1887
Volume 2023, Issue 4
  • ISSN: 0253-8253
  • EISSN: 2227-0426

Abstract

Background: Parkinsonism-hyperpyrexia syndrome (PHS) is a potentially life-threatening condition that occurs due to the abrupt withdrawal or significant dose reduction of antiparkinsonian medications. It presents similarly to neuroleptic malignant syndrome (NMS) and is characterized by severe rigidity, fever, autonomic instability, and altered mental status.

Case: A 62-year-old male with a 10-year history of Parkinson’s disease (PD) underwent laparoscopic mesh repair for a left-sided diaphragmatic and large hiatus hernia. His antiparkinsonian medications included levodopa/carbidopa, amantadine, pramipexole, and benzhexol. Medications were withheld as part of the nil per os (NPO) status. Postoperatively, he developed withdrawal features, including tremors, difficulty speaking, tachycardia, hypertension, fever, and sweating. PHS, resulting from the withdrawal of antiparkinsonian medications, was diagnosed. The patient was transferred to the intensive care unit (ICU), intubated, and his antiparkinsonian medications were reintroduced. The patient’s condition improved gradually, and he was discharged home on the 15th postoperative day.

Discussion: The abrupt discontinuation of antiparkinsonian medications precipitated PHS in our patient. Recognizing the clinical picture of PHS and differentiating it from other possible conditions, such as neuroleptic malignant syndrome and malignant hyperthermia, is pivotal. Management involves resuming medications and providing supportive care. Early recognition and prompt reintroduction of the antiparkinsonian medications are essential for the patient’s recovery.

Conclusion: PHS is a rare but potentially life-threatening condition that occurs due to the withdrawal of antiparkinsonian medications, leading to an acute hypodopaminergic state. Our case emphasizes the importance of careful perioperative management of antiparkinsonian medications and early recognition and management of withdrawal symptoms in patients with Parkinson’s disease undergoing surgery.

Loading

Article metrics loading...

/content/journals/10.5339/qmj.2023.34
2024-01-02
2024-07-17
Loading full text...

Full text loading...

/deliver/fulltext/qmj/2023/4/qmj.2023.34.html?itemId=/content/journals/10.5339/qmj.2023.34&mimeType=html&fmt=ahah

References

  1. Bandopadhyay R, Mishra N, Rana R, Kaur G, Ghoneim MM, Alshehri S, et al.. Molecular Mechanisms and Therapeutic Strategies for Levodopa-Induced Dyskinesia in Parkinson’s Disease: A Perspective Through Preclinical and Clinical Evidence. Front Pharmacol. 2022 Apr 7;13::805388. doi: 10.3389/fphar.2022.805388.
    [Google Scholar]
  2. Armstrong MJ, Okun MS. Diagnosis and Treatment of Parkinson Disease: A Review. JAMA. 2020 Feb 11;323:(6):548–60 . doi: 10.1001/jama.2019.22360.
    [Google Scholar]
  3. Grover S, Sathpathy A, Reddy SC, Mehta S, Sharma N. Parkinsonism-hyperpyrexia syndrome: A case report and review of literature. Indian J Psychiatry. 2018;60:(4):499–503 . doi: 10.4103/psychiatry.IndianJPsychiatry_113_18.
    [Google Scholar]
  4. Toru M, Matsuda O, Makiguchi K, Sugano K. Neuroleptic malignant syndrome-like state following a withdrawal of antiparkinsonian drugs. J Nerv Ment Dis. 1981 May;169:(5):324–7. doi: 10.1097/00005053-198105000-00011.
    [Google Scholar]
  5. Newman EJ, Grosset DG, Kennedy PGE. The parkinsonism-hyperpyrexia syndrome. Neurocrit Care. 2009;10:(1):136–40. doi: 10.1007/s12028-008-9125-4.
    [Google Scholar]
  6. Litman RS, Flood CD, Kaplan RF, Kim YL, Tobin JR. Postoperative Malignant Hyperthermia: An Analysis of Cases from the North American Malignant Hyperthermia Registry. Anesthesiology. 2008 Nov 1;109:(5):825–9. doi: 10.1097/ALN.0b013e31818958e5.
    [Google Scholar]
  7. Azar J, Jaber Y, Ayyad M, Abu Alia W, Owda F, Sharabati H, et al.. Parkinsonism-Hyperpyrexia Syndrome: A Case Series and Literature Review. Cureus. 2022 Sep;14:(9):e29646. doi: 10.7759/cureus.29646.
    [Google Scholar]
  8. Gurrera RJ, Caroff SN, Cohen A, Carroll BT, DeRoos F, Francis A, et al.. An international consensus study of neuroleptic malignant syndrome diagnostic criteria using the Delphi method. J Clin Psychiatry. 2011 Sep; 72:(9):1222–8. doi: 10.4088/JCP.10m06438.
    [Google Scholar]
  9. Oprea AD, Keshock MC, O’Glasser AY, Cummings KC, Edwards AF, Hunderfund AL, et al.. Preoperative Management of Medications for Neurologic Diseases: Society for Perioperative Assessment and Quality Improvement Consensus Statement. Mayo Clinic Proceedings. 2022 Feb 1;97:(2):375–96. doi: 10.1016/j.mayocp.2021.
    [Google Scholar]
  10. Fujii T, Nakabayashi T, Hashimoto S, Kuwano H. Successful perioperative management of patients with Parkinson’s disease following gastrointestinal surgery: report of three cases. Surg Today. 2009;39:(9):807–10. doi: 10.1007/s00595-008-3938-9.
    [Google Scholar]
  11. Mizuno J, Kato S, Watada M, Morita S. [Perioperative management of a patient with Parkinson’s disease with intravenous infusion of levodopa]. Masui. 2009 Oct;58:(10):1286–9.
    [Google Scholar]
  12. Kim YE, Kim HJ, Yun JY, Jeon BS. Intravenous amantadine is safe and effective for the perioperative management of patients with Parkinson’s disease. J Neurol. 2011 Dec; 258:(12):2274–5. doi: 10.1007/s00415-011-6083-0.
    [Google Scholar]
  13. llner U, Kassubek J, Odin P, Schwarz M, Naumann M, Häck HJ, et al.. Transdermal rotigotine for the perioperative management of Parkinson’s disease. J Neural Transm (Vienna). 2010;117:(7):855–9. doi: 10.1007/s00702-010-0425-4.
    [Google Scholar]
  14. Gálvez-Jiménez N, Lang AE. Perioperative problems in Parkinson’s disease and their management: apomorphine with rectal domperidone. Can J Neurol Sci. 1996 Aug;23:(3):198–203. doi: 10.1017/s0317167100038518.
    [Google Scholar]
  15. Akcali A, Savas L. Malignant syndrome of two Parkinson patients due to withdrawal of drugs. Ann Acad Med Singap. 2008 Jan; 37:(1):77–8.
    [Google Scholar]
  16. Cheung YF, Hui CHT, Chan JHM. Parkinsonism-hyperpyrexia syndrome due to abrupt withdrawal of amantadine. Hong Kong Med J. 2011 Apr; 17:(2):167–8.
    [Google Scholar]
  17. Arora A, Fletcher P. arkinsonism hyperpyrexia syndrome caused by abrupt withdrawal of ropinirole. Br J Hosp Med (Lond). 2013 Dec; 74:(12):698–9. doi: 10.12968/hmed.2013.74.12.698.
    [Google Scholar]
  18. Nagayama H, Kajimoto Y, Kumagai T, Nishiyama Y, Mishina M, Kimura K. Pharmacokinetics of Levodopa before and after Gastrointestinal Resection in Parkinson’s Disease. CRN. 2015;7:(3):181–5. doi: 10.1159/000381181.
    [Google Scholar]
  19. Miyaue N, Yabe H, Nagai M, Nomoto M. Gastrointestinal surgical procedures affect levodopa pharmacokinetics in Parkinson’s disease. Parkinsonism Relat Disord. 2020 Jul; 76::29–31. doi: 10.1016/j.parkreldis.2020.05.040.
    [Google Scholar]
  20. Nyholm D, Odin P, Johansson A, Chatamra K, Locke C, Dutta S, et al.. Pharmacokinetics of Levodopa, Carbidopa, and 3-O-Methyldopa Following 16-hour Jejunal Infusion of Levodopa-Carbidopa Intestinal Gel in Advanced Parkinson’s Disease Patients. AAPS J. 2012 Dec 11;15:(2):316–23. doi: 10.1208/s12248-012-9439-1.
    [Google Scholar]
  21. Aoki FY, Sitar DS. Clinical pharmacokinetics of amantadine hydrochloride. Clin Pharmacokinet. 1988 Jan; 14:(1):35–51. doi: 10.2165/00003088-198814010-00003.
    [Google Scholar]
  22. Deleu D, Northway MG, Hanssens Y. Clinical pharmacokinetic and pharmacodynamic properties of drugs used in the treatment of Parkinson’s disease. Clin Pharmacokinet. 2002;41:(4):261–309. doi: 10.2165/00003088-200241040-00003.
    [Google Scholar]
/content/journals/10.5339/qmj.2023.34
Loading
/content/journals/10.5339/qmj.2023.34
Loading

Data & Media loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error