Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0030567 (Parkinson's disease)
 63,064 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Neuroleptic malignant syndrome is characterized by altered consciousness, fever, extrapyramidal signs, autonomic instability, elevated creatine kinase level, and leukocytosis. Although originally described in patients receiving neuroleptic drugs, this syndrome may also occur in patients with Parkinson's disease during withdrawal or reduction of levodopa therapy or other dopaminergic drug therapy. We have encountered three cases of neuroleptic malignant syndrome related to withdrawal of levodopa therapy. These cases illustrate the variety of circumstances in which alteration of therapy with dopaminergic drugs can cause this syndrome and the relative unfamiliarity of the neuroleptic malignant syndrome-levodopa relationship among physicians who do not treat large numbers of patients with Parkinson's disease. An understanding of the role of brain dopamine in the pathogenesis of neuroleptic malignant syndrome and an appreciation of the great variety of drugs whose manipulation can result in this potentially fatal syndrome will aid its proper and timely recognition, especially when the offending pharmacologic manipulation does not involve neuroleptic drugs.
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PMID:Neuroleptic malignant syndrome in Parkinson's disease after withdrawal or alteration of dopaminergic therapy. 149 12

Muscarinic cholinergic receptors were analysed in lymphocyte membranes from 35 patients with early (n = 20) and late onset (n = 15) Alzheimer's disease (AD), 86 patients with other neurological disorders and 60 normal controls by the specific binding of 3H-N-methyl-scopolamine (3H-NMS). The number of binding sites of 3H-NMS (Bmax) was significantly decreased both in early and late onset AD groups as compared with age-matched controls, by 54% and 40%, respectively, whereas the apparent binding affinity (Kd) was the same in all disease and control groups. In addition, the average Bmax in early AD was significantly lower than in late AD. The density of the binding of 3H-NMS was also significantly lower in a subgroup of old subjects with Down's syndrome (DS), whereas no changes were found in younger individuals with DS or in patients with Parkinson's disease, whether they were demented or not, multi-infarct dementia, myasthenia gravis or epilepsy. In the AD group, the difference in binding sites was unrelated either to the severity of dementia or disease duration. Treatment of the patients with cholinergic agents did not alter the binding values in any of the examined group. We conclude that the alteration of lymphocyte muscarinic receptors is highly associated with AD, but whether this reflects the central cholinergic deficit in these patients is uncertain.
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PMID:An analysis of lymphocyte 3H-N-methyl-scopolamine binding in neurological patients. Evidence of altered binding in Alzheimer's disease. 188 77

Neuroleptic malignant syndrome (NMS) is being increasingly recognized as a potential complication of neuroleptic therapy. Similar hyperthermic episodes have also been described in other settings of abrupt cessation of dopaminergic stimulation such as levodopa withdrawal. We report a fatal NMS-like episode occurring as a complication of an "off" period in a patient with Parkinson's disease.
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PMID:"On-off"-induced lethal hyperthermia. 281 93

Neuroleptic malignant syndrome is an uncommon, occasionally lethal reaction to drug therapy. Patients taking neuroleptic medication are usually the victims of this complex disorder, but others, such as patients with Parkinson's disease, are also at risk. The classic presentation includes autonomic instability, rigidity, hyperthermia, confusion and other neurologic symptoms. Family physicians may be the first to see these patients and must be able to make the diagnosis quickly to avoid delay in treatment.
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PMID:Neuroleptic malignant syndrome. 318 25

Neuroleptic malignant syndrome (NMS) was first recognized as a life-threatening complication of dopamine receptor antagonists characterized by extrapyramidal disturbances, hyperthermia, and elevated serum creatine kinase levels. Concepts of NMS have changed because medications other than classic neuroleptic drugs have been implicated as triggering agents and because syndromes identical to NMS have been observed in patients with Parkinson's disease withdrawn from their medication or suffering akinetic hyperthermic parkinsonian crisis. The neurochemical key features in all these conditions are probably functional dopamine deficiency and ensuing hyperactivity of excitatory amino acid neurotransmission in the basal ganglia and hypothalamus. Recognition of NMS is the most important step in its management; the outcome is good if causative drugs are discontinued or if parkinsonian therapy is readjusted. Supportive care includes management of hyperthermia and fluid replacement. Controversial therapeutic measures include the application of dopamine receptor agonists, excitatory amino acid antagonists, or dantrolene. Psychiatric patients with a history of NMS and psychotic relapse necessitating neuroleptic drugs do not commonly redevelop NMS when reexposed to dopamine receptor antagonists but may be treated most safely with atypical neuroleptic drugs such as clozapine.
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PMID:Neuroleptic malignant syndrome. 795 45

