Neuroleptic Malignant Syndrome When Dantrolene and Dopamine Agonists Did Not Achieve Adequate Control
Clinical Scenario
This protocol applies to patients with neuroleptic malignant syndrome (NMS) who have already received first-line pharmacologic treatment and have not met the required clinical goals — specifically those who continue to show insufficient improvement despite initial intervention.
Previous Treatment — Targets Not Reached
Prior line did not achieve targets
Initial management with dantrolene — a direct-acting skeletal-muscle relaxant — or with a dopamine agonist (bromocriptine or amantadine) failed to reach the required goals:
Unmet targets from prior line
- Reduction of muscular rigidity
- Mitigation of hyperthermia
- Reduction of elevated serum creatine kinase
Next-Line Approach Partial — full regimen below
When pharmacologic treatment has not produced an adequate response, a procedural intervention has been reported to be rapidly effective in life-threatening cases. The complete protocol, including patient selection and full sequencing, is available via the link below.
References
DOI: 10.1056/NEJMra2404606
- In life-threatening cases, electroconvulsive therapy (ECT) has been reported to be rapidly effective, but it has been reserved for patients who do not have a response to other treatments.