi @raynerpitt - sorry to hear you and your wife are going through this. I was wondering which countries you were speaking of when mentioning the “many foreign information sources”? My mother has severe camptocormia (bent spine syndrome) as well as pronounced Pisa syndrome and I feel like everyone (incl. her treating neurologist and PD nurse, and physiotherapist) have sort of accepted these developments as inevitable, which I struggle to accept.

Hi Fridainthesky, Perhaps I should have said ‘some’ rather than ‘many’; I found these warnings online on US and Australian medication notes as mentioned above. And the possible link between Pisa syndrome and this class of drugs seems to have been suggested in work from Japan and quoted in various publications, including some from UK. If it is a real effect I guess it must be pretty uncommon. (Of course there are lots of papers on PD and posture, as a keyword search will show.) Anyway I hope things are going well for your mother and her carers.

Thank you for the clarification @raynerpitt. I guess I’ve read academic articles stating the link between the pisa syndrome and Parkinson’s meds but not so much about camptocornia.