The akinetic crisis is an "off" state that lasts more than 48 hours with akinesia, rigidity and bradykinesia, occurring with signs of CNS dysregulation in advanced stages of Parkinson's disease. 7 akinetic crises lasting 4 to 14 days (average 9.3) were observed in 744 hospitalizations over a period of 7 years. The age of the patients with akinetic crisis and the mean duration and the severity of the disease were significantly higher than in the other patients. While bradykinesia and rigor are the most relevant clinical signs in some 40% of parkinsonian patients, 6 of our 7 patients (86%) had an akinetic-rigid form of the disease. Levodopa withdrawal preceded the akinetic crisis in 4 patients: in 3 patients the akinetic crisis occurred despite adequate dopaminergic therapy, in one patient after benzodiazepine withdrawal, in another case after gastrointestinal bleeding, and in one case without known cause. Hyperthermia, tachycardia and sweating were the most common collateral manifestations. Apomorphine given subcutaneously was effective in four cases, apomorphine and amantidine were effective in one case, and one patient died during an akinetic crisis. The akinetic crisis is a distinct form of motor fluctuation in advanced stages of Parkinson's disease, with clinical signs resembling malignant neuroleptic syndrome (NMS). While NMS is related to dopaminergic receptor blockade or dopaminergic depletion, akinetic crisis can occur despite adequate dopaminergic therapy as a symptom of severe basal ganglia dysfunction related to the advanced stages of Parkinson's disease. Outcome and therapy of akinetic crisis depend on the underlying causes.
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PMID:[Akinetic crisis in Parkinson disease]. 802

In this study, the authors set out to determine the presence of M3 muscarinic receptors in rat striatum by examining the binding of [3H]N-methylscopolamine ([3H]NMS) to striatal membranes and its displacement by antagonists with different affinity for M1 and M3 muscarinic receptors -pirenzepine; 4-diphenylacetoxy-N-methylpiperidine methiodide, 4-DAMP; and the p-fluoro analog of hexahydro-sila-difenidol, pFHHSiD). The specific binding of [3H]NMS to membranes from rat striatum (551 +/- 40 fmol.mg prot.-1, KD 0.11 +/- 0.01 nM) was displaced in a concentration-dependent manner by all three antagonists tested. Inhibition curves best fit to a single-site model for 4-DAMP (pKi 9.1 +/- 0.1), whereas for both pirenzepine and pFHHSiD, the best fit was to the two-site model. The pKi values for the high-affinity (8.0 +/- 0.2) and low-affinity (6.7 +/- 0.2) components for pirenzepine-mediated inhibition of [3H]NMS binding corresponded to those reported for M1 and M3 receptors, respectively. The pKi values for the high-affinity (7.7 +/- 0.1) and low-affinity (7.1 +/- 0.2) components for pFHHSiD inhibition were in good agreement with those reported for M3 and M1 receptors, respectively. Altogether, these results indicate the presence in rat striatum of both M1 and M3 muscarinic receptors. These findings might be relevant to the design and use of muscarinic antagonists in the treatment of neurological disorders such as Parkinson's disease.
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PMID:Muscarinic M1 and M3 receptors in rat striatum: a binding study. 942 72

Neuroleptic malignant syndrome is a clinical syndrome characterized by fever, muscle rigidity, and mutism. Some patients with neuroleptic syndrome may have elevated creatine phosphokinase values and abnormal liver aminotransferase values. Precipitating factors are important clues for prompt diagnosis. Typical precipitating factors include antipsychotic agents and major tranquilizers. In Parkinson disease, drug withdrawal, menstruation, and hyponatremia are precipitating factors. We report a case of neuroleptic malignant syndrome in a patient with Parkinson disease and hypernatremia. In addition, we hypothesized that sudden change of sodium concentrations in the central nervous system could trigger neuroleptic malignant syndrome in patients with Parkinson disease. According to our experience, neuroleptic malignant syndrome is a clinical diagnosis and prompt diagnosis avoids unnecessary, expensive work-ups.
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PMID:Acute hypernatremia and neuroleptic malignant syndrome in Parkinson disease. 1040 64

Neuroleptic malignant syndrome is a serious complication of levodopa withdrawal in patients with Parkinson's disease. We report a patient with advanced parkinsonism who developed neuroleptic malignant syndrome in the setting of inadequate levodopa intake. His symptoms improved with levodopa replacement, but dramatically worsened when enteral feeding was begun due to interference with intestinal absorption of levodopa.
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PMID:Neuroleptic malignant syndrome in advanced Parkinson's disease. 1174 31

Neuroleptic malignant-like syndrome (NMLS) occurred after rapid switch from bromocriptine to pergolide in a Parkinsonian patient. Although the underlying mechanisms are as yet obscure, we hypothesize that differences in dopamine receptor affinities between bromocriptine and pergolide may be involved. Long-term treatment with bromocriptine may thus have induced plastic changes in intracellular signal processing in the nigrostriatal system, which resulted in reduced dopaminergic efficacy of pergolide. We recommend vigilant outpatient supervision during performance of rapid switchover from one dopamine agonist to another in advanced Parkinson's disease or in subjects with predisposing factors for onset of a neuroleptic malignant syndrome.
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PMID:Neuroleptic malignant-like syndrome after rapid switch from bromocriptine to pergolide. 1247 2


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