From the Guidelines
The treatment for Neuroleptic Malignant Syndrome (NMS) involves primarily supportive care and removal of the initiating agent, with management of cardiorespiratory compromise, dehydration, and elevated creatine kinase levels as needed 1. The key components of treatment include:
- Discontinuation of the causative antipsychotic medication
- Supportive care in an intensive care setting
- Management of complications like respiratory distress or renal failure
- Aggressive cooling for hyperthermia using external cooling measures such as cooling blankets
- Intravenous fluids for hydration
- Treatment of dehydration or elevated creatine kinase and rhabdomyolysis with IV fluids
- Consideration of benzodiazepines as the first-line agent for agitation
- Treatment of fever with external cooling measures It is essential to note that the treatment of NMS is focused on supportive care and management of symptoms, rather than specific pharmacological interventions, although benzodiazepines may be used to manage agitation 1. In cases where antipsychotic therapy must be resumed later, a different class should be selected with gradual titration and close monitoring. Electroconvulsive therapy (ECT) may be considered in severe cases of NMS, particularly when there is a lack of response to other treatments or when the patient's condition is life-threatening 1. However, the primary focus of treatment should be on supportive care and removal of the initiating agent, with careful monitoring of vital signs, creatine kinase levels, and renal function.
From the Research
Treatment Overview
The treatment for Neuroleptic Malignant Syndrome (NMS) typically involves a combination of nonpharmacologic and pharmacologic interventions.
- Nonpharmacologic management includes aggressive supportive care, such as vigilant nursing, physical therapy, cooling, rehydration, and anticoagulation 2.
- Pharmacologic interventions involve the immediate discontinuation of antipsychotics, judicious use of anticholinergics, and adjunctive benzodiazepines 2.
Pharmacologic Interventions
Specific agents that have been considered for the treatment of NMS include:
- Bromocriptine and other dopaminergic drugs, which have been used with some success 2, 3, 4.
- Dantrolene sodium, which has been reported as a potential treatment for NMS and has been used in some cases 2, 5, 3, 4.
- Electroconvulsive therapy (ECT), which has been identified as a second-line treatment for NMS, particularly in severe cases 2, 3, 6.
Treatment Outcomes
The effectiveness of different NMS therapies has been compared in several studies, with varying results.
- One study found that there were no statistically significant differences in mortality rate or duration of treatment between dantrolene, bromocriptine, or ECT compared to supportive care 3.
- However, a subgroup analysis of severe NMS cases found that specific pharmacotherapy (dantrolene, bromocriptine) and ECT were associated with a lower mortality rate compared to symptomatic therapy alone 3.
- Another study reported a case of drug-resistant NMS that was successfully treated with ECT 6.