Malignant deep brain stimulator withdrawal syndrome

BMJ Case Rep. 2019 May 15;12(5):e229122. doi: 10.1136/bcr-2018-229122.

Abstract

Parkinsonism-hyperpyrexia syndrome (PHS) is a neurologic potentially fatal emergency that mimics neuroleptic malignant syndrome. It commonly presents as systemic inflammatory response syndrome, acute onset worsening of muscular rigidity, autonomic instability, hyperpyrexia, confusion, diaphoresis and high creatine phosphokinase. The most common trigger for PHS is reduction or withdrawal of anti-Parkinson's medications, especially levodopa. It was also reported in a few cases following deep brain stimulation of the subthalamic nucleus surgery shortly after anti-Parkinson's medications were discontinued. Rare causes of PHS include deep brain stimulator (DBS) malfunction due to battery depletion. To the best of our knowledge, PHS following DBS battery depletion was reported only in three occasions. Here, we report a case of PHS due to DBS battery depletion presented as sepsis and was successfully treated with the administration of dopamine agonists, intravenous fluids and changing the DBS battery.

Keywords: neuroendocrinology; neurology (drugs and medicines).

Publication types

  • Case Reports

MeSH terms

  • Acute Disease
  • Aged
  • Antiparkinson Agents / administration & dosage
  • Antiparkinson Agents / adverse effects*
  • Deep Brain Stimulation / adverse effects*
  • Female
  • Humans
  • Parkinson Disease / therapy*
  • Substance Withdrawal Syndrome / diagnosis*

Substances

  • Antiparkinson Agents