Parkinsonism-Hyperpyrexia Syndrome Following Deep Brain Stimulation Battery Depletion during the COVID-19 Pandemic: A Case Series and Review of the Literature.

backgroundParkinsonism-hyperpyrexia syndrome (PHS) is a rare but life-threatening complication in Parkinson's disease (PD), typically triggered by abrupt withdrawal of dopaminergic therapy. It can also occur following deep brain stimulation (DBS) failure, most often due to battery depletion. Limited access to elective neurological care during the COVID-19 pandemic increased the risk of such DBS-related complications. CASES: We present seven patients with advanced PD who developed PHS following DBS battery depletion during the COVID-19 pandemic. All patients exhibited motor deterioration, autonomic symptoms, and elevated creatine phosphokinase levels. Despite varied outcomes, five patients recovered following urgent battery replacement and supportive care. Two patients died due to delayed intervention and systemic complications. LITERATURE REVIEW: A review of 38 published cases of PHS following DBS failure revealed that to date, it has occurred in patients with more than 11 years of PD and at least 2 years of DBS. IPG battery depletion was the leading cause of failure (68.4%), with 76.3% of patients recovering after timely device replacement. Delayed or absent intervention was associated with higher mortality, underscoring the importance of prompt diagnosis and management.

conclusionTimely intervention, remote monitoring, and virtual follow-up are critical to prevent PHS, especially during healthcare disruptions like the COVID-19 pandemic.