Sudden Cessation of Parkinson’s Treatment
Today, my 78-year-old mother-in-law was admitted to the hospital due to a high fever reaching 103°F. It’s been almost 24 hours since she last received her Parkinson’s medications. She is prescribed Carbidopa-Levodopa 25/100, taken four times a day, in addition to Entacapone 200 mg, also administered four times daily. My mother-in-law has been battling Parkinson’s disease and recently endured a fall two weeks ago, which caused a T12 burst fracture. Prior to this incident, she was on the verge of stage 5 Parkinson’s, managing to use a walker for mobility, although she required assistance to sit and rise. While she could feed herself as long as the food was appropriately cut, her ability to handle utensils was somewhat limited. There were moments of hallucinations and episodes where she became irritable with her husband, but she also had times when she appeared quite lucid and ‘normal.’ After her fall, she spent around ten days in the hospital. During that time, she underwent an MRI while under anesthesia due to her tremors and anxiety about enclosed spaces. Unfortunately, post-MRI, there seemed to be a decline in her mental clarity. She exhibited persistent sadness, frustration, and tears, often expressing a strong desire to leave the hospital, directed at her husband, which could be classified as hospital delirium. The medical team noted the burst fracture was stable, treating it conservatively with a TLSO brace and physical therapy. When the physical therapist visited, she struggled to stand, requiring support from three individuals, raising concerns about her future mobility. Upon her discharge on Friday afternoon to a skilled nursing facility, her emotional state appeared unchanged, with continued agitation and sadness. By Saturday, she remained visibly distressed and tearful. However, on Sunday, her condition shifted dramatically; she became somewhat catatonic, with eyes closed but still capable of eating, drinking, and responding to certain commands when asked, while also requesting a bedpan. On Monday, the skilled nursing staff detected she had developed a fever and transported her to the emergency room. Reports indicated she vomited during the transfer. After thorough checks, the medical team found no signs of infection but has been administering fluids throughout the day. As of now, her fever has subsided, and vital signs are stable, albeit with a slightly low blood pressure. Her current state is concerning; she is largely unresponsive, twitching and trembling, intermittently moaning and attempting to express herself, though often nonsensical. I learned that she hasn’t received any medication for her Parkinson’s today due to her being designated NPO (nothing by mouth), pending an evaluation by a speech-language pathologist before reintroducing anything orally. I’ve come across information regarding the risks associated with abruptly halting Parkinson’s medication, which may be contributing to her tremors, distress, and current condition. I also worry that this might have resulted from negligence in administering her medication at the skilled nursing facility. My husband has raised this issue with the nursing staff and requested an urgent visit from a physician; however, hours have passed with no response. What steps should we take next? We plan to request a hospice consultation, focusing solely on comfort care, but I’m anxious that the abrupt cessation of her medications is inflicting unnecessary suffering on her.
Answers (1)
2/17/2026, 12:20:46 AM
OpenHealth AI
I'm really sorry to hear about your mother-in-law's situation. It sounds extremely challenging for both her and your family. The abrupt cessation of Parkinson's medications can indeed lead to significant distress and physical challenges, and it's vital to address this as quickly as possible.
Main Points:
- Medication Disruption Impact: Stopping Parkinson's medications suddenly can lead to increased tremors, rigidity, and other distressing symptoms, including confusion and emotional fluctuations.
- Current Hospital Care: It's good that she is being monitored, but immediate action is essential, especially given her unresponsiveness and the concerning changes in her condition.
- Urgent Next Steps: Ensure that her medical team is aware of the need to resume her Parkinson's medications as soon as possible and advocate for a thorough evaluation.
Explanation:
Medications like Carbidopa-Levodopa and Entacapone are critical for managing Parkinson's symptoms. When these medications are missed, especially over a longer period, patients can experience a rebound effect, worsening their mobility, cognitive clarity, and emotional stability. The agitation, catatonia, and confusion you describe can be exacerbated by withdrawal from these medications.
Furthermore, her recent experiences in the skilled nursing facility, particularly related to fluid management and potential swallowing difficulties, may have created added complexity in her care.
Next Steps:
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Advocate for Medication Resumption: While in the hospital, insist that the medical team considers resuming her Parkinson's medications as soon as her clinical status allows, even if it means adjusting the route of administration (e.g., through a feeding tube if necessary).
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Communicate with Care Team: Continue discussing your concerns with the nursing staff about her severe symptoms and make absolutely clear the urgency of resuming her treatment. Ask for the on-call physician or a neurologist to evaluate her condition directly.
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Request a Speech-Language Pathology Assessment ASAP: Ensure that an assessment occurs promptly so that oral intake can be safely resumed, allowing her medications to be administered.
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Document Everything: Keep a detailed record of her symptoms, the timing of medications, and any communication you've had with the care team. This documentation can be crucial if additional action is required later.
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Consider Palliative Care Options: Engaging with hospice or palliative care services can indeed be beneficial, even if the focus remains on comfort care. They can provide support and enhance quality of life if that becomes necessary.
Supportive Measures:
- Ensure that family members are present, as familiar faces can often provide comfort and reassurance during challenging emotional moments.
- Monitor her hydration and nutrition status, even in the face of NPO status, using the care team to help with managing any potential nutritional needs she may require.
Your care and concern for her comfort during this difficult time are evident. It’s important to stay persistent in advocating for the necessary adjustments in her care to improve her quality of life. Please take care, and be sure to continue expressing your concerns to the medical team effectively.
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