Increased incidence of akinetic crises in Parkinson's disease patients treated with Levodopa-Carbidopa Intestinal Gel: A case series and review of the literature.

Akinetic crisis (AC) is a severe, potentially life-threatening condition affecting individuals with Parkinson's Disease (PD). Similar to neuroleptic malignant syndrome, AC is characterized by a rapid worsening of motor symptoms, including bradykinesia, rigidity, and dysphagia. Additional symptoms may include hyperthermia and autonomic dysfunction. Large-scale prospective studies indicate that the incidence of AC among PD patients ranges from 3.1 % to 3.9 %. In our department, we recorded nine episodes of AC in seven out of 44 patients treated with Levodopa-Carbidopa Intestinal Gel (LCIG) since 2011. This incidence rate is notably higher than the figures reported in larger studies. No significant differences were observed between our patients and those in previous studies, except for mean disease duration. Therefore, LCIG therapy may be linked to a higher incidence of AC. Notably, one of our patients with a parkin gene mutation experienced AC three times. This aligns with previous findings that genetic PD, particularly with parkin mutations, is associated with a higher risk of AC, especially recurrent episodes. Further research is necessary to definitively establish a link between LCIG treatment and AC. Large-scale prospective studies are needed to assess the potential increased risk of this serious complication, which can significantly impact morbidity and mortality in advanced PD patients.