Key result
A patient with a neurotoxic syndrome indistinguishable from neuroleptic malignant syndrome, induced by serotonin-affecting agents, successfully recovered following treatment with lorazepam and ECT.
Case Report (n=1)
NMS and TSS may be non-specific generalized neurotoxic syndromes and subtypes of catatonia that respond to benzodiazepines and ECT.
Supports lorazepam and ECT for serotonin-induced neurotoxic syndromes resembling NMS; leaves open catatonia overlap hypothesis for future study.
Administration of medications which affect brain dopamine and serotonin levels are occasionally associated with neurotoxic behavioral and autonomic syndromes, variously described as the neuroleptic malignant (NMS) and the toxic serotonin (TSS) syndromes. Based on concepts of the presumed brain mechanisms of action of the drugs, different corrective interventions have been recommended. We describe a case of neurotoxic syndrome with characteristics indistinguishable from NMS in which the offending agents are those which affect the serotonin and not the dopamine systems. The patient recovered with lorazepam and electroconvulsive therapy (ECT). We argue that NMS and TSS are examples of a non-specific generalized neurotoxic syndrome, and not specific syndromes: and that these are subtypes of catatonia. Patients today should be treated with benzodiazepines, and if these fail, with ECT, interventions which are effective in relieving catatonia.
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Max Fink (2007) conducted a case report in Neurotoxic syndrome (Toxic Serotonin Syndrome / Neuroleptic Malignant Syndrome) (n=1). Lorazepam and electroconvulsive therapy (ECT) was evaluated on Recovery from neurotoxic syndrome. A patient with a neurotoxic syndrome indistinguishable from neuroleptic malignant syndrome, induced by serotonin-affecting agents, successfully recovered following treatment with lorazepam and ECT.
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