Table 1

Precipitant factors of severe off and the parkinsonism-hyperpyrexia syndrome

Dopaminergic treatment relatedNon-dopaminergic treatment related
Abrupt withdrawal or medication switch
Decrease of absorption:
  • Enteral and parenteral nutrition with high protein diet

  • Gastrointestinal problems (severe constipation, paralytic ileus)

Dosage reduction:
  • Loss of compliance

  • Psychiatric problems (confusion, hallucinations)

  • Severe dyskinesia

  • Postoperative period

Addition of dopaminergic blocker
Concurrent conditions:
  • Infection

  • Trauma

  • Stress

  • Dehydration

  • Excessively hot weather