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• W2012149503 abstract "Neuroleptic malignant syndrome (NMS) is a potentially lethal disorder that can occur in patients on neuroleptic medication.1 The main features of the syndrome are extrapyramidal symptoms and elevated temperature. Other common findings are autonomic instability, confusion, incontinence, diaphoresis, and agitation. Common laboratory abnormalities include leukocytosis and elevated creatine phosphokinase. It is commonly thought that NMS occurs predominantly in young patients2 and that it is generally underrecognized and unreported in the elderly.3 Despite these common views, a literature search of NMS revealed 18 cases of NMS occurring in patients 60 years old and over (Table 1).3–16 Of these, 14 were being treated with neuroleptics. Three cases occurred in patients with Parkinson's disease (PD) who had stopped antiparkinsonian medications, and in one patient with PD who developed NMS while continuing medication. Calling this syndrome NMS may be incorrect, as these patients were not receiving neuroleptic therapy; nevertheless the syndrome appears in an identical way. Furthermore, the occurrence of NMS in these patients lends support to the hypothesis that the underlying pathophysiology of NMS is hypodopaminergic functioning.14 The most common neuroleptic agent in these cases was haloperidol, a potent dopamine-receptor blocker. Although haloperidol is commonly implicated in cases of NMS,1 it is unclear whether this effect is related to its potent dopamine-blocking action or to the frequency of haloperidol use in this age group. Certainly haloperidol is often used in an elderly population because it has relatively fewer toxic effects on the cardiovascular system than other neuroleptic drugs. The patients in this series were receiving relatively large doses of neuroleptic drugs for this age group. This is consistent with the idea that high doses of neuroleptic drugs are a risk factor for NMS, though NMS may occur at a relatively low dosage. In the literature NMS has been reported in patients in various psychiatric diagnostic categories, including two patients with Alzheimer's disease. Early recognition of NMS symptoms in the elderly is critical. Morbidity and mortality in NMS are related to the development of cardiac problems, pneumonia, pulmonary emboli, and renal failure.17 Renal failure may occur secondary to myoglobinuria. As older patients frequently have preexisting medical illnesses involving these systems, they are more likely to suffer the devastating effects of this disorder. In this series, two cases resulted in death. The most important factor in treatment is the early recognition of the incipient syndrome and prompt discontinuation of neuroleptic medication. Supportive care must be instituted with careful monitoring of nutrition and fluid balance, and prevention of prolonged immobility. If NMS persists, more specific treatments are available. The benzodiazepines, bromocriptine, amantadine, and dantrolene have all been used with some success,18 but carefully controlled trials have not been done to determine their efficacy. All of these agents must be used with care as they all have potentially deleterious side effects. In summary, clinicians treating elderly patients with neuroleptics and antiparkinsonian medication should be carefully mindful of the possibility of the development of NMS. Early recognition of this potentially lethal syndrome is crucial." @default.
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• W2012149503 date "1987-11-01" @default.
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• W2012149503 title "Neuroleptic Malignant Syndrome in Elderly Patients" @default.
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• W2012149503 doi "https://doi.org/10.1111/j.1532-5415.1987.tb04005.x" @default.
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