Objective: To investigate the clinical characteristics of Parkinson’s disease (PD) patients who experienced acute akinesia and immobilization requiring emergency medical care.

Background: PD patients sometimes experience prolonged off-states, resulting in multi-day immobility. The most recognized condition associated with this phenomenon is neuroleptic malignant syndrome (NMS), and “akinetic crisis” is sometimes used to describe similar states. Despite its clinical significance, the causes of sustained immobility in PD have received little research attention, and its pathophysiology and prognosis remain poorly understood.

Method: We conducted a retrospective chart review of PD patients who experienced acute immobilization lasting more than 24 hours, requiring emergency transport and hospitalization at two hospitals. Clinical characteristics were analyzed based on medical records, including levodopa dosage, causative factors, duration of immobilization, peak creatine kinase (CK) levels, length of hospital stay, and Modified Rankin Scale (mRS) at discharge.

Results: Nine PD patients (4 females) were included. The mean age was 71.1 years (range: 54–90). Two patients had not been previously diagnosed with PD at the time of their akinetic collapse. The remaining seven had been diagnosed for an average of 4.7 years and were receiving levodopa at 314 ± 195 mg/day. The duration of immobilization was 3.5 ± 2.7 days. The primary triggers were discontinuation of antiparkinsonian drugs in five patients (due to poor adherence or cognitive fluctuations), dehydration in three, and a fall in one. The mean body temperature on admission was 37.1 ± 0.76°C, and peak CK levels averaged 1688 ± 2200 U/L. Four patients developed moderate to severe pressure ulcers. The mean hospital stay was 34.2 ± 13.5 days, and the mRS at discharge was 3.7 ± 1.0. One patient did not survive.

Conclusion: Acute akinesia led to prolonged immobilization, often resulting in poor outcomes, extended hospitalization, and, in one case, death. Unlike NMS, this condition manifested as persistent akinesia without severe muscle rigidity or significant autonomic dysfunction. We propose classifying this distinct condition as “acute akinetic collapse.” Social factors, such as the rising number of patients living alone and the lack of sufficient caregiving support, contributed to the worsening of prolonged immobilization.

References: Objective
To investigate the clinical characteristics of Parkinson’s disease (PD) patients who experienced acute akinesia and immobilization requiring emergency medical care.
Background
PD patients sometimes experience prolonged off-states, resulting in multi-day immobility. The most recognized condition associated with this phenomenon is neuroleptic malignant syndrome (NMS), and “akinetic crisis” is sometimes used to describe similar states. Despite its clinical significance, the causes of sustained immobility in PD have received little research attention, and its pathophysiology and prognosis remain poorly understood.
Methods
We conducted a retrospective chart review of PD patients who experienced acute immobilization lasting more than 24 hours, requiring emergency transport and hospitalization at two hospitals. Clinical characteristics were analyzed based on medical records, including levodopa dosage, causative factors, duration of immobilization, peak creatine kinase (CK) levels, length of hospital stay, and Modified Rankin Scale (mRS) at discharge.
Results
Nine PD patients (4 females) were included. The mean age was 71.1 years (range: 54–90). Two patients had not been previously diagnosed with PD at the time of their akinetic collapse. The remaining seven had been diagnosed for an average of 4.7 years and were receiving levodopa at 314 ± 195 mg/day. The duration of immobilization was 3.5 ± 2.7 days. The primary triggers were discontinuation of antiparkinsonian drugs in five patients (due to poor adherence or cognitive fluctuations), dehydration in three, and a fall in one. The mean body temperature on admission was 37.1 ± 0.76°C, and peak CK levels averaged 1688 ± 2200 U/L. Four patients developed moderate to severe pressure ulcers. The mean hospital stay was 34.2 ± 13.5 days, and the mRS at discharge was 3.7 ± 1.0. One patient did not survive.
Conclusions
Acute akinesia led to prolonged immobilization, often resulting in poor outcomes, extended hospitalization, and, in one case, death. Unlike NMS, this condition manifested as persistent akinesia without severe muscle rigidity or significant autonomic dysfunction. We propose classifying this distinct condition as “acute akinetic collapse.” Social factors, such as the rising number of patients living alone and the lack of sufficient caregiving support, contributed to the worsening of prolonged immobilization.

« Back to 2025 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/clinical-picture-of-acute-akinetic-collapse-leading-to-multi-day-immobility-in-parkinsons-disease/