Akinetic crisis or neuroleptic malignant syndrome
Hi, I am writing to try to explore treatment possibilities to discuss with the doctor of a close relative of mine who is evidently suffering from either an akinetic crisis or NMS.
Brief background— 68 m history of normal pressure hydrocephalus and possible Parkinson’s like syndrome but no clear Parkinson’s dx. Presented to ER with intractable hiccups per PC doc to rule out stroke or cardiac causes. Workup was ok. Given dose of metoclopromide to treat hiccups, which worked temporarily. Next day began experiencing severe weakness and collapsed at home several times. Returned to ER and found to have fever. Admitted with suspicion of sepsis and at some point given Thorazine.
Days 1-3 of hospital admit given high dose broad spectrum antibiotics and fever control. Fever oscillated up to 103 degrees. Patient became more rigid and unable to walk. Shunt tapped day 4 to assess for infection. Day 5 improvement and could stand and walk 10 feet with assistance.
Slowly began to lose the ability to walk, use arms or speak over the course of a few more days. Transfer scheduled to higher level hospital which took two days. At higher hospital full assessment took another couple of days. After CTs, MRI of brain and spine, EEG and PET scans, nothing remarkable (eeg showed “mild encephalopathy). Blood exams unremarkable. CSF and blood cultures with no growth and meningitis panel negative. Antibody (for autoimmune encephalitis) panel pending but PET didn’t indicate encephalitis.
At this point they believe it is Parkinsonism triggered by the acute illness at the beginning and the medication. They began dose of sinemet 25/100 three days ago with very mild improvement in alertness. Still trouble speaking but oriented x3. However dysphagia developed and the had to insert NG tube so missed day 4 of sinemet. Back on tomorrow with plan to transfer to skilled nursing in 2 days or so.
My question is: I feel like the therapeutic treatment he’s received has been feeble and I would like to know that treatment is working (confirming the suspected diagnosis) before transferring to SNF. Otherwise we still don’t know what the root cause is. What other treatments could be explored? Prior to the day he saw PC doc, he was living independently, walking with cane, climbing stairs, using phones and technology. Now physically can’t do anything. Docs have given us a hopeful prognosis but I fail to see what it is based on… please advise what I should discuss with them before we don’t have access to neurologists every day and he’s under the care of one medical director for the whole SNF.
Many thanks.