Table 1.

Precipitant factors of severe off and the parkinsonism-hyperpyrexia syndrome

Dopaminergic treatment related	Non-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