Table 2.

The clinical features of all DHS cases

Report	A/G/YOD	Season	Possible triggers	Anti-Parkinsonism medications before DHS	Levodopa equivalent daily dose	Symptoms and complications	Duration of DHS	Treatment	Outcome
Gil-Navarro, 2010 [4]	68/F/12	NA	NA	Levodopa/carbidopa/entacapone (5 daily doses of 150/50/200 mg) Pramipexole 4 mg per day Amantadine 200 mg per day	1680 mg	Peak body temperature 41.2 °C Generalized dyskinesias Confusion and hallucination CK = 1455 IU/L Tachycardia	Within 6 days	Intravenous fluids Antipyretic Pramipexole tapered off Quetiapine 25 mg	Recovery
Lyoo, 2011 [7]	74/M/17	NA	Dopaminergic drug dose increase (levodopa 1050 mg increased to 3400 mg)	12 tablets of levodopa/carbidopa 250/25 mg per day 4 tablets of levodopa/benserazide 100/25 mg per day	3400 mg	Peak body temperature 38.2 °C Generalized dyskinesias Consciousness was normal CK = 24,651 IU/L Acute renal injury (176.8 µmol/L)	5 days	Sedative Dopaminergic drug was stopped	Recovery
Taguchi, 2015 [8]	70/F/13	Autumn	Dopaminergic drug form change (pramipexole IR to ER)	Levodopa 600 mg per day Pramipexole (ER) 3 mg per day Selegiline 5 mg per day	950 mg	Peak body temperature 40.3 °C Generalized dyskinesias Confusion and hallucination CK = 35,000 IU/L Tachycardia	7 days	Intravenous fluids Antipyretic Reduced dopaminergic drugs	Recovery
Herreros, 2016 [9]	74/F/16	Summer (8 episodes from 2007 to 2009)	High ambient temperature	NA	1390 mg	Peak body temperature 39 °C Generalized dyskinesias Consciousness was normal CK = 845 IU/L	NA	After the summer of 2009, the patient started to receive an LCIG (1310 mg/d)	Recovery
			High ambient temperature	NA	975 mg	Peak body temperature 40 °C Generalized dyskinesias Consciousness was normal CK = 1008 IU/L	NA		Recovery
			High ambient temperature	NA	975 mg	Peak body temperature 39.6 °C Generalized dyskinesias Consciousness was normal CK = 2509 IU/L	NA		Recovery
			High ambient temperature	NA	826 mg	Peak body temperature 38.8 °C Generalized dyskinesias Consciousness was normal CK = 211 IU/L	NA		Recovery
			High ambient temperature	NA	826 mg	Peak body temperature 38.3 °C Generalized dyskinesias Consciousness was normal CK = 178 IU/L	NA		Recovery
			High ambient temperature	NA	670 mg	Peak body temperature 40.2 °C Generalized dyskinesias Consciousness was normal CK = 257 IU/L	NA		Recovery
			High ambient temperature	NA	NA	Peak body temperature NA Generalized dyskinesias Consciousness was normal CK = NA	NA		Recovery
			High ambient temperature	NA	NA	Peak body temperature NA Generalized dyskinesias Consciousness was normal CK = NA	NA		Recovery
Acebrón Sánchez-Herrera, 2017 [10]	66/F/16	Summer	High ambient temperature/dopaminergic drug dose increase	LCIG (1450 mg/d and 362.5 mg/day) Amantadine 200 mg per day Ropinirole (ER) 8 mg per day Safinamide 100 mg per day	1810 mg	Peak body temperature 40.2 °C Generalized dyskinesias Confusion and hallucination CK = 7177 IU/L	4 days	Intravenous fluids Antipyretic Sedative LCIG reduced Amantadine, ropinirole and safinamide were stopped	Recovery
Baek, 2017 [11]	74/F/23	Spring (72 years old)	Trauma/infection	Levodopa 375 mg per day Pramipexole (ER) 1 mg per day Amantadine 200 mg per day	675 mg	Peak body temperature 40.3 °C Generalized dyskinesias Confusion and hallucination CK = 10,230 IU/L Acute renal injury (142 µmol/L) Aspiration pneumonia	4 days	Sedative Antibiotic LCIG reduced Amantadine and pramipexole were stopped	Recovery
		Spring (74 years old)	Trauma/infection	Levodopa 500 mg per day Pramipexole (ER) 1 mg per day Amantadine 300 mg per day	900 mg	Peak body temperature 39.2 °C Generalized dyskinesias Confusion CK = 6670 IU/L Acute renal injury (108 µmol/L)	1 day	Intravenous fluids Antipyretic Levodopa reduced to 300 mg and pramipexole stopped	Recovery
Sarchioto, 2018 [12]	80/M/20	Summer	High ambient temperature/infection	LCIG 1500 mg per day Pramipexole 1 mg per day Amantadine 200 mg per day Sertraline 50 mg per day	1550 mg	Peak body temperature 42 °C Generalized dyskinesias Confusion and lethargy CK = 16,040 IU/L Acute renal failure (186.5 µmol/L) Pneumonia	5 days	Intravenous fluids Antipyretic Antibiotics Pramipexole and amantadine stopped LCIG reduced to 700 mg	Death
	76/F/10	Summer	High ambient temperature/infection	LCIG 1200 mg per day Pramipexole 1 mg per day	1060 mg	Peak body temperature 41 °C Generalized dyskinesias Stupor CK = 2967 IU/L Pneumonia Respiratory failure	1 day	Antibiotics	Death
	79/F/30	Summer	High ambient temperature/infection	LCIG 1250 mg per day	1000 mg	Peak body temperature 39.5 °C Generalized dyskinesias CK = 1967 IU/L Pneumonia Acute renal injury (175 µmol/L)	Within 10 days	Intravenous fluids Antibiotics LCIG reduced to 675 mg	Recovery
Novelli, 2019 [13]	62/M/34	Summer	High ambient temperature/infection	STN-DBS (R-3 V, L-2.6 V) Levodopa/carbidopa 250/25 mg 8 daily doses per day Entacapone 200 mg 8 daily doses per day	2528 mg	Peak body temperature 40.7 °C Generalized dyskinesias Confusion CK = 4891 IU/L Tachycardia	2 days	Intravenous fluids Antipyretic agents Antibiotics DBS reduced to 1 V bilaterally Levodopa/carbidopa 125/12.5 mg 6 daily doses per day Entacapone 200 mg 6 doses per day	Recovery
Zu, 2021 [14]	76/F/16	NA	Dopaminergic drug dose increase (levodopa/carbidopa sustained-release tablets from 600/150 mg increased to 750/75 mg)	Levodopa/carbidopa sustained-release tablets 750/75 mg per day Entacapone 300 mg per day Rasagiline 1 mg per day	1150 mg	Peak body temperature 40.2 °C Generalized dyskinesias Unconsciousness CK = 2489 IU/L Tachycardia	Within 10 days	Reduced dopaminergic drugs	Recovery

A age, G gender, YOD years of Parkinson’s disease, M male, F female, NA not available, IR immediate-release, ER extended-release, LCIG levodopa-carbidopa intestinal gel, STN-DBS subthalamic nucleus deep brain stimulation, CK creatine kinase,