Multiple episodes of NMS: overlap with malignant catatonia

Hardy, Kate; Evans, Robert C.

doi:10.1002/pnp.412

Cited by 3 publications

(2 citation statements)

References 9 publications

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“…Catatonia responds to benzodiazepines and ECT [1,5]. Reports indicate that malignant catatonia overlaps with NMS [6]. Bromocriptine is used for treating NMS [7,8].…”

Section: Discussionmentioning

confidence: 99%

Malignant Catatonia Requiring High Dose Bromocriptine: Case Report

Meresh¹,

Korneffel²,

Rajah³

et al. 2021

OBM Neurobiology

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Catatonia can occur in patients diagnosed with schizophrenia and bipolar disorder and malignant catatonia is life threatening. Anti-psychotic medications should be discontinued during acute phase of catatonia. Anti-psychotic discontinuation in catatonia is a challenge in patients maintained on long-acting injectable antipsychotics because of the extended release. Case report: We present a case of malignant catatonia developed in a patient with history of schizophrenia and developmental delay. Symptoms lasted several weeks as he was recently administered long acting injectable antipsychotic medication, requiring high dose Bromocriptine treatment. Patient required several days of bromocriptine treatment. Because of the shorter half-life, frequent and higher dosing of bromocriptine led to resolution of malignant catatonia. Malignant catatonia is a medical emergency and prompt treatment including high dose bromocriptine could lead to resolution of catatonia.

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“…Catatonia responds to benzodiazepines and ECT [1,5]. Reports indicate that malignant catatonia overlaps with NMS [6]. Bromocriptine is used for treating NMS [7,8].…”

Section: Discussionmentioning

confidence: 99%

Malignant Catatonia Requiring High Dose Bromocriptine: Case Report

Meresh¹,

Korneffel²,

Rajah³

et al. 2021

OBM Neurobiology

View full text Add to dashboard Cite

show abstract

“…With high symptom overlap, NMS is phenomenologically and physiologically related to malignant catatonia. The distinction, however, is that NMS is related to effective DA depletion such as antipsychotics (DA antagonists) or the withdrawal or rapid cessation of a dopaminergic agonist (4)(5)(6). Perhaps NMS lies on the most extreme continuum of severity of an underlying, diverse condition known as catatonia with its incompletely understood pathophysiological processes (7).…”

Section: Introductionmentioning

confidence: 99%

Rapid symptom control in neuroleptic malignant syndrome with electroconvulsive therapy: A case report

et al. 2023

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IntroductionNeuroleptic malignant syndrome (NMS), thought to arise through dopamine antagonism, is life-threatening. While prompt diagnosis of NMS is critical, it may be obscured by other diagnoses, such as malignant catatonia, with overlapping, life-threatening symptoms. Initiation of dopamine-blocking agents such as antipsychotics and abrupt cessation of dopaminergic medications such as amantadine can precipitate NMS. Once NMS is suspected, deft medical management should ensue. Multiple case reports detail electroconvulsive therapy’s (ECT’s) effectiveness in the treatment of NMS. While this relationship is well-documented, there is less literature regarding comparative efficacy of ECT in the acute treatment of NMS-like states precipitated by withdrawal of dopamine agonists, such as amantadine.CaseWe present a 52-year-old female with schizoaffective disorder bipolar type, with a history of a lorazepam-resistant catatonic episode the prior year that had responded to amantadine. She presented febrile with altered mental status, lead pipe rigidity, mutism, grasp reflex, stereotypy, autonomic instability, and a Bush-Francis Catatonia Rating Scale (BFCRS) of 24, suggesting malignant catatonia versus NMS. There was concern over a potentially abrupt cessation of her amantadine of which she had been prescribed for the past year.InterventionsOrganic etiologies were ruled out, and a presumptive diagnosis of NMS was made with central dopaminergic depletion from abrupt dopamine agonist (amantadine) withdrawal as the suspected underlying etiology. After intravenous lorazepam and reinduction of amantadine failed to alleviate her symptoms, urgent ECT was initiated. Our patient received an index series of ECT of seven treatments. After ECT #1 she was no longer obtunded, after treatment #2 her symptoms of mutism, rigidity, stereotypy, and agitation showed improvement, and by ECT #3, the NMS had rapidly dissipated as evidenced by stable vital signs, lack of rigidity, and coherent conversation.ConclusionBrisk identification of potentially life-threatening NMS and NMS-like states, including malignant catatonia, warrants a trial of ECT. ECT’s theoretical mechanisms of action coincide with the theoretical pathophysiology of the conditions. It is a viable and safe treatment option for reducing mortality. With prompt initiation of ECT, we obtained rapid control of a condition with a potentially high mortality.

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Antipsychotics

2016

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Multiple episodes of NMS: overlap with malignant catatonia

Cited by 3 publications

References 9 publications

Malignant Catatonia Requiring High Dose Bromocriptine: Case Report

Malignant Catatonia Requiring High Dose Bromocriptine: Case Report

Rapid symptom control in neuroleptic malignant syndrome with electroconvulsive therapy: A case report

Antipsychotics

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