Wei Li, Chen Yinghui
Department of Neurology, Jinshan Hospital, Fudan University, Shanghai, People's Republic of China ; Department of Neurology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.
Patient Prefer Adherence. 2014 Feb 27;8:271-3. doi: 10.2147/PPA.S59150. eCollection 2014.
Neuroleptic malignant-like syndrome (NMLS) is a rare but catastrophic complication of drug treatment for Parkinson's disease (PD). Sudden withdrawal and abrupt reduction of antiparkinsonian drugs are major risk factors. Just as its name suggests, the clinical features of NMLS are similar to neuroleptic malignant syndrome, which is a dangerous adverse response to antipsychotic drugs. Both of these conditions can present with hyperthermia, marked muscle rigidity, altered consciousness, autonomic dysfunction, and elevated serum creatine-kinase (CK) levels. However, we describe a special NMLS case with a slight elevation of CK levels and respiratory failure in the full course of her treatment. The patient, a 68-year-old woman with a 4-years history of Parkinson's disease, presented with hyperthermia and severe muscular rigidity. During the course of her treatment, her maximum temperature was extremely high (above 41°C). At the beginning, the diagnosis of NMLS secondary to dopamine decrease was difficult to make, because her initial blood examination revealed that her serum CK levels were mildly elevated and decreased to normal range rapidly. Although antiparkinsonian drugs and supportive treatment were applied, the patient developed an acute respiratory failure in the early course of treatment. This case report highlights that when confronted with Parkinson's patients with high body temperature and muscle rigidity, NMLS should be taken into consideration even if there is no CK elevation. Likewise, the need for supportive care is essential, because its complications are severe, even such as respiratory failure.
抗精神病药物恶性综合征样综合征（NMLS）是帕金森病（PD）药物治疗中一种罕见但灾难性的并发症。突然停用和骤然减量抗帕金森病药物是主要危险因素。顾名思义，NMLS的临床特征与抗精神病药物恶性综合征相似，后者是抗精神病药物的一种危险不良反应。这两种情况都可能表现为高热、明显的肌肉强直、意识改变、自主神经功能障碍以及血清肌酸激酶（CK）水平升高。然而，我们描述了一例特殊的NMLS病例，其在整个治疗过程中CK水平轻度升高且出现呼吸衰竭。该患者为一名68岁女性，有4年帕金森病病史，表现为高热和严重肌肉强直。在治疗过程中，她的最高体温极高（超过41°C）。起初，继发于多巴胺减少的NMLS诊断难以确立，因为她最初的血液检查显示血清CK水平轻度升高且迅速降至正常范围。尽管应用了抗帕金森病药物和支持治疗，但患者在治疗早期出现了急性呼吸衰竭。本病例报告强调，当面对体温升高和肌肉强直的帕金森病患者时，即使没有CK升高也应考虑NMLS。同样，支持性护理至关重要，因为其并发症严重，甚至会出现呼吸衰竭。
