Managing an effective treatment for neuroleptic malignant syndrome.
BACKGROUND
Neuroleptic malignant syndrome (NMS) is a rare, but sometimes fatal, adverse reaction to neuroleptics characterized principally by fever and rigor. The aim of this study was to prove the efficacy of different NMS treatment strategies, focusing on the efficacy of dantrolene.


METHODS
Altogether, 271 case reports were included. These cases were categorized into four treatment groups and compared to each other according to effectiveness of therapy within 24 hours, mortality, complete time of remission in days, effectiveness due to increase of dosage, relapse on the basis of decrease of dosage, and improvement of symptoms.


RESULTS
Between the four treatment groups, the complete time of remission was significantly different (analysis of variance, F = 4.02; degrees of freedom = 3; p = 0.008). In a logistic regression with adjustment for age, gender, and severity code, no significant predictor of the treatment for the complete time of remission (dichotomized by median) could be found. However, if the premedication was a monotherapy with neuroleptics, the complete time of remission was significantly shorter with dantrolene monotherapy (t = -2.97; p = 0.004).


CONCLUSIONS
The treatment of NMS with drugs that are combined with dantrolene is associated with a prolongation of clinical recovery. Furthermore, treatment of NMS with dantrolene as monotherapy seems to be associated with a higher overall mortality. Therefore, dantrolene does not seem to be the evidence-based treatment of choice in cases of NMS but might be useful if premedication consisted of a neuroleptic monotherapy.
Reulbach
Udo
U
Department of Psychiatry and Psychotherapy, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany. udo.reulbach@psych.imed.uni-erlangen
Dütsch
Carmen
C
Biermann
Teresa
T
Sperling
Wolfgang
W
Thuerauf
Norbert
N
Kornhuber
Johannes
J
Bleich
Stefan
S
D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects; D003620:Dantrolene / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D009125:Muscle Relaxants, Central / Q000009:adverse effects / Q000627:therapeutic use*; D009459:Neuroleptic Malignant Syndrome / Q000188:drug therapy* / Q000401:mortality; D012074:Remission Induction; D013997:Time Factors; D016896:Treatment Outcome
D014150:Antipsychotic Agents; D009125:Muscle Relaxants, Central; D003620:Dantrolene