Neuroleptic malignant syndrome treatment

Kosten TR, Kleber HD Rapid death during cocaine abuse a variant of the neuroleptic malignant syndrome Am J Drug Alcohol Abuse 14 335-346, 1988 Kosten TR, Kleber HD, Morgan C Treatment of cocaine abuse with buprenorphine. Biol Psychiatry 26 637—639, 1989... 

Neuroleptic malignant syndrome is an acute iatrogenic condition caused by neuroleptics, characterized by tremor, catatonia, fluctuating consciousness, hyperthermia, and cardiovascular instability. It is relatively uncommon, occuring in 1-1.5% of patients but is fatal in 11-38%, most often due to cardiovascular collapse (Jahan et al. 1992). The pathogenesis of neuroleptic malignant syndrome is poorly understood, but it is believed to result from altered dopamine and serotonin transmission in the hypothalamus, spinal cord, and striatum. Treatment includes discontinuation of neuroleptics and administration of drugs that increase dopamine transmission bromocriptine or L-dopa (Jahan etal. 1992 Baldessarini 1996). 

Extrapyramidal symptoms (EPS) Dystonic reactions develop primarily with the use of traditional antipsychotics. EPS has occurred during the administration of haloperidol and pimozide frequently, often during the first few days of treatment. Neuroleptic malignant syndrome (NMS) A potentially fatal symptom complex sometimes referred to as NMS has been reported in association with administration of antipsychotic drugs. Clinical manifestations of NMS are hyperpyrexia, muscle rigidity, altered mental status, and evidence of autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis, cardiac dysrhythmia). Additional signs may include elevated creatine phosphokinase, rhabdomyolysis, and acute renal failure. 

Unlabeled Uses Treatment of cocaine addiction, hyperprolactinemia associated with pituitary adenomas, neuroleptic malignant syndrome... 

Unlabeled Uses Relief of exercise-induced pain in patients with muscular dystrophy, treatment of flexor spasms and neuroleptic malignant syndrome... 

The primary indication for ECT in adolescents is the short-term treatment of mood symptoms, depressive or manic (Walter et al., 1999). Mood symptoms in the course of major depression, psychotic depression, bipolar disorder, organic mood disorders, schizophrenia, and schizoaffective disorder respond well to ECT. Psychotic symptoms in mood disorders also respond well to ECT whereas the effectiveness of ECT in the treatment of psychotic symptoms in schizophrenia is doubtful. There are suggestions that other uncommon clinical conditions in adolescents such as catatonia and neuroleptic malignant syndrome also benefit from ECT. The effectiveness of ECT seems to lessen when there is a comorbid personality disorder or drug and/or alcohol problems. There are very few data about usefulness on prepubertal children. 

There have been no fatalities attributable to ECT that have been described in young persons. There is an account of a 16-year-old girl who had eight ECTs and died of cardiac failure 10 days after the last treatment (Kish et ah, 1990). However, her death is likely to have been due to the continued administration of neuroleptic medication in spite of her neuroleptic malignant syndrome. 

Other diagnostic indications. A few less well-known diagnostic indications for ECT exist. The use of ECT in patients with Parkinson s disease is receiving greater interest. ECT is an effective treatment for depressions associated with this illness and may also be of benefit for the motor manifestations [see C. H. Kellner et al. 1994 for review]. Other conditions in which the use of ECT may be appropriate include catatonia and the neuroleptic malignant syndrome [Sackeim et al. 1995]. 

Repeated high i.m. doses over several days are inadvisable inasmuch as most patients do not require such aggressive intervention, and this strategy may increase the risk for severe EPS and the neuroleptic malignant syndrome (NMS). Finally, it is preferable to switch patients to oral treatment as quickly as possible to manage the remainder of an acute episode. 

Addonizio G, Susman VL. ECT as a treatment alternative for patients with symptoms of neuroleptic malignant syndrome. J Clin Psychiatry 1987 48 102-105. 

Davis JM, Janicak PG, Sakkas P, et al. Electroconvulsive therapy in the treatment of the neuroleptic malignant syndrome. Convuls Ther 1991 7 111-120. 

In terms of clinical treatment and the public health, howevep TDAK [tardive akathisia] is a fact, not a question. It is one more serious side effect of neuroleptic treatment, like TD and the Neuroleptic Malignant Syndrome. Taken together, they define neuroleptic treatment as a necessary evil, a treatment that should be administered with care and caution, and reserved for patients who have no other recourse. 

Coons, D. J., Hillman, F. J., Marshall, R. W. (1982). Treatment of neuroleptic malignant syndrome with dantrolene sodium A case report. American Journal of Psychiatry, 139, 943-945. 

Burch EA Jr, Downs J. Development of neuroleptic malignant syndrome during simultaneous amoxapine treatment and alprazolam discontinuation. J Clin Psychopharmacol 1987 7(l) 55-6. 

Combinations are often used in patients with treatment-resistant schizophrenia and schizoaffective disorders, and the published data (29 case reports and case series, n = 172, and one double-blind placebo-controlled trial, n = 28) between 1985 and 2003 has been reviewed (22). Significant adverse effects were rarely reported (by only 36 of the 200 subjects) and did not appear to be different in nature from those of monotherapy regimens hypersalivation (n = 6), mild akathisia (n = 4), exacerbation of hoarding behavior (n = 2), neuroleptic malignant syndrome (n = 2), and neutropenia, agranulocytosis, oculogyric crises, atrial extra beats, and aggravation of previous tardive dyskinesia (n = 1 each). 

The occurrence of neuroleptic malignant syndrome in a patient with cancer after the use of haloperidol has given rise to some comments (a) clinical oncologists are not familiar with the neuroleptic malignant syndrome (b) neuroleptic malignant syndrome is difficult to diagnose, because its presentation resembles that of cancer itself, and sometimes other treatment-related complications (348). 

Tanaka K, Akechi T, Yamazaki M, Hayashi R, Nishiwaki Y, Uchitomi Y. Neuroleptic malignant syndrome during haloperidol treatment in a cancer patient. A case report. Support Care Cancer 1998 6(6) 536-8. 

Amore M, Zazzeri N, Berardi D. Atypical neuroleptic malignant syndrome associated with clozapine treatment. Neuropsychobiology 1997 35(4) 197-9. 

Dursun SM, Oluboka OJ, Devarajan S, Kutcher SP. High-dose vitamin E plus vitamin B6 treatment of risperidone-related neuroleptic malignant syndrome. J Psychopharmacol 1998 12(2) 220-1. 

Newman M, Adityanjee, Jampala C. Atypical neuroleptic malignant syndrome associated with risperidone treatment. Am J Psychiatry 1997 154(10) 1475. 

Thomas P, Maron M, Rascle C, Cottencin O, Vaiva G, Goudemand M. Carbamazepine in the treatment of neuroleptic malignant syndrome. Biol Psychiatry 1998 43(4) 303-5. 

Mueller PS, Vester JW, Fermaglich J. Neuroleptic malignant syndrome. Successful treatment with bromocriptine. JAMA 1983 249(3) 386-8. 

Goekoop JG, Carbaat PA. Treatment of neuroleptic malignant syndrome with dantrolene. Lancet 1982 2(8288) 49-50. 

Nisijima K, Ishiguro T. Electroconvulsive therapy for the treatment of neuroleptic malignant syndrome with psychotic symptoms a report of five cases. J ECT 1999 15(2) 158-63. 

Nisijima K, Kusakabe Y, Ohtuka K, Ishiguro T. Addition of carbamazepine to long-term treatment with neuroleptics may induce neuroleptic malignant syndrome. Biol Psychiatry 1998 44(9) 930-1. 

Spivak M, Adams B, Crockford D. Atypical neuroleptic malignant syndrome with clozapine and subsequent haloperidol treatment. Can J Psychiatry 2003 48 66. 

Gheorghiu S, Knobler HY, Drumer D. Recurrence of neuroleptic malignant syndrome with olanzapine treatment. Am J Psychiatry 1999 156(11) 1836. 

Jarventausta K, Leinonen E. Neuroleptic malignant syndrome during olanzapine and levomepromazine treatment. 

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