Parkinsonism-hyperpyrexia syndrome after deep brain stimulation surgery: case report.
OBJECTIVE
Deep brain stimulation is an alternative treatment for advanced Parkinson's disease. Levodopa medications are usually discontinued the night before surgery to localize the optimal response site to intraoperative macrostimulation. However, abrupt withdrawal of medication may result in side effects. We report a case of parkinsonism-hyperpyrexia syndrome (PHS), a rare complication resulting from discontinuation of antiparkinsonian medication, after a deep brain stimulation (DBS) procedure for bilateral subthalamic-nucleus (STN).


METHODS
A 66-year-old woman with an 11-year history of idiopathic Parkinson's disease was admitted for DBS. She had experienced wearing-off symptoms, severe peak-dose dyskinesia, and medication-induced side effects. Antiparkinsonian medication was discontinued 2 days before surgery because of severe drug-related complications. DBS for bilateral STN was performed uneventfully, but the patient was unconscious with fever, tachycardia, and hypertension after surgery.


METHODS
Levodopa and dopamine agonist replacement by nasogastric tube and hydration were immediately administered with conservative treatment for the hypertension, tachycardia, and fever. The patient's serum creatine kinase level increased to 786 U/L 3 days after the surgery and then decreased gradually as the patient's consciousness improved.


CONCLUSIONS
Physicians should be aware of the possibility of PHS after a deep brain stimulation procedure. If the patient shows unexplained changes in consciousness with hyperpyrexia after surgery, PHS should be considered and adequate treatment should be given immediately to prevent death.
Kim
Jong Hyun
JH
Department of Neurosurgery, Korea University Guro Hospital, Seoul, Korea.
Kwon
Taek-Hyun
TH
Koh
Seong-Beom
SB
Park
Jung Youl
JY
D000368:Aged; D000978:Antiparkinson Agents / Q000009:adverse effects; D046690:Deep Brain Stimulation / Q000009:adverse effects*; D005260:Female; D005334:Fever / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D010300:Parkinson Disease / Q000503:physiopathology / Q000628:therapy*; D020734:Parkinsonian Disorders / Q000209:etiology* / Q000503:physiopathology
D000978:Antiparkinson Agents