Institute of Neurology, Movement Disorders Center, Department of Oncology and Neuroscience, University G. D'Annunzio Chieti-Pescara, Italy.
Parkinsonism Relat Disord. 2009 Dec;15 Suppl 3:S233-6. doi: 10.1016/S1353-8020(09)70821-1.
This article reviews literature on three emergencies in Parkinson's disease (PD): Akinetic crisis, severe dyskinesias or life-threatening dyskinesias, and polyneuropathy during duodenal L-Dopa gel infusion treatment. Akinetic crisis is also known as Parkinsonian hyperpyrexia, Neuroleptic-like malignant syndrome, Acute akinesia, and Malignant syndrome in parkinsonism. It appears in 0.3% of PD patients/year, and is characterized in the most severe cases by total akinesia with dysphagia, hyperthermia, dysautonomia, increment of muscle enzymes and alterations of mental status, but it may also appear in less severe forms ("forme frusta"). At difference with the continuum of motor hypokinesias observed in PD it is characterized by transient (in cases with favorable outcome) unresponsiveness to rescue drugs. Life-supporting measures are mandatory in patients affected by this emergency. Severe dyskinesia, or life-threatening dyskinesia, is due to increased dopaminergic stimulation (either by the patient or by the prescriber): when it appears the level of dopaminomimetic stimulation should be reduced. Polyneuropathy during duodenal L-Dopa gel infusion is a recently described complication, attributed to the onset of Guillain-Barré syndromes. However, hemapheresis was not effective in some reported cases, and recent evidence suggests that Vitamin B12 deficiency or direct high-dose chronic L-Dopa toxicity might play a role in its origin.
本文综述了帕金森病（PD）三种急症的文献：运动不能危象、严重运动障碍或危及生命的运动障碍，以及十二指肠 L-Dopa 凝胶输注治疗期间的多发性神经病。运动不能危象又称帕金森高热、神经阻滞剂恶性综合征、急性运动不能、帕金森病恶性综合征。它在 0.3%的 PD 患者/年中出现，在最严重的情况下表现为完全运动不能伴吞咽困难、高热、自主神经功能障碍、肌肉酶升高和精神状态改变，但也可能以较轻的形式出现（“不全危象”）。与 PD 中观察到的运动低下连续体不同，它的特征是对抢救药物的短暂（在预后良好的情况下）无反应。受此急症影响的患者需要采取生命支持措施。严重运动障碍或危及生命的运动障碍是由于多巴胺能刺激增加（无论是由患者还是由处方者引起）：当出现这种情况时，应降低多巴胺激动剂的刺激水平。十二指肠 L-Dopa 凝胶输注期间的多发性神经病是一种新描述的并发症，归因于格林-巴利综合征的发作。然而，在一些报告的病例中，血浆置换并不有效，最近的证据表明，维生素 B12 缺乏或直接高剂量慢性 L-Dopa 毒性可能在其发病机制中起作用。
