A REVIEW ON NEUROLEPTIC MALIGNANT SYNDROME AND ITS TREATMENT STRATEGY: FOR CLINICIANS
Abstract
Neuroleptic malignant syndrome (NMS) is one of the serious complications of antipsychotics that occur rarely. Its prevalence is more commonly seen in individuals of age 20 to 40 years. Major etiology includes depletion of dopamine levels in central nervous system (CNS). It usually occurs, when high doses of antipsychotics are administered or sudden change in doses of antipsychotics or any withdrawal of anticholinergics abruptly. Sometimes, NMS follows withdrawal of dopaminergic medication in Parkinson’s patients. It is characterized by ‘lead pipe’ muscle rigidity, autonomic dysfunction, hyperthermia, extra pyramidal side effects. Clinical manifestations of NMS resemble malignant hyperthermia, serotonin syndrome, lethal catatonia and infectious disorders of CNS. NMS is a diagnosis of exclusion, thus differential diagnosis is of utmost important, by an expertise clinician. Laboratory findings that help in diagnosis are creatine phosphokinase (CPK) levels, leukocyte count, myoglobinuria and liver enzymes. Most lethal complication constitutes death, due to multi organ failure which accounts 10% to 20 % of renal and cardiovascular failure. Management comprises of prompt withdrawal of offending antipsychotic agent/neuroleptic drug after diagnosis, dopaminergic agonists are administered and supportive care is provided to the subject. A prompt medical attention is required as a consequence of high mortality. Thus, the treatment options were proposed to reduce the mortality due to NMS in clinical settings
Keywords:
Antipsychotics, Dopamine agonists, Malignant hyperthermia, Neuroleptic malignant syndrome, NeurolepticsReferences
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