Friday, September 30, 2016

A Note on Parkinsonism–Hyperpyrexia Syndrome (PHS)

Parkinsonism–hyperpyrexia syndrome (PHS) is potentially one preventable entity in hospitals including ICUs. It mostly occurs when patient's regular Parkinson's disease medications (levodopa, dopamine agonists, or amantadine) get interrupted for some reason including NPO status in the hospital, noncompliance or before/after surgery. Post-surgery, it may mimic neuroleptic malignant syndrome (NMS). It is characterized by hyperthermia, dysautonomia, mental status change, rigidity, and elevated CK levels. Other causes which may induce PHS are discontinuation of subthalamic nucleus deep brain stimulation (DBS), sepsis, hot weather, dehydration, and reduction of the previous dose of medication. Treatment is supportive and restart of medications. Few reports suggest that dantrolene may help in PHS alike NMS. 


Robottom BJ, Weiner WJ, Factor SA. Movement disorders emergencies. Part 1: hypokinetic disorders. Arch Neurol 2011; 68:567–572.

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