[Akinetic crisis in Parkinson disease]

The akinetic crisis is an "off" state that lasts more than 48 hours with akinesia, rigidity and bradykinesia, occurring with signs of CNS dysregulation in advanced stages of Parkinson's disease. 7 akinetic crises lasting 4 to 14 days (average 9.3) were observed in 744 hospitalizations over a period of 7 years. The age of the patients with akinetic crisis and the mean duration and the severity of the disease were significantly higher than in the other patients. While bradykinesia and rigor are the most relevant clinical signs in some 40% of parkinsonian patients, 6 of our 7 patients (86%) had an akinetic-rigid form of the disease. Levodopa withdrawal preceded the akinetic crisis in 4 patients: in 3 patients the akinetic crisis occurred despite adequate dopaminergic therapy, in one patient after benzodiazepine withdrawal, in another case after gastrointestinal bleeding, and in one case without known cause. Hyperthermia, tachycardia and sweating were the most common collateral manifestations. Apomorphine given subcutaneously was effective in four cases, apomorphine and amantidine were effective in one case, and one patient died during an akinetic crisis. The akinetic crisis is a distinct form of motor fluctuation in advanced stages of Parkinson's disease, with clinical signs resembling malignant neuroleptic syndrome (NMS). While NMS is related to dopaminergic receptor blockade or dopaminergic depletion, akinetic crisis can occur despite adequate dopaminergic therapy as a symptom of severe basal ganglia dysfunction related to the advanced stages of Parkinson's disease. Outcome and therapy of akinetic crisis depend on the underlying causes.