Key result
Sudden withdrawal or reduction of levodopa in patients with multiple system atrophy precipitated neuroleptic malignant-like syndrome, resulting in one death and two recoveries upon reinstating therapy.
Why the study?
Multiple system atrophy associated with neuroleptic malignant-like syndrome is rare and few cases have been described in the literature.
Case Report (n=3)
No
In patients with multiple system atrophy, sudden withdrawal of levodopa can precipitate life-threatening neuroleptic malignant-like syndrome, which requires prompt reinstatement of dopaminergic therapy.
Answers are grounded in this paper and cite their sources.
MSA-NMLS cases warrant diagnostic vigilance in parkinsonism; extends sparse literature but remains hypothesis-generating for management.
BACKGROUND: Multiple system atrophy (MSA) associated with neuroleptic malignant-like syndrome (NMLS) is rare and few cases have been described in the literature. CASE PRESENTATION: In the present study, three patients with MSA associated with NMLS were analyzed from January 2012 to January 2020 to characterize their clinical presentations. Data collected from the patients for analysis included general patient history, the fluctuation and severity of disease symptoms, the indicated therapies and disease progression at follow-up. All patients had histories of sudden withdrawal or reduction of levodopa prior to the onset of symptoms. Clinical presentations were characterized by hyperthermia, autonomic dysfunction, worsening of extrapyramidal symptoms, and elevated serum creatine kinase (CK) levels. During hospitalization, one patient rapidly progressed and died, while the other two patients were successfully treated. CONCLUSIONS: Early diagnosis and treatment are very important for patient outcomes in NMLS. Notably, the correct dose and time of administration of dopaminergic medication may be key in treating NMLS.
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Lin et al. (2022) conducted a case report in Multiple system atrophy (MSA) associated with neuroleptic malignant-like syndrome (NMLS) (n=3). Sudden withdrawal or reduction of levodopa was evaluated on Clinical presentation and outcome. Sudden withdrawal or reduction of levodopa in patients with multiple system atrophy precipitated neuroleptic malignant-like syndrome, resulting in one death and two recoveries upon reinstating therapy.
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