The Parkinsonism-Hyperpyrexia Syndrome

Abstract

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.

Delayed Administration and Contraindicated Drugs Place Hospitalized Parkinson's Disease Patients at Risk; Doxorubicin Liposomal Mix-up; Avoid Mix-ups between Hydroxyprogesterone and Medroxyprogesterone

“…Serious reactions such as neuroleptic malignant-like syndrome can occur when antiparkinsonian medications are discontinued or the dose of levodopa has been reduced abruptly. 10 This can result in a high fever, sweating, unstable blood pressure, stupor, muscular rigidity, and autonomic dysfunctions, which can be life-threatening.…”

The Preoperative Neurological Evaluation

“…Abrupt cessation of levodopa has been associated with parkinsonismhyperpyrexia syndrome, which involves hyperpyrexia, dysautonomia, and increased creatine kinase. 121 To avoid this syndrome as well as the much more common debilitating ''off'' times, patients should be allowed to continue their levodopa medication up to the moment of the surgery. Levodopa should then be restarted as soon as possible after the surgery.…”

Parkinson’s disease in the acute hospital

“…13 It is usually precipitated by abrupt withdrawal or malabsorption of levodopa 14,15 but can arise secondary to triggers such as infection or anaemia. 16 The condition is characterised by a sustained unresponsiveness to dopamine or dopaminergic therapy which may last days to weeks and must not be interpreted as treatment failure.…”

“…As in NMS, dantrolene can be used to treat rigidity and hyperpyrexia (Fig 3). 13 Although not established treatments, iv steroids 17 and electroconvulsive therapy 18 have also been successfully used. Dopaminergic replacement therapy is the mainstay of treatment by nasogastric levodopa administration, continuous subcutaneous administration of the dopamine agonist apomorphine or a combination of both.…”