Emergencies and critical issues in Parkinson's disease

Abstract

Complications from Parkinson's disease may develop over the disease course, sometimes unexpectedly, and require prompt or even urgent medical intervention. The most common are associated with aggravation of motor symptoms; serious non-motor complications, such as psychosis, orthostatic hypotension or sleep attacks, also occur. Here we review such complications, their clinical presentation, precipitating factors and management, including those related to using device-aided therapies. Early recognition and prompt attention to these critical situations is challenging, even for the Parkinson's disease specialist, but is essential to prevent serious problems.

Keywords: apomorphine; deep brain stimulation; emergencies; levodopa intestinal gel infusion; parkinson’s disease.

Figure 1

Management of parkinsonism-hyperpyrexia syndrome. DA, dopamine agonist; LCIG, levodopa/carbidopa intestinal gel; LD, levodopa.; PHS, parkinsonism-hyperpyrexia syndrome

Figure 2

(A) Arm contusion in a patient with Parkinson's disease with REM-sleep behaviour disorder after falling out of bed while enacting a dream during REM-sleep. (B) Protection measures during the night to avoid falls and injuries during the episodes. (Courtesy of Dr. Alex Iranzo [42]). PD, Parkinson's disease; REM, rapid eye movement.

Figure 3

Hardware complication of deep brain stimulation: skin lesion induced by electric current after break of extension cable connecting with the subcutaneous pacemaker.

Figure 4

An algorithm approach for DBS efficacy loss. DBS, deep-brain stimulation; LD, levodopa.