Fatal Parkinsonism–hyperpyrexia syndrome in a Parkinson's disease patient while actively treated with deep brain stimulation

Factor, Stewart A.

doi:10.1002/mds.21172

Cited by 33 publications

(13 citation statements)

References 6 publications

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“…The importance of infection, intestinal absorption changes, and pre-menstrual state [16][17][18] is less certain. This syndrome has also been reported following bilateral subthalamic stimulation, during which there was a rapid reduction in antiparkinson medication dosage [19].…”

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confidence: 62%

The Parkinsonism-Hyperpyrexia Syndrome

2008

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The parkinsonism-hyperpyrexia syndrome (PHS) is a rare but potentially fatal complication seen in Parkinson's disease (PD) patients, most commonly following reduction or cessation of antiparkinson medications. Clinically it resembles neuroleptic malignant syndrome with rigidity, pyrexia, and reduced conscious level. There may be features of autonomic instability, and serum creatine kinase (CK) may be elevated. Complications of PHS include acute renal failure, aspiration pneumonia, deep venous thrombosis/pulmonary embolism, and disseminated intravascular coagulation (DIC). Management consists of dopaminergic drug replacement, supportive measures, and treatment of complications. The prognosis is improved with early recognition and management. Mortality of up to 4% has been reported, but an additional one-third of patients have permanent sequelae. Patients and physicians should be warned against sudden reduction in antiparkinson medications. PHS should always be considered in a patient with parkinsonism who presents with an acute deterioration in symptoms.

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confidence: 62%

The Parkinsonism-Hyperpyrexia Syndrome

2008

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“…Thus, withdrawal of antiparkinsonian drugs combined with further surgery is more likely to cause the complication than either factor alone. Until now, about 5 cases of PHS after DBS surgery have been documented; 3 of these cases occurred due to perioperative drug cessation [4,6,7], while, the other 2 cases occurred 6 and 8 days after antiparkinsonian drug dosages were reduced abruptly when the DBS system was activated [3,8]. In our case, the patient first experienced rapid reduction of antiparkinsonian drugs due to dyskinesia.…”

Section: Discussionmentioning

confidence: 66%

Parkinsonism-hyperpyrexia syndrome after withdrawal of antiparkinsonian drugs and deep brain stimulation surgery

Han

Meng

et al. 2017

Chin Neurosurg Jl

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Background: Parkinsonism-hyperpyrexia syndrome (PHS) is a rare but potentially fatal condition in patients with Parkinson's disease. Deep brain stimulation (DBS) is a widely used and efficacious treatment for advanced Parkinson's disease. Case presentation: Here, we report a case of PHS in a patient who first underwent withdrawal of antiparkinsonian medications and then bilateral subthalamic nucleus DBS. Conclusions: Patients should be advised to gradually decrease rather than suddenly stop antiparkinsonian medications when they must stop taking a medication and antiparkinsonian medications should be reintroduced as soon as possible after surgery.

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“…Linazasoro et al, 5 in 2004, were the first to the describe a case of PHS after DBS for advanced Parkinson disease. Factor, 6 in 2007, and Kim et al, 7 in 2010, also observed that the main symptoms were confusion, fever and worsening of rigidity accompanied by raised creatine kinase levels. Additionally, the present report highlights that dehydration and difficulty on oral intake and intestinal absorption of levodopa may worse the patient's symptoms.…”

Section: Discussionmentioning

confidence: 98%

“…Parkinsonism-hyperpyrexia syndrome (PHS) is an extremely rare clinical complication following bilateral DBS surgery, with only four cases previously reported in the English medical literature to date. [5][6][7][8] The aim of the present report is to describe the case of a 65 years-old man that evolved parkinsonism-hyperpyrexia syndrome (PHS) following DBS procedure for bilateral subthalamic nucleus (STN) after discontinuation of antiparkinsonian medications.…”

Section: Introductionmentioning

confidence: 99%