The neuroleptic malignant syndrome: agent and host interaction

Abstract

This review comprises an exhaustive analysis of 120 case reports of neuroleptic malignant syndrome (NMS) representing the majority of published clinical data on this syndrome. Epidemiological, clinical and biological parameters, as well as those concerning the agent and the treatment of the syndrome, are critically evaluated on the basis of this data. The rate of neuroleptic loading is shown to play a cardinal role in the development of NMS. Rechallenge and aftercare of patients who need anti-psychotic treatment after NMS are considered.

Encephalopathy Associated with Psychotropic Drug Therapy

“…Once antipsychotics are stopped, NMS is self-limited barring complications, with the duration to resolution of NMS up to two weeks in the majority of cases (Shalev & Munitz, 1986;Addonizio et al, 1987;Caroff et al, 1988). The notion that prompt withdrawal of the offending agent at early stage can prevent progression to definite NMS has been corroborated by the study reported by Shiloh et al (2003).…”

“…Although the reported duration of exposure to antipsychotics prior to the development of NMS is extremely varied, the majority of cases occur within 1 to 2 weeks after the initiation of an offending drug (Shalev & Munitz, 1986;Addonizio et al, 1987;Caroff et al, 1988). Though nonspecific, the following signs and symptoms have been reported to precede NMS in some cases: unexpected changes in mental status, particularly obtundation or new-onset catatonia; episodic tachycardia, tachypnea, or hypertension; incontinence; low-grade temperature elevations; dysarthria, dysphagia, diaphoresis, sialorrhea, rigidity, myoclonus, tremor or other EPS unresponsive to antiparkinsonian agents; and unexplained elevation in serum CPK (Caroff et al, 1991;Caroff & Mann, 1993).…”

A successful management with electroconvulsive therapy of neuroleptic malignant syndrome due to amisulpride

“…ECT was also used in addition to the supportive therapy. ECT is a rapid and effective treatment for NMS and it was shown to decrease the complication incidence and obtain rapid improvement when it was used in the early periods of the syndrome (21)(22)(23). In addition to ECT, bromocriptine and dantrolene can be used to treat NMS (24).…”

Neuroleptic malignant syndrome induced acute renal failure: Is mental retardation an additional risk factor?

“…Mortality and morbidity rate are high among the NMS patients with mental retardation [29]. Acute renal failure develops in 16% of all cases of NMS and mortality increases by approximately 50 % [30,31].…”