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November 15, 1985, Vol 254, No. 19 >
ARTICLE | November 15, 1985

A Neuroleptic Malignantlike Syndrome due to Levodopa Therapy Withdrawal FREE

Joseph H. Friedman, MD; Stanford S. Feinberg, MD; Robert G. Feldman, MD
[+] Author Affiliations

Reprint requests to Department of Medicine, Roger Williams General Hospital, 825 Chalkstone Ave, Providence, RI 02908 (Dr Friedman).


JAMA. 1985;254(19):2792-2795. doi:10.1001/jama.1985.03360190098033
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References

Three cases of a syndrome resembling neuroleptic malignant syndrome are described in patients never exposed to neuroleptics. Each patient had a long history of Parkinson's disease treated with a carbidopa-levodopa combination. Two patients developed the syndrome when administration of the drug was discontinued temporarily. One developed the syndrome before the "drug holiday," and then died during the holiday because of this complication.

(JAMA 1985;254:2792-2795)

REFERENCES

1 +
Delay J, Deniker P:  Drug-induced extrapyramidal syndromes , in Vinken PJ, Bruyn GW (eds): Handbook of Clinical Neurology: Diseases of the Basal Ganglia . Amsterdam, North Holland Publishing Co, 1968;, vol 6, pp 248-266.
2 +
Caroff S:  Neuroleptic malignant syndrome . J Clin Psychiatry 1980;;41:79-83.
3 +
Mueller P, Vester J, Fermaglich HJ:  Neuroleptic malignant syndrome: Successful treatment with bromocriptine . JAMA 1983;;249:386-388.
4 +
Smego R, Durack D:  The neuroleptic malignant syndrome . Arch Intern Med 1982;;142:1183-1185.
5 +
Cohen W, Cohen N:  Lithium carbonate, haloperidol and irreversible brain damage . JAMA 1974;;230:1283-1287.
6 +
Regestein Q, Alpert J, Reich P:  Sudden catatonic stupor with disastrous outcome . JAMA 1977;;238:618-620.
7 +
Burke R, Fahn S, Mayeux R, et al:  Neuroleptic malignant syndrome caused by dopamine depleting agents in a patient with Huntington's disease . Neurology 1981;;31:1022-1026.
8 +
Greenblatt DR, Gross PL, Harris J, et al:  Fatal hyperthermia following haloperidol therapy of sedative-hypnotic withdrawal . J Clin Psychiatry 1978;;39:673-675.
9 +
Moyes D:  Malignant hyperpyrexia caused by trimeprazine . Br J Anaesth 1973;;45:1163-1164.
10 +
Sechi G, Tanda F, Mutani R:  Fatal hyperpyrexia after withdrawal of levodopa . Neurology 1984;;34:249-251.
11 +
Toru M, Matsuda O, Magiguchi K, et al:  Neuroleptic malignant syndrome-like state following a withdrawal of anti-parkinsonian drugs . J Nerv Ment Dis 1981;;169:324-327.
12 +
Figa-Talamanca L, Gualandi C, DiMeo L, et al:  Hyperthermia after discontinuance of levodopa and bromocriptine therapy: Impaired dopamine receptor a possible cause . Neurology 1985;;35:258-261.
13 +
Henderson VW, Wooten GF:  Neuroleptic malignant syndrome: A pathogenic role for dopamine receptor blockade? Neurology 1981;; 31:132-137.
14 +
Gronert G:  Malignant hyperthermia . Anesthesiology 1980;;53:395-423.
15 +
Downey GP, Rosenberg M, Caroff S, et al:  Neuroleptic malignant syndrome: Patient with unique clinical and physiologic features . Am J Med 1984;;77:338-340.
16 +
Goulon M, Rohan-Cabot P, Elkharrat D, et al:  Beneficial effects of dantrolene in the treatment of neuroleptic malignant syndrome: A report of two cases . Neurology 1983;;33:516-518.
17 +
Granato J, Stern B, Rengel A, et al:  Neuroleptic malignant syndrome: Successful treatment with dantrolene and bromocriptine . Ann Neurol 1983;;14:89-90.
18 +
Klawans HL, Goetz CG, Tanner CM, et al:  Levodopa-free periods ('drug holidays') in the management of parkinsonism . Adv Neurol 1983;; 37:33-34.
19 +
Direnfeld LK, Feldman RG, Alexander MP, et al:  Is L-dopa drug holiday useful? Neurology 1980;;30:785-788.
20 +
Marsden CD, Fahn S:  Problems in Parkinson's disease , in Marsden CD, Fahn S (eds): Butterworth International Medical Reviews . Washington, DC, Butterworth Inc, 1982;, vol 2, pp 1-7.
21 +
Marsden CD, Parkes JD, Quinn N:  Fluctuations of disability in Parkinson's disease: Clinical aspects , in Marsden CD, Fahn S (eds): Butterworth International Medical Reviews . Washington, DC, Butterworth Inc, 1982;, vol 2, pp 96-122.
22 +
Sweet RD, Lee JE, Spiegel HE, et al:  Enhanced responses to low doses of levodopa after withdrawal from chronic treatment . Neurology 1972;;22:520-525.

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1 +
Delay J, Deniker P:  Drug-induced extrapyramidal syndromes , in Vinken PJ, Bruyn GW (eds): Handbook of Clinical Neurology: Diseases of the Basal Ganglia . Amsterdam, North Holland Publishing Co, 1968;, vol 6, pp 248-266.
2 +
Caroff S:  Neuroleptic malignant syndrome . J Clin Psychiatry 1980;;41:79-83.
3 +
Mueller P, Vester J, Fermaglich HJ:  Neuroleptic malignant syndrome: Successful treatment with bromocriptine . JAMA 1983;;249:386-388.
4 +
Smego R, Durack D:  The neuroleptic malignant syndrome . Arch Intern Med 1982;;142:1183-1185.
5 +
Cohen W, Cohen N:  Lithium carbonate, haloperidol and irreversible brain damage . JAMA 1974;;230:1283-1287.
6 +
Regestein Q, Alpert J, Reich P:  Sudden catatonic stupor with disastrous outcome . JAMA 1977;;238:618-620.
7 +
Burke R, Fahn S, Mayeux R, et al:  Neuroleptic malignant syndrome caused by dopamine depleting agents in a patient with Huntington's disease . Neurology 1981;;31:1022-1026.
8 +
Greenblatt DR, Gross PL, Harris J, et al:  Fatal hyperthermia following haloperidol therapy of sedative-hypnotic withdrawal . J Clin Psychiatry 1978;;39:673-675.
9 +
Moyes D:  Malignant hyperpyrexia caused by trimeprazine . Br J Anaesth 1973;;45:1163-1164.
10 +
Sechi G, Tanda F, Mutani R:  Fatal hyperpyrexia after withdrawal of levodopa . Neurology 1984;;34:249-251.
11 +
Toru M, Matsuda O, Magiguchi K, et al:  Neuroleptic malignant syndrome-like state following a withdrawal of anti-parkinsonian drugs . J Nerv Ment Dis 1981;;169:324-327.
12 +
Figa-Talamanca L, Gualandi C, DiMeo L, et al:  Hyperthermia after discontinuance of levodopa and bromocriptine therapy: Impaired dopamine receptor a possible cause . Neurology 1985;;35:258-261.
13 +
Henderson VW, Wooten GF:  Neuroleptic malignant syndrome: A pathogenic role for dopamine receptor blockade? Neurology 1981;; 31:132-137.
14 +
Gronert G:  Malignant hyperthermia . Anesthesiology 1980;;53:395-423.
15 +
Downey GP, Rosenberg M, Caroff S, et al:  Neuroleptic malignant syndrome: Patient with unique clinical and physiologic features . Am J Med 1984;;77:338-340.
16 +
Goulon M, Rohan-Cabot P, Elkharrat D, et al:  Beneficial effects of dantrolene in the treatment of neuroleptic malignant syndrome: A report of two cases . Neurology 1983;;33:516-518.
17 +
Granato J, Stern B, Rengel A, et al:  Neuroleptic malignant syndrome: Successful treatment with dantrolene and bromocriptine . Ann Neurol 1983;;14:89-90.
18 +
Klawans HL, Goetz CG, Tanner CM, et al:  Levodopa-free periods ('drug holidays') in the management of parkinsonism . Adv Neurol 1983;; 37:33-34.
19 +
Direnfeld LK, Feldman RG, Alexander MP, et al:  Is L-dopa drug holiday useful? Neurology 1980;;30:785-788.
20 +
Marsden CD, Fahn S:  Problems in Parkinson's disease , in Marsden CD, Fahn S (eds): Butterworth International Medical Reviews . Washington, DC, Butterworth Inc, 1982;, vol 2, pp 1-7.
21 +
Marsden CD, Parkes JD, Quinn N:  Fluctuations of disability in Parkinson's disease: Clinical aspects , in Marsden CD, Fahn S (eds): Butterworth International Medical Reviews . Washington, DC, Butterworth Inc, 1982;, vol 2, pp 96-122.
22 +
Sweet RD, Lee JE, Spiegel HE, et al:  Enhanced responses to low doses of levodopa after withdrawal from chronic treatment . Neurology 1972;;22:520-525.

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