Key result
A multimodal approach utilizing NMDA receptor antagonists, longer-acting benzodiazepines, and advocacy for timely ECT was used to manage recurrent neuroleptic malignant syndrome in a 69-year-old man.
Case Report (n=1)
Highlights the use of a multimodal approach including NMDA receptor antagonists and ECT for managing recurrent neuroleptic malignant syndrome when standard therapies fail.
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May inform refractory recurrent NMS management; hypothesis-generating and requires prospective validation before practice change.
Neuroleptic malignant syndrome (NMS), an iatrogenic form of malignant catatonia, carries high morbidity and mortality rates especially in the context of delayed recognition and standard intervention protocol of lorazepam trial. However, there is limited guidance available through literature for further management if benzodiazepine treatment is ineffective and electroconvulsive therapy (ECT) is not readily accessible. This case report describes a multimodal approach to address the diagnostic, treatment, and logistical system challenges in an acute medical hospital through the case of a 69-year-old man with schizophrenia who represented from a psychiatric ward with neuroleptic malignant syndrome. We educated our inpatient colleagues for timely recognition of hyperexcited subtype of catatonia to avoid iatrogenic progression to neuroleptic malignant syndrome and our medical colleagues on the clinical course of catatonic symptoms to avoid any further disagreements and delays in treatment. We advocated for timely electroconvulsive therapy in the setting of limited access and utilized creative pharmacologic strategies such as N-methyl-D-aspartate (NMDA) receptor antagonists and longer acting benzodiazepines while managing medical complications.
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Verma et al. (2018) conducted a case report in Neuroleptic malignant syndrome (n=1). Multimodal approach (NMDA receptor antagonists, longer acting benzodiazepines, and ECT) was evaluated. A multimodal approach utilizing NMDA receptor antagonists, longer-acting benzodiazepines, and advocacy for timely ECT was used to manage recurrent neuroleptic malignant syndrome in a 69-year-old man.
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