From the Guidelines
Neuroleptic malignant syndrome (NMS) management involves primarily supportive care and removal of the initiating agent, with a focus on cardiorespiratory compromise, dehydration, and elevated creatine kinase levels. The treatment approach should prioritize the patient's morbidity, mortality, and quality of life. According to the study published in Pediatrics in 2016 1, the management of NMS involves:
- Removal of the initiating agent
- Supportive care for cardiorespiratory compromise
- Treatment of dehydration or elevated creatine kinase and rhabdomyolysis with IV fluids
- Management of agitation with benzodiazepines as the first-line agent
- Treatment of fever with external cooling measures, such as cooling blankets Key considerations in the management of NMS include:
- Close monitoring of the patient's vital signs and laboratory results
- Aggressive management of complications, such as renal failure, which may require hemodialysis
- Avoidance of antipsychotics for at least 2 weeks after symptom resolution, and use of a different class with lower D2 receptor affinity if necessary later. The goal of treatment is to reduce morbidity and mortality, and improve the patient's quality of life, with a focus on early recognition and aggressive management of NMS, as highlighted in the study 1.
From the Research
Management of Neuroleptic Malignant Syndrome
The management of neuroleptic malignant syndrome (NMS) involves several key steps, including:
- Discontinuation of the offending antipsychotic agent, as this is the initial step in the treatment of NMS 2, 3, 4, 5, 6
- Implementation of supportive measures, such as vigilant nursing, physical therapy, cooling, rehydration, and anticoagulation 4
- Pharmacological interventions, including the use of dantrolene sodium and bromocriptine, which have been shown to be effective in the treatment of NMS 2, 5, 6
- Consideration of other treatments, such as electroconvulsive therapy, which may be used as a second line of treatment 4
Treatment Options
Treatment options for NMS include:
- Dantrolene sodium, a peripheral muscle relaxant that has been shown to be effective in the treatment of NMS 5, 6
- Bromocriptine, a dopamine agonist that has been used to treat NMS 2, 4, 5, 6
- Amantadine, a dopamine agonist that has been used to treat NMS 5
- Electroconvulsive therapy, which may be used as a second line of treatment 4
Importance of Early Diagnosis
Early diagnosis and treatment of NMS are critical to preventing significant morbidity and death 3. A high degree of suspicion and the discontinuation of antipsychotic agents, even if the diagnosis is not established, are essential for the safety of the patient 2.