Parkinsonism-Hyperpyrexia Syndrome in Parkinson’s Disease

The Parkinsonism-Hyperpyrexia Syndrome

“…In addition, changes in peripheral and central sympathetic outflow and alteration in central serotonin metabolism have also been implicated [20]. A reduced CSF concentration of the dopamine metabolite homovanillic acid (HVA), which was attributed to abrupt medication withdrawal, has been found in PD patients who discontinue dopaminergic medications [21,22].…”

“…The patient becomes rigid, sometimes with tremor, and progresses to an immobile state [20] (see Table 1). Within 72-96 h, most patients develop pyrexia and a reduced conscious level, ranging from confusion to coma.…”

“…Patients often require high dependency or intensive care, with respiratory support and central venous pressure monitoring if necessary [20,26]. Supportive measures such as intravenous fluid replacement, anti-pyretics, and cooling blankets are recommended.…”

Endocopic approaches to the skull base

“…Reports of hyperthermia subsequent to atropine or hyoscine are very rare62; but physostigmine is an effective treatment, not only for delirium but also for the hyperthermia 62, 92. A number of authors have suggested that antimuscarinic drugs may be harmful in patients with NMS and that they should be ceased if NMS with hyperthermia is developing 7, 93–98…”

“…Many terms have been used for NMS‐like syndromes, and these have generally been considered very similar or the same as NMS, both in presentation and etiology 7, 8, 11, 111. The terms used include parkinsonism‐hyperpyrexia syndrome,7, 112 neuroleptic malignant‐like syndrome,113, 114 levodopa‐withdrawal hyperthermia, lethal hyperthermia,115 dopaminergic malignant syndrome,116 acute dopamine depletion syndrome,117 akinetic crisis,118 and acute akinesia,111 which leads back to Delay et al's original akinetic hypertonic syndrome. There is strong clinical evidence that multiple thermoregulatory control mechanisms are relevant in a large proportion of these cases, viz , the thermoregulatory effects of antipsychotic and antimuscarinic drugs (decreased heat dissipation), the APR (surgery and infection), and the dehydration/reduced cardiac output.…”