Rotigotine and parkinsonism-hyperpyrexia syndrome.

Introduction: Parkinsonism-hyperpyrexia syndrome (PHS) is a potentially fatal complication of Parkinson's disease (PD) often triggered by antiparkinsonian medication discontinuation or reduction. Rotigotine, a transdermal dopamine agonist, provides continuous drug delivery and can be administered even when oral administration is difficult. However, the association between rotigotine use and development of PHS remains unclear. Methods: We retrospectively reviewed 166 episodes of emergency hospitalization for PD at Hyogo Medical University Hospital (2010-2024). After excluding 19 episodes with insufficient data, 147 were analyzed. Thirty episodes met the diagnostic criteria for PHS (PHS group), and 117 episodes did not (non-PHS group). Clinical characteristics, antiparkinsonian medications, and precipitating events during hospitalization were assessed. A multivariable logistic regression analysis was performed using age, sex, disease duration, and rotigotine administration as covariates. Results: The PHS group had a shorter disease duration, lower modified Hoehn and Yahr stages, and a lower levodopa equivalent dose than the non-PHS group. Poor medication compliance was the most common precipitating factor among PHS cases (n = 11, 36.7%). Rotigotine was administered in five PHS and 41 non-PHS episodes. In the multivariable analysis, age was significantly negatively associated with the development of PHS (odds ratio [OR], 0.894; 95% confidence interval [CI], 0.840-0.952; p = 0.0005). And rotigotine administration showed a tendency to suppress the development of PHS (OR, 0.353; 95% CI, 0.121-1.031; p = 0.0569). Conclusion: Although not statistically significant, rotigotine use tends to be associated with a lower incidence of PHS. Maintaining good medication adherence is critical for preventing PHS, and we consider that rotigotine may be a useful therapeutic option.