Parkinsonism-hyperpyrexia Syndrome After Amantadine Withdrawal

Abstract

Introduction: Parkinsonism-hyperpyrexia syndrome (PHS) is a rare and potentially fatal complication of Parkinson disease (PD) characterized by a neuroleptic malignant-like syndrome due to abrupt discontinuation of antiparkinsonian medications. Case Report: A 79-year-old woman with late-stage PD presented at the hospital with neuropsychiatric and uncontrolled parkinsonian motor symptoms. Soon after the abrupt discontinuation of amantadine, the patient suddenly presented with global rigidity, global unresponsiveness, diaphoresis, tachycardia, recurrent hyperpyrexia, and a mildly elevated creatine kinase, which lead to the diagnosis of PHS. Amantadine was then reinitiated and her symptoms resolved within 10 days. Conclusions: Amantadine is an antiparkinsonian medication scarcely associated with PHS. The few reported cases are further summarized and discussed in this article. This case highlights the importance of early recognition of PHS, which may be caused by changes in other antiparkinson agents such as amantadine, and the need to slowly titrate such agents.

Amantadine withdrawal in a patient with spinocerebellar ataxia

“…Risk factors include advanced age, prolonged use of amantadine and underlying dementia 7. Most prior reports involved patients with Parkinson’s disease with or without cognitive impairment 5 7–13. Similar to NMS, AWS presents with fever, extrapyramidal symptoms, delirium and hallucinations.…”