When time is of the essence: Managing care in emergency situations in Parkinson's disease.

A movement disorder emergency is an acute or sub-acutely evolving neurological illness predominated by a primary movement disorder. Although Parkinson's disease (PD) is a chronic, progressive disorder, patients may present with a variety of acute symptoms. Timely diagnosis and management is crucial to reduce mortality and morbidity. The underlying causes of an emergency in PD may be attributable to either disease related emergencies which occur as a direct consequence of the disease pathophysiology or secondary to anti-parkinsonian medications, such as Parkinsonism-hyperpyrexia syndrome, acute psychosis, etc. Indirect disease related emergencies, are those which not directly associated with the disease but occur secondary to deficits produced by the disease, e.g. falls and pneumonia. Emergencies in patients with PD may also be related to deep brain stimulation or systemic illnesses which are unrelated to PD. Complications may also occur during the surgical management of patients with PD owing to the effects of the disease on cardiovascular and respiratory functions or interactions of PD medication with anesthetic agents. Additionally, although motor complications are expected to form a majority of ER admissions in PD, several studies have reported indirect or non-PD related complications as the predominant primary reason for emergency admissions. The present article aims to review emergencies encountered in patients with PD with focus on the identification and management of these emergencies.