From the Guidelines
The primary treatment for Neuroleptic Malignant Syndrome (NMS) involves immediately stopping the causative antipsychotic medication and providing supportive care, as recommended by the most recent and highest quality study available 1. Here's a comprehensive approach to managing NMS:
- Discontinue the offending antipsychotic medication immediately to prevent further exacerbation of the condition.
- Provide intensive supportive care, including:
- Maintenance of hydration with IV fluids to prevent dehydration and support cardiovascular stability.
- Management of fever with external cooling measures, such as cooling blankets, to reduce the risk of hyperthermia-related complications.
- Monitoring and correction of electrolyte imbalances to prevent further complications.
- Administer specific medications, such as:
- Benzodiazepines, which are suggested as the first-line agent for agitation, as per the study 1.
- Consider the reintroduction of an anti-Parkinsonism drug if NMS is triggered by its abrupt withdrawal, as mentioned in the study 1.
- Monitor closely for complications, such as cardiorespiratory compromise, rhabdomyolysis, and renal failure, and provide organ support as needed, including standard supportive measures, IV fluids, and hemodialysis if necessary, as outlined in the study 1. The rationale behind this treatment approach is to address the underlying mechanisms of NMS and provide supportive care to manage the potentially life-threatening symptoms and complications, with the goal of reducing morbidity, mortality, and improving quality of life.
From the Research
Treatment Overview
The treatment for Neuroleptic Malignant Syndrome (NMS) involves several key steps, including:
- Immediate discontinuation of the offending agent 2, 3, 4, 5
- Supportive therapy of clinical symptoms, such as aggressive supportive care, vigilant nursing, physical therapy, cooling, rehydration, and anticoagulation 2, 3, 4, 5
- Use of medications such as dantrolene sodium, bromocriptine, or amantadine to help manage symptoms 2, 3, 5
Pharmacologic Interventions
Pharmacologic interventions for NMS may include:
- Judicious use of anticholinergics 5
- Adjunctive benzodiazepines 5
- Use of dopaminergic drugs such as bromocriptine 3, 5, 6
- Use of dantrolene sodium 2, 3, 5, 6
Alternative Treatments
In severe or drug-resistant cases of NMS, alternative treatments such as electroconvulsive therapy (ECT) may be considered 5, 6
- ECT has been shown to be effective in relieving symptoms of NMS in some cases 6
Post-NMS Management
After an episode of NMS, patients should be reassessed for further treatment with antipsychotics and rechallenge should not be attempted at least 2 weeks following resolution of symptoms of NMS 4
- Patients and their families should be educated about the episode and consent for further medication use obtained after a clear explanation of the risk-benefit analysis 4