<p>Neuroleptic Malignant Syndrome: Early Diagnosis Saves Lives in Low-Resource Settings</p>

Abstract

Context: Neuroleptic malignant syndrome (NMS) is an uncommon but serious adverse event to antipsychotic medications. Case Details: A 14-year-old Ugandan lady presented with high grade fevers, multiple convulsions, altered mentation and lead-pipe rigidity following an intramuscular injection of zuclopenthixol acetate (as Clopixol-Acuphase ®). Her labs were significant for elevated aminotransferases and leucocytosis. She had a normal brain CT scan, renal function and cerebrospinal fluid analysis. Discontinuation of Clopixol, administration of bromocriptine 5mg once daily and dantrolene 25mg three times a day and supportive treatment resulted in a complete neurological recovery within 4 weeks of the onset of symptoms. Discussion: Early diagnosis and prompt supportive therapy are required to reduce mortality and morbidity. Early recognition of symptoms and discontinuation of offending agent by health care providers are needed to have recovery even in settings with limited resources.

Extrapyramidal Side Effects in a Patient with Alcohol Withdrawal Symptoms: A Reflection of Quality of the Mental Health Care System

“…Then, discontinuation of the offending drugs or dose reduction, followed by different treatment modes depending on the EPS symptoms as needed ( Table 2 ). 2 , 29–31 However, the management of EPS patients with addiction disorders is likely challenging since most of the medications used to control EPS symptoms have addictive properties – for example, trihexyphenidyl, benzodiazepines, barbiturates and stimulants. 4 , 32–34 This increases the risk of reward effect to the newly introduced substance to treat the EPS.…”

“…Besides, the caution of addictive drugs is highly suggested being added in the health awareness programs with the motto of “no drug should be used without a physician's recommendation”. 29 …”

“…Starting dose 25 mg daily for 1 week; increase by 25 mg per day every few days Valbenazine 40–80 mg PO. Starting dose 40 mg daily; can increase to 80 mg per day after 1 week Neuroleptic malignant syndrome 29 , 31 , 35 Bromocriptine 2.5 mg PO/via NG tube. Starting dose 2.5 mg 2 or 3 times a day; can increase by 2.5 mg every 24 hours until response.…”

Bromocriptine therapy: Review of mechanism of action, safety and tolerability

“…Bromocriptine can be used in combination with dantrolene for more pronounced treatment effects or recommended as an add on therapy to the dantrolene 178,182 . Moreover, few case reports have mentioned the use of bromocriptine for management of NMS associated with use of zuclopenthixol 183,184 …”

“…Improvements of extrapyramidal symptoms in hepatic encephalopathy have been reported by some researchers after adding bromocriptine therapy as third line agent to the conventional therapy 201 . Similarly, several case reports has been filed by researchers against the successful use of bromocriptine therapy as an adjunct therapy to the primary treatment in NMS, 178,180,184 alcohol withdrawal syndrome, 18,192 HC 211 and in various neurological disorders, 216 whereas to check its effectiveness in cognitive control and working memory as well as in endometriosis, etc, various animal and human studies have also been conducted 130,221,223 . Furthermore, off label use of bromocriptine has been reported for the treatment of Cushing's disease, 281 OHSS 32 and researchers also suggest bromocriptine as an effective adjunct agent in various cancer treatment protocols 282,296 304,308 310 …”