[Akinetic crisis in Parkinson disease]

Area of Science:

• Neurology
• Movement Disorders
• Parkinson's Disease Pathophysiology

Background:

• Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by motor symptoms like bradykinesia, rigidity, and tremor.
• Advanced PD often involves motor fluctuations, including debilitating
• off
• states, which significantly impact patient quality of life.

Observation:

• This study observed 7 akinetic crises over 7 years in 744 hospitalizations, noting these events lasted 4-14 days.
• Patients experiencing akinetic crisis were older and had more severe PD compared to others.
• A significant majority (86%) of akinetic crisis patients presented with an akinetic-rigid phenotype.

Findings:

• Akinetic crisis is defined as an
• off
• state exceeding 48 hours, marked by akinesia, rigidity, bradykinesia, and central nervous system (CNS) dysregulation.
• Triggers included levodopa withdrawal (4 patients), benzodiazepine withdrawal (1 patient), gastrointestinal bleeding (1 patient), and unknown causes (1 patient).
• Common manifestations included hyperthermia, tachycardia, and sweating; apomorphine showed efficacy in treatment.

Implications:

• Akinetic crisis is a distinct motor fluctuation in advanced PD, differing from neuroleptic malignant syndrome (NMS) as it can occur despite adequate dopaminergic therapy.
• It signifies severe basal ganglia dysfunction in advanced Parkinson's disease.
• Effective management requires addressing underlying causes and may involve therapies like apomorphine.