Rotigotine and parkinsonism-hyperpyrexia syndrome

Parkinsonism-hyperpyrexia syndrome (PHS) is a potentially fatal complication of Parkinson's disease (PD) often triggered by antiparkinsonian medication discontinuation or reduction. Rotigotine, a transdermal dopamine agonist, provides continuous drug delivery and can be administered even when oral administration is difficult. However, the association between rotigotine use and development of PHS remains unclear.

We retrospectively reviewed 166 episodes of emergency hospitalization for PD at Hyogo Medical University Hospital (2010-2024). After excluding 19 episodes with insufficient data, 147 were analyzed. Thirty episodes met the diagnostic criteria for PHS (PHS group), and 117 episodes did not (non-PHS group). Clinical characteristics, antiparkinsonian medications, and precipitating events during hospitalization were assessed. A multivariable logistic regression analysis was performed using age, sex, disease duration, and rotigotine administration as covariates.

The PHS group had a shorter disease duration, lower modified Hoehn and Yahr stages, and a lower levodopa equivalent dose than the non-PHS group. Poor medication compliance was the most common precipitating factor among PHS cases (n = 11, 36.7%). Rotigotine was administered in five PHS and 41 non-PHS episodes. In the multivariable analysis, age was significantly negatively associated with the development of PHS (odds ratio [OR], 0.894; 95% confidence interval [CI], 0.840-0.952; p = 0.0005). And rotigotine administration showed a tendency to suppress the development of PHS (OR, 0.353; 95% CI, 0.121-1.031; p = 0.0569).

Although not statistically significant, rotigotine use tends to be associated with a lower incidence of PHS. Maintaining good medication adherence is critical for preventing PHS, and we consider that rotigotine may be a useful therapeutic option.