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Parkinson's Medication Withdrawal Syndrome — SCE Palliative Medicine MCQ

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HardNon-Malignant Palliative CareParkinson's Medication Withdrawal SyndromeSCE Palliative Medicine

A 70-year-old man with advanced Parkinson's disease and dementia is dying. His levodopa has been administered via crushed tablets through a nasogastric tube. As he enters the active dying phase, the nasogastric tube is removed and no alternative dopamine-delivery method is provided. What is the critical risk of abruptly stopping levodopa?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Parkinsonism‑hyperpyrexia syndrome: an acute hypodopaminergic state characterized by rigidity, fever, altered consciousness, elevated CK, rhabdomyolysis, and potential fatality

Explanation lettering: C = shown as B · B = shown as C · E = shown as D · D = shown as E

The abrupt cessation of levodopa in advanced Parkinson’s disease can precipitate Parkinsonism‑hyperpyrexia syndrome (PHS), a rare but potentially fatal emergency resembling neuroleptic malignant syndrome, marked by severe rigidity, hyperthermia, altered consciousness, autonomic instability, and elevated CK from rhabdomyolysis. Recognized UK guidance (NICE NG71) warns against abrupt withdrawal of antiparkinsonian drugs to avert neuroleptic malignant–type syndromes. NHS Scotland acute management resources explicitly name PHS as a fatal risk when levodopa stops suddenly or absorption fails. Options A, B, C, and D misrepresent or trivialize the clinical risk. Only E accurately describes the pathognomonic syndrome and its urgency.

Reference: NICE NG71 Recommendations (antiparkinsonian withdrawal risk), 2017 (last reviewed 2024); NHS Scotland acute Parkinson’s management NBM guidance, 2017 (reviewed 2019), https://www.nice.org.uk/guidance/ng71/chapter/Recommendations