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The akinetic crisis is a relatively rare event, however subacute mild-moderate motor symptom deterioration in Parkinson\u00b4s disease (PD) patients is a frequent cause of hospitalization. In this review, we propose that the akinetic crisis is the upper end of a continuous spectrum of acute akinetic states depending on the degree of the progressive levodopa-resistance. Clinical symptomatology, risk factors, and instrumental diagnostics as the DAT-SPECT reflecting a biomarker of levodopa-resistance will be discussed to evaluate the spectrum of akinetic states. Pathophysiological considerations about the potential role of proinflammatory cytokines on the progressive levodopa-resistance will be discussed and therapeutical, consensus-based guidelines will be presented.<\/jats:p>","DOI":"10.1007\/s00702-024-02817-8","type":"journal-article","created":{"date-parts":[[2024,8,17]],"date-time":"2024-08-17T15:02:05Z","timestamp":1723906925000},"page":"1199-1207","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["The akinetic crisis in Parkinson\u00b4s disease- the upper end of a spectrum of subacute akinetic states"],"prefix":"10.1007","volume":"131","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7680-2147","authenticated-orcid":false,"given":"Monika","family":"P\u00f6tter-Nerger","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Schrader","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfgang H.","family":"Jost","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00fcnter","family":"H\u00f6glinger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,8,17]]},"reference":[{"key":"2817_CR27","doi-asserted-by":"publisher","first-page":"1349","DOI":"10.1007\/s00702-023-02693-8","volume":"130","author":"A Antonini","year":"2023","unstructured":"Antonini A, D\u2019Onofrio V, Guerra A (2023) Current and novel infusion therapies for patients with Parkinson\u2019s disease. 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CS reports honoraria from Abbvie, Desitin, Medtronic and Ever Pharma outside the submitted work. WHJ reports personal (lector and\/or consultant) or study fees from Abbvie, Bial, Desitin, Esteve, Merz, Stada, Zambon outside the submitted work. GH has ongoing research collaborations with Roche, UCB, Abbvie; serves as a consultant for Abbvie, Alzprotect, Amylyx, Aprinoia, Asceneuron, Bayer, Bial, Biogen, Biohaven, Epidarex, Ferrer, Kyowa Kirin, Lundbeck, Novartis, Retrotope, Roche, Sanofi, Servier, Takeda, Teva, UCB; received honoraria for scientific presentations from Abbvie, Bayer, Bial, Biogen, Bristol Myers Squibb, Kyowa Kirin, Pfizer, Roche, Teva, UCB, Zambon; received publication royalties from Academic Press, Kohlhammer, and Thieme.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}