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Neuroleptic malignant syndrome complicating levodopa withdrawal
D C Reutens1, W B Harrison, P R Goldswain
1Royal Perth Hospital, WA.
The Medical Journal of Australia
|July 1, 1991
Summary
Neuroleptic Malignant Syndrome (NMS) can occur even with low-dose levodopa withdrawal in mild Parkinson's disease. This case highlights the importance of considering NMS when patients develop fever and rigidity after stopping Parkinson's medication.
Area of Science:
- Neurology
- Pharmacology
Background:
- Parkinson's disease management often involves levodopa therapy.
- Withdrawal of dopaminergic agents can precipitate serious adverse events.
Observation:
- A 76-year-old woman with mild Parkinson's disease experienced confusion while on low-dose levodopa (50 mg) and benserazide (12.5 mg) thrice daily.
- Following abrupt withdrawal, she developed fever (38.5°C), tachycardia, increased confusion, severe rigidity, and myoclonus within 12 hours.
- Creatine kinase levels significantly elevated to 2058 U/L.
Findings:
- Reintroduction of levodopa successfully resolved the fever.
- Severe rigidity persisted, requiring additional treatment with dantrolene sodium.
Implications:
- Neuroleptic Malignant Syndrome (NMS) can be triggered by the withdrawal of even low levodopa doses in mild Parkinson's disease.
- The distinct central dopaminergic pathways may underlie the hyperthermia and rigidity observed in NMS.
- Clinicians should maintain a high index of suspicion for NMS during levodopa withdrawal, regardless of disease severity or dosage.