Defining acute akinesia

Acute akinesia may be a clinical entity distinct from other PD motor fluctuations, according to authors of a recent report. They suggest that the condition should be defined on the basis of refractoriness to rescue medication.Over a period of 12 years, Dr Onofrj and Dr Thomas identified 26 patients who developed acute akinesia out of a cohort of 675 patients from their outpatient clinic. Seventeen of the patients developed akinesia during an infection or after surgery. In these patients, it was considered that akinesia was unrelated to treatment withdrawal or antidopaminergic drug administration and therefore differentiated from neuroleptic malignant syndrome. The remaining nine patients developed akinesia concurrently with gastrointestinal disease or drug manipulations. In these patients, akinesia was likely to have developed as a consequence of altered drug dynamics. The authors suggest that the definition of acute akinesia should be based on the transient refractoriness to dopaminergic rescue medication. "It is unlike the 'wearing off' phenomenon that occurs when dopaminergic drug levels decline and responds to dopaminergic rescue drugs," they say. They add, "Based on refractoriness and on the common clinical characteristics, we suggest that the historical entity of acute akinesia, identified as a syndrome with multiple etiologies, might include the categories of NMLS, NMS, or malignant syndrome."By adopting this definition, the authors suggest that it may be possible to explain the apparent acute onset of PD after anaesthesia, stress or trauma in patients not previously diagnosed with the disease. They say that these cases may represent an episode of acute akinesia in previously undiagnosed PD patients.The mainstay of treatment for acute akinesia should include intensive rehydration, reduction in hyperthermia, antithrombotic prophylaxis and removal of co-morbid factors, the authors suggest. They add, "Antiparkinsonian treatments might transiently appear ineffective, but the evidence of delayed recovery in the majority of patients should encourage the physician to persist with therapies." Reference...