Integrating Physiotherapy in Neuroleptic Malignant Syndrome Management: A Case Report

Abstract

Neuroleptic malignant syndrome (NMS) is a rare but potentially fatal condition characterized by hyperthermia, autonomic dysregulation, altered mental status, and muscular rigidity. It typically results from the blockade of dopamine receptors by antipsychotic medications. We present the case of a 70-year-old female who developed NMS after non-compliant use of clozapine. She presented with symptoms including irrelevant talk, breathlessness, and generalized muscle weakness. On examination, she was drowsy with a Glasgow Coma Scale score of 11, tachycardia, tachypnea, and hypertonicity in all limbs. Diagnostic evaluations revealed increased urea and creatinine levels, raised creatine phosphokinase, and metabolic acidosis, which are consistent with NMS. Medical management included the discontinuation of clozapine and the initiation of bromocriptine. The report emphasizes how important physical therapy is to the NMS recovery process. The goals of physical therapy were to improve functional mobility, lessen muscle rigidity, and avoid problems from extended immobility. Kinesthetic stimulation, active cycle breathing methods, soft rocking motions, neural warmth, weight-bearing exercises, and mobility training were all incorporated into the protocol. Significant progress was observed in the patient's degree of consciousness, movement, and oxygen reliance over a two-week period. With the patient eventually managing room air without additional oxygen, the Glasgow Coma Scale score improved, and the ICU Mobility Scale score increased from 1 to 5. This instance emphasizes the need for prompt diagnosis and all-encompassing NMS care, with physiotherapy playing a critical role. Physiotherapy can significantly enhance overall healing, improve respiratory function, and facilitate neuromuscular re-education through tailored therapies. The results indicate that physiotherapy has to be regarded as a crucial component of the multidisciplinary strategy for managing NMS, with the goal of enhancing patient outcomes and quality of life. More studies are required to optimize physiotherapy interventions for NMS patients.