متلازمة الخبث العصبي: علاج الخط التالي بعد فشل الرعاية الحرجة الداعمة الأولية في السيطرة على العلامات العضلية

References

DOI: 10.1056/NEJMra2404606

• However, if muscular signs of neuroleptic malignant syndrome persist or worsen, dantrolene, a direct-acting skeletal-muscle relaxant that inhibits the release of calcium at the sarcoplasmic reticulum, can be administered.
• By reducing rigidity and through ostensible effects on central thermoregulatory areas, dantrolene mitigates hyperthermia and reduces elevated levels of serum creatine kinase.
• Bromocriptine or amantadine has been suggested as an alternative agent; both are dopamine agonists that displace antipsychotic dopamine antagonists and are associated with few short-term side effects.
• These specific dopaminergic interventions are usually justified when the core temperature reaches 38 to 40°C and rigidity is moderate or severe, as marked by a transition from palpably mild rigidity with cogwheeling to sustained rigidity.