Akinetic crisis and withdrawal syndromes: guideline "Parkinson's disease" of the German Society of Neurology

J Neurol. 2024 Oct;271(10):6485-6493. doi: 10.1007/s00415-024-12649-x. Epub 2024 Aug 27.

Abstract

The akinetic crisis is a well-known, rare, potentially life-threatening condition in Parkinson's disease with subacute worsening of akinesia, rigidity, fever, impaired consciousness, accompanying vegetative symptoms and transient dopa-resistance. The akinetic crisis was historically supposed to be a "withdrawal syndrome" in the sense of discontinuation of dopaminergic medication. Recently, other "withdrawal syndromes" as the specific "dopamine agonist withdrawal syndrome" or "deep brain stimulation withdrawal syndrome" have been described as emergency situations with specific subacute symptom constellations. All three conditions require immediate start of the adequate therapy to improve the prognosis. Here, the diagnostic criteria and treatment options of these three acute, severely disabling syndromes will be reported along the current guidelines of the German Parkinson Guideline Group.

Keywords: Akinetic crisis; Deep brain stimulation withdrawal syndrome; Diagnostic criteria; Dopamine agonist withdrawal syndrome; German Parkinson Guideline; Therapy.

Publication types

  • Review

MeSH terms

  • Antiparkinson Agents / adverse effects
  • Antiparkinson Agents / therapeutic use
  • Deep Brain Stimulation / standards
  • Germany
  • Humans
  • Neurology / standards
  • Parkinson Disease* / diagnosis
  • Parkinson Disease* / drug therapy
  • Parkinson Disease* / therapy
  • Practice Guidelines as Topic / standards
  • Societies, Medical / standards
  • Substance Withdrawal Syndrome* / diagnosis

Substances

  • Antiparkinson Agents