Parkinsonism Hyperpyrexia Syndrome and Dyskinesia Hyperpyrexia Syndrome

1. A D E W I J A Y A , M D
S E P T E M B E R 2 0 2 1
Parkinsonism-hyperpyrexia Syndrome
&
Dyskinesia-hyperpyrexia Syndrome

2. Parkinsonism-hyperpyrexia Syndrome

3.  Akinetic attack
 Due to abrupt change in dopaminergic medication
 Incidence of 0.3% and mortality of 4%
Onofrj M, Thomas A. Acute akinesia in Parkinson disease. Neurology 2005;64:1162–9.
Newman EJ, Grosset DG, Kennedy PGE. The parkinsonismhyperpyrexia syndrome. Neurocrit Care 2009;10:136–40.

4. Precipitant Factors
Onofrj M, Thomas A. Acute akinesia in Parkinson disease. Neurology 2005;64:1162–9.
Newman EJ, Grosset DG, Kennedy PGE. The parkinsonismhyperpyrexia syndrome. Neurocrit Care 2009;10:136–40.

5. Clinical Picture
 Akinetic off
 Hyperthermia
 Elevated serum muscle enzymes, following muscle
damage from marked rigidity.
 Some patients develop dysautonomic features, such
as tachycardia, unstable blood pressure and
diaphoresis
Onofrj M, Bonanni L, Cossu G, et al. Emergencies in parkinsonism: akinetic crisis, life-threatening dyskinesias, and polyneuropathy during L-Dopa gel treatment. Park
Realt Disord 2009;15:S233–6.

6. Complication
 Aspiration pneumonia
 Acute renal failure from rhabdomyolysis and
dehydration
 Thrombotic events such as deep vein thrombosis,
pulmonary thromboembolism or (in severe cases)
disseminated intravascular coagulation
Simonet C, Tolosa E, Camara A, Valldeoriola F. Emergencies and critical issues in Parkinson’s disease. Practical neurology. 2020 Feb 1;20(1):15-25.

7. Management
Simonet C, Tolosa E, Camara A, Valldeoriola F. Emergencies and critical issues in Parkinson’s disease. Practical neurology. 2020 Feb 1;20(1):15-25.

8. L E V O D O P A - I N D U C E D D Y S K I N E S I A S C A N B E S E V E R E A N D
O C C A S I O N A L L Y E V E N L I F E - T H R E A T E N I N G , P R E S E N T I N G
A S A D Y S K I N E T I C S T O R M
Dyskinesia-hyperpyrexia Syndrome
Onofrj M, Bonanni L, Cossu G, et al. Emergencies in parkinsonism: akinetic crisis, life-threatening dyskinesias, and polyneuropathy during L-Dopa gel treatment. Park
Realt Disord 2009;15:S233–6.

9. Clinical Picture
 Generalised and exhausting dyskinetic movements
that eventually cause motor collapse with
consequent dehydration and rhabdomyolysis
Gil-Navarro S, Grandas F. Dyskinesia-hyperpyrexia syndrome: another Parkinson's disease emergency. Mov Disord 2010;25:2691–2.
Baek MS, Lee HW, Lyoo CH, Seok Baek M, Woo Lee H, Hyoung Lyoo C. A patient with recurrent dyskinesia and hyperpyrexia syndrome. JMD 2017;10:154–7.

10. Management
 Reducing the dopaminergic medication
 Rehydration and electrolyte monitoring and
repletion
 In extreme cases, they may need sedation with
propofol
 Deep-brain stimulation may be a feasible long-term
treatment
Onofrj M, Bonanni L, Cossu G, et al. Emergencies in parkinsonism: akinetic crisis, life-threatening dyskinesias, and polyneuropathy during L-Dopa gel treatment. Park
Realt Disord 2009;15:S233–6.

11. THANK YOU