Neuroleptic malignant syndrome-like, or—dopaminergic malignant syndrome—due to levodopa therapy withdrawal. Clinical features in 11 patients

Serrano‐Dueñas, Marcos

doi:10.1016/s1353-8020(02)00035-4

Cited by 55 publications

(33 citation statements)

References 14 publications

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“…However, 2 patients taking L-dopa and adjunct treatment omitted all of their medication for 72 hr, which is within the latency observed in patients developing the neuroleptic malignant syndrome. 19 It is well documented in many disease areas 1 as well as in Parkinson's disease 6 that adherence worsens as the number of doses per day increases, and we also found this in the present study. In particular, once daily drugs (e.g.…”

Section: Discussionsupporting

confidence: 86%

Adherence to antiparkinson medication in a multicenter European study

Grosset

Antonini²,

Canesi³

et al. 2009

Movement Disorders

155

139

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Two small studies reported suboptimal therapy adherence in Parkinson's disease. We conducted a larger multicenter European study to assess medicine-taking behavior. Parkinson's disease patients taking dopaminergic therapy were enrolled in 8 centers in 5 countries, and disease severity and demographics recorded. Antiparkinson drug adherence was measured for 4 weeks using electronic monitoring bottles which record the date and time of cap opening (Aardex, Switzerland). One hundred twelve patients, mean age 65 years (standard deviation (SD) 10), with Parkinson's disease for 7.7 (SD 8.2) years completed the study. Total median adherence (doses taken/doses prescribed) was 97.7% (interquartile range [IQ] 90.6-100), days adherence (correct dose days) was 86.2% (IQ 61.1-96.2) and timing adherence (doses taken at correct time intervals) was 24.4% (IQ 5.3-56.5). Fourteen patients (12.5%) took less than 80% of prescribed doses, which was defined as suboptimal adherence. Patients with satisfactory adherence took a median of 8 mg/day (IQ 0-33) less than their prescribed dose of levodopa (P = NS), while suboptimal adherence patients took a median of 481 mg/day (IQ 205-670) less than their prescribed dose (P = 0.0006). The Parkinson motor score was significantly higher in patients with suboptimal adherence at 29 (IQ 20-40), versus those with satisfactory adherence at 19 (IQ 13-26), P = 0.005. Once daily drugs had significantly better adherence when compared with drugs prescribed more frequently (P < 0.0001). Suboptimal therapy adherence is associated with significant deviation from prescribed levodopa doses, despite greater Parkinson's motor severity. Optimizing oral medication intake has a potential role in maximizing the therapy response in Parkinson's disease.

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Section: Discussionsupporting

confidence: 86%

Adherence to antiparkinson medication in a multicenter European study

Grosset

Antonini²,

Canesi³

et al. 2009

Movement Disorders

155

139

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“…A further series of 11 PD patients developed PHS following withdrawal of levodopa and other antiparkinson medications [24]. Patients had a mean disease duration of 9 years and developed symptoms of PHS on average 93 h following medication withdrawal.…”

Section: The Clinical Profilementioning

confidence: 99%

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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“…These symptoms may indeed indicate NMS or pre-NMS during PD. 6,7 The symptoms of NMS and malignant catatonia are indistinguishable. 8,9 Both are characterized by progressive hyperthermia, autonomic dysfunction, clouding of consciousness, in addition to the rigidity.…”

mentioning

confidence: 99%