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KMID : 1201420210140020088
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Journal of Neurocritical Care
2021 Volume.14 No. 2 p.88 ~ p.97
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Neuroleptic malignant syndrome cases in a Moroccan intensive care unit: a retrospective analysis and literature review
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Touzani Soumaya
Hamdouni Mohammed
Houari Nawfal
Khbiza Youssef Yaakoubi
Elbouazzaoui Abderrahim
Boukatta Brahim
Kanjaa Nabil
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Abstract
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Background: Neuroleptic malignant syndