Treatment of Parkinson's Disease in Akinetic Crisis

An akinetic crisis is a severe, acute deterioration in Parkinson's disease requiring prompt recognition and urgent, structured management — ideally in an intermediate or intensive care setting, particularly when complications arise.

Clinical scenario

Akinetic crisis demands early and adequate treatment. When complications develop, care in an intermediate or intensive care unit is recommended. Rapid identification and management of precipitating risk factors — such as intercurrent infections — is a priority.

Approach overview

Management involves immediate correction of any triggering risk factors alongside comprehensive supportive measures. Restoring adequate dopaminergic stimulation through alternative delivery routes is central to the approach; additional non-dopaminergic agents may also have a role in select situations. Full regimen — routes, agents, sequencing, and monitoring details — available in the complete protocol below.

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References

DOI: 10.1186/s42466-024-00325-4

Adequate treatment for an akinetic crisis should be given early and sufficiently, ideally in an intermediate or intensive care unit, especially if complications develop.

Risk factors that can cause an akinetic crisis, such as infections, should be treated immediately.

Supportive therapy approaches such as fluid intake, thrombosis prophylaxis, fever-reducing measures and regular monitoring of vital functions should be implemented.

Dopaminergic medication in the form of soluble levodopa via a nasogastric tube, subcutaneous or sublingual application of apomorphine or transdermal rotigotine should be ensured.

Non-dopaminergic drugs such as intravenous amantadine sulphate should be considered or, in specific cases, benzodiazepines.

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