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 using standard supportive measures, such as IV fluids and external cooling measures. The management of NMS requires a comprehensive approach, including the removal of the causative agent, and supportive care in an intensive care setting 1. Key aspects of treatment include:
- Discontinuation of the antipsychotic medication
- Supportive measures, such as cooling and hydration
- Management of complications, including cardiorespiratory compromise and renal failure
- Use of benzodiazepines, such as lorazepam, for agitation
- Consideration of reintroduction of an anti-Parkinsonism drug if NMS is triggered by its abrupt withdrawal 1. It is essential to note that NMS is a life-threatening condition, and prompt recognition and aggressive treatment are crucial for favorable outcomes, with the goal of reducing morbidity, mortality, and improving quality of life. In clinical practice, the treatment of NMS should prioritize the patient's safety and well-being, with a focus on supportive care and management of complications, rather than solely on the removal of the initiating agent 1.
From the Research
Treatment Options for Neuroleptic Malignant Syndrome (NMS)
- The initial step in the treatment of NMS is the removal of the offending agent 2
- Supportive care, including nutritive and electrolyte therapies, is essential for the treatment of NMS 2, 3
- Pharmacotherapy, such as benzodiazepines, bromocriptine, and dantrolene, may be used to treat NMS 4, 5, 2
- Electroconvulsive therapy (ECT) is recommended for drug-resistant and severe cases of NMS 6, 4
- ECT has been shown to be effective in treating NMS, with a remission rate of 73.3% in one study 6
- Daily ECT may be necessary to minimize recurrence of catatonic signs 4
Key Considerations in the Treatment of NMS
- Early recognition and prompt management are crucial in the treatment of NMS 3
- A high degree of suspicion and the discontinuation of antipsychotic agents are essential for the safety of the patient 2
- The management of NMS should be based on a hierarchy of symptom severity 3
- Patients should be monitored daily for dehydration and elevated temperature, and vital signs should be checked regularly 3
- Antipsychotics should be used conservatively with gradual titration of doses 3