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Neuroleptic malignant syndrome complicating levodopa withdrawal
Author(s) -
Reutens David C,
Harrison William B,
Goldswain Peter R T
Publication year - 1991
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.1991.tb116385.x
Subject(s) - levodopa , neuroleptic malignant syndrome , medicine , benserazide , anesthesia , dantrolene , amantadine , myoclonus , disease , parkinson's disease , pharmacology , calcium
Objective : To describe a case of neuroleptic malignant syndrome (NMS) resulting from withdrawal of low‐dose levodopa therapy for mild Parkinson's disease. Clinical features : Treatment with levodopa, 50 mg, and benserazide, 12.5 mg, three times a day was withdrawn from a 76‐year‐old woman with mild Parkinson's disease because she was experiencing intermittent confusion. Fever (38.5°, tachycardia, increased confusion, severe rigidity and generalised stimulus‐sensitive myoclonus developed after 12 hours. The creatine kinase level rose to 2058 U/L. Intervention and outcome : The fever abated with reintroduction of levodopa. Rigidity was slow to resolve and required additional treatment with dantrolene sodium. Conclusion : NMS may be precipitated by withdrawal of relatively low doses of levodopa, even in patients with mild Parkinson's disease. Hyperthermia and rigidity in NMS may result from involvement of separate central dopaminergic pathways.