Malignes neuroleptisches Syndrom durch Amisulprid

Abstract

Malignant neuroleptic syndrome (MNS) is a rare side effect of antipsychotic medications but means a serious and life-threatening complication. The risk of MNS seems to be lower for second generation antipsychotics (SGA). We report the 9-month history of a 42-year-old female patient whose antipsychotic medication was switched to 800 mg per day of amisulpride. Two weeks after discharge she suffered muscular pain, stiffness, weakness of the legs, rigor, and fever. After attending our outpatient department and being diagnosed, she was transferred to the neurological intensive unit, where the creatine kinase (CK) level was measured at 160,000 U/l. Furthermore extensive rhabdomyolysis accompanied by a compartment syndrome was seen. Surgical intervention was necessary for the latter. The patient was then retransferred to the psychiatric department after treatment with lorazepam and withdrawal of antipsychotic medications. In addition a therapy with valproate sodium was conducted. Long-term high levels of CK and abnormalities in the electromyogram led to the hypothesis of myopathy as a possible risk factor, but a final diagnostic classification was not feasible. This report describes the appearance of a MNS as a consequence of SGA therapy, discusses risk factors and therapy options, and shows the 9-month course.

Neuroleptic malignant syndrome: an easily overlooked neurologic emergency

“…In other words, the syndrome can still be encountered even with the availability of the second-generation of newly designed agents,132 although the clinical picture might be milder than what is encountered in NMS with typical antipsychotics 10,11. Amisulpride, a relatively newly designed atypical antipsychotic, has also been shown to be associated with the occurrence of NMS 133. This has to be attributed to the fact that we do not know the nature of the exact biological changes that occur in the neurons of psychotic patients.…”

Neuroleptic malignant syndrome associated with amisulpride and lithium: a case report

“…There were no cases of NMS associated with amisulpride reported in these two reviews [3,18]. However, we found six single case studies of NMS during amisulpride treatment described in the literature since 2004 [19][20][21]. In three of these cases the contribution of additional factors was present, i.e.…”

“…In three of these cases the contribution of additional factors was present, i.e. addition of oxcarbazepine to amisulpride, myopathy and chronic toxic encephalopathy [19,20]. In one of the cases lethal amisulpride-induced neuroleptic malignant syndrome was diagnosed at autopsy [21].…”