Olanzapine is one of the second-generation "atypical" anti-psychotic drugs, with fewer extra-pyramidal side-effects than conventional anti-psychotics, increasingly used as first line therapy for schizophrenia and delusional disorders [
5]. Olanzapine has also been indicated for the treatment of bipolar disorder. Olanzapine has been held responsible for neuroleptic malignant syndrome, rhabdomyolysis or elevation of serum creatine kinase, and overdose of olanzapine is associated with acute muscle toxicity [
6‐
8]. In our case, there is a high index of suspicion for the accountability of olanzapine in muscle damage. Based on previous reported cases, temporal connection between exposure to the drug and onset of symptoms, evidence for paraspinal muscle damage on MRI, favorable outcome after discontinuation of the drug, and lack of alternative explanation, we believe that rhabdomyolisis leading to camptocormia was probably induced by olanzapine in our patient [
7]. A long term side-effect of haloperidol is less probable as this treatment was provided during ten years without problem. Neuroleptic malignant syndrome may be evoked but neither hyperthermia nor cognitive changes were observed. The combination of haloperidol and olanzapine muscle toxicity may also be discussed.
It is thus debatable whether camptocormia relates mainly to a dystonic disorder connected to Parkinson disease, or to a primary neuromuscular disorder [
2]. The "muscle theory" of camptocormia has mainly been developed in Europe, and there is evidence that, at least in some cases, camptocormia relates to a primary neuromuscular disorder [
1,
3]. This is supported by muscle changes on computed tomography scans or spinal MRI, myopathic changes with fatty degeneration in biopsy specimens and electromyograms of the paraspinal muscles. In selected cases some improvement with steroid treatment can be observed. Camptocormia may be associated with a variety of neuromuscular disorders, such as amyotrophic lateral sclerosis, focal myopathy, inflammatory myositis including inclusion body myositis, and some other heterogeneous muscular conditions [
2,
3,
9‐
12]. Laroche
et al. (1995), basing their studies on a series of 27 patients, argued that camptocormia in older adults relates mainly to a genetically transmitted condition of muscular dystrophy or myopathy restricted to the spinal muscles [
9]. However, the "central" and "peripheral" concepts of the pathogenesis of camptocormia do not necessarily contradict, as atrophy of the paraspinal muscles might be secondary to a prior action dystonia of the spine, as some recent studies have suggested [
13]. Selected case reports and series indicate that both central (dysfunction in basal ganglia) and peripheral (muscle pathology) may coexist in patients with camptocormia [
10,
13‐
15].