Table 1.
Comparison of neuroleptic malignant syndrome, akinetic crisis, and malignant STN‐DBS withdrawal syndrome
| Feature | Neuroleptic Malignant Syndrome | Akinetic Crisis | Malignant STN‐DBS Withdrawal Syndrome |
|---|---|---|---|
| Underlying illness | Psychosis | PD/atypical parkinsonism | PD |
| Precipitating factor | Antipsychotic use, typical > atypical | Dopaminergic drug withdrawal, surgery, trauma, infection | Abrupt cessation of neurostimulation |
| Pathophysiology: presynaptic | Normal | Low DAT activity; near absent DAT activity in the striatum during crisis | ?Low DAT activity |
| Synaptic dopamine | Normal | Fluctuating/high | Low |
| Postsynaptic | D2 blockade striatum and anterolateral hypothalamus | Slightly reduced D2 receptor binding in l‐dopa‐treated individuals | ?Downregulation/reduced affinity of receptors;postsynaptic striatal dendritic degeneration in advanced PD |
| Fever | +++ | +/− | +/− |
| Autonomic instability | ++ | +/− | +/− |
| Muscular rigidity | +++ | +++ | +++ |
| Elevated muscle enzymes | +++ | ++ | ++ |