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Afterlife

Is there any role of ECT in the treatment of NMS?

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I have read in the Irish Medical News that there may be some role of ECT in the Neuroleptic Malignant Syndrome. The consultant however did not mention any detail. If you know anything about this please add to the forum. I will be obliged. DR.Kamran Asghar Shaikh UK :(

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Yes, it is an effective treatment.Advisable first to use medication to stabilise autonomic function, before starting ECT. Since the patients antipsychotic Rx has been discontinued, ECT has the advantage of both treating the psychosis and the NMS. Outcome is similar to drug Rx alone ie about half the mortality of those who are not treated at all.

See Trollor, Aus & NZ J Psych 1999 33 650-9 for a review and report of cases

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ECT is one of the choice. Remember to mention bromociptine and dantrolene prior to ECT treatment. ???

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it can be PMP question. how to manage someone with nms.

fist, stop all antipsychotics, lithium and antidepressants. second, monitor vital signs, set up iv line and manage fever. third, put pt in ward with adequat light and minimum stimulatio. forth, pharmacological tx include use of dopamine agonist(bromocriptin) and muscle relaxant (dantrolene), benzodiazepam of short acting can be used for agitation and other disturbing behaviours. fifth, trial ect if overtly psychotic with agitaion or if catatonic. sixth, rechallenge with another antipsychotics with very low dose initially and monitor cpk and renal fx, thioridazine is rarely used nowadays because of various choose of 2nd generation antipsychotics. seventh, remeber to have medic alert on the drug which lead to nms of the pt.

hope useful for you clinically or in exam.

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