Treatment of Neuroleptic Malignant Syndrome

Abstract

Neuroleptic malignant syndrome (NMS) was first described in the 1960s after the introduction of the dopamine receptor-blocking antipsychotic agents. Any drug with this pharmacologic profile, including the modern atypical antipsychotic agents and the antiemetic agent metoclopramide, can cause the typical syndrome consisting of all or some of the classical clinical features of hyperthermia, muscle rigidity, autonomic disturbance, and mental status changes. An almost identical syndrome, Parkinson-hyperpyrexia syndrome, can result from abrupt reduction or withdrawal of dopaminergic therapy in Parkinson’s disease patients. Although there are few formal studies assessing the efficacy of proposed treatments for NMS, bromocriptine and dantrolene are the most widely accepted medical treatments for this condition. Electroconvulsive therapy is useful in intractable cases. Most patients should be cared for in an ICU to adequately treat autonomic, respiratory, and renal complications. With treatment, most patients with NMS recover in 1–2 weeks, but recent surveys show an overall mortality of 5%.