title: Parkinsonism-hyperpyrexia syndrome: the role of electroconvulsive therapy.
abstract: Herein, we present a case of a parkinsonism-hyperpyrexia syndrome (PHS) in a 58-year-old man with a 10-year history of Parkinson's disease. The patient presented with a 2-week history of fever and increasing confusion, in the context of a number of changes to his medication regimen. On presentation, he was noted to be febrile with autonomic instability, diaphoresis and marked rigidity. He was disoriented and responding to visual hallucinations. Investigations revealed an elevated creatine kinase and a provisional diagnosis of PHS was made. After the patient failed to respond during a 2-week period to supportive measures, electroconvulsive therapy (ECT) treatment was commenced. A good response to eight bilateral ECT treatments was achieved, with resolution of his confusional state and associated psychotic phenomena. We discuss the nosological and management issues associated with this case and discuss the role of ECT as a treatment modality in this condition.
authors.affiliation: Department of Psychological Medicine, Royal North Shore Hospital, Pacific Highway, St Leonards, Sydney, New South Wales, Australia. lintonmeagher@hotmail.com
authors.forename: L J
authors.initials: LJ
authors.lastname: Meagher
authors.forename: D
authors.initials: D
authors.lastname: McKay
authors.forename: G K
authors.initials: GK
authors.lastname: Herkes
authors.forename: M
authors.initials: M
authors.lastname: Needham
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D000212:Acyclovir / Q000627:therapeutic use; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000978:Antiparkinson Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D001007:Anxiety / Q000150:complications / Q000188:drug therapy; D002230:Carbidopa / Q000627:therapeutic use; D002443:Ceftriaxone / Q000627:therapeutic use; D002574:Cervical Vertebrae; D003863:Depression / Q000150:complications / Q000188:drug therapy; D003907:Dexamethasone / Q000627:therapeutic use; D003975:Diazepam / Q000627:therapeutic use; D004316:Doxepin / Q000627:therapeutic use; D004565:Electroconvulsive Therapy; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009459:Neuroleptic Malignant Syndrome / Q000150:complications / Q000628:therapy*; D010098:Oxycodone / Q000627:therapeutic use; D010146:Pain / Q000188:drug therapy / Q000209:etiology; D010300:Parkinson Disease / Q000150:complications / Q000188:drug therapy; D012642:Selegiline / Q000627:therapeutic use; D013124:Spinal Injuries / Q000150:complications
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D014151:Anti-Anxiety Agents; D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D000978:Antiparkinson Agents; D000998:Antiviral Agents; D004316:Doxepin; D012642:Selegiline; D000082:Acetaminophen; D007980:Levodopa; D002443:Ceftriaxone; D003907:Dexamethasone; D010098:Oxycodone; D002230:Carbidopa; D003975:Diazepam; D000212:Acyclovir