Parkinsonism Hyperpyrexia Syndrome following Deep Brain Stimulation

Govindappa, Shyla T.; Abbas, Masoom M.; Hosurkar, Guruprasad; Varma, Ravi Gopal; Muthane, Uday B.

doi:10.1016/j.parkreldis.2015.08.004

Cited by 13 publications

(8 citation statements)

References 6 publications

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“…However, clinical observations in PD patients, who have been able to markedly reduce or stop dopaminergic medication after subthalamic stimulation, an effective treatment for motor fluctuations and dyskinesias, suggest that this pathological “priming” is potentially reversible . Rare cases of life‐threatening and even fatal stimulation withdrawal syndrome have been described when a sudden failure or interruption of subthalamic stimulation occurs . In this point of view, we present our hypothesis of postoperative dopaminergic desensitization as the key underlying mechanism contributing to such life‐threatening events.…”

mentioning

confidence: 91%

Reversing dopaminergic sensitization

et al. 2017

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mentioning

confidence: 91%

Reversing dopaminergic sensitization

et al. 2017

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“…Thus, withdrawal of antiparkinsonian drugs combined with further surgery is more likely to cause the complication than either factor alone. Until now, about 5 cases of PHS after DBS surgery have been documented; 3 of these cases occurred due to perioperative drug cessation [4,6,7], while, the other 2 cases occurred 6 and 8 days after antiparkinsonian drug dosages were reduced abruptly when the DBS system was activated [3,8]. In our case, the patient first experienced rapid reduction of antiparkinsonian drugs due to dyskinesia.…”

Section: Discussionmentioning

confidence: 66%

Parkinsonism-hyperpyrexia syndrome after withdrawal of antiparkinsonian drugs and deep brain stimulation surgery

Han

Meng

et al. 2017

Chin Neurosurg Jl

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Background: Parkinsonism-hyperpyrexia syndrome (PHS) is a rare but potentially fatal condition in patients with Parkinson's disease. Deep brain stimulation (DBS) is a widely used and efficacious treatment for advanced Parkinson's disease. Case presentation: Here, we report a case of PHS in a patient who first underwent withdrawal of antiparkinsonian medications and then bilateral subthalamic nucleus DBS. Conclusions: Patients should be advised to gradually decrease rather than suddenly stop antiparkinsonian medications when they must stop taking a medication and antiparkinsonian medications should be reintroduced as soon as possible after surgery.

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“…The most common trigger for PHS is withdrawal of anti-Parkinson’s medications, especially levodopa. Due to ultra-short half-life of levodopa, sudden withdrawal of dopaminergic medications during the perioperative period may cause PHS 9–15. Additional triggers reported in the PD patient include prescription of neuroleptic medication, infection, dehydration and excessive hot weather 16 17…”

Section: Discussionmentioning

confidence: 99%

Malignant deep brain stimulator withdrawal syndrome

Azar¹,

Elinav

Safadi

et al. 2019

BMJ Case Rep

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Parkinsonism-hyperpyrexia syndrome (PHS) is a neurologic potentially fatal emergency that mimics neuroleptic malignant syndrome. It commonly presents as systemic inflammatory response syndrome, acute onset worsening of muscular rigidity, autonomic instability, hyperpyrexia, confusion, diaphoresis and high creatine phosphokinase. The most common trigger for PHS is reduction or withdrawal of anti-Parkinson’s medications, especially levodopa. It was also reported in a few cases following deep brain stimulation of the subthalamic nucleus surgery shortly after anti-Parkinson’s medications were discontinued. Rare causes of PHS include deep brain stimulator (DBS) malfunction due to battery depletion. To the best of our knowledge, PHS following DBS battery depletion was reported only in three occasions. Here, we report a case of PHS due to DBS battery depletion presented as sepsis and was successfully treated with the administration of dopamine agonists, intravenous fluids and changing the DBS battery.

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Parkinsonism Hyperpyrexia Syndrome following Deep Brain Stimulation

Cited by 13 publications

References 6 publications

Reversing dopaminergic sensitization

Reversing dopaminergic sensitization

Parkinsonism-hyperpyrexia syndrome after withdrawal of antiparkinsonian drugs and deep brain stimulation surgery

Malignant deep brain stimulator withdrawal syndrome

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