We report on a patient with
neuroleptic malignant syndrome (NMS) caused by a
therapy for
endogenous depression. The symptoms were
hyperpyrexia (39.2 degrees C), rigidity, elevated
creatine kinase (CK: 594 U/l) and
coma. After transfer from an outside hospital, he was treated, at first without effect with
dantrolene p.o. (80 mg q.i.d.) and i.v. (1 mg/kg-1/h-1). Clinical improvement and temperature reduction were noted when the levels of
neuroleptic drugs fell during unspecific
intensive care with
mechanical ventilation, sedation (
flunitrazepam,
barbiturates), relaxation (
pancuronium), and hydration. After uncomplicated weaning from the
ventilator the patient became more cooperative and was returned to the psychiatric ward. Further treatment took the form of combined
drug therapy with
biperiden and
flunitrazepam and in addition a series of 12 electroconvulsive therapies (ECT). The elevated CK levels initially decreased, serum
potassium levels were found to be within normal limits, and
myoglobinuria was not detected during the further course. Trigger agents for NMS are
antipsychotic drugs such as
thioxanthenes,
phenothiazines and
butyrophenones. Because the signs and symptoms are so similar to those of
malignant hyperthermia (MH), it has been suggested that NMS and MH are related diseases. The postulated mechanisms of NMS become apparent in the CNS, whereas those of MH affect the muscle cell itself. An abnormal in vitro contraction test after NMS should suggest to triggering of MH crisis after
succinylcholine administration in anaesthesia for ECT.(ABSTRACT TRUNCATED AT 250 WORDS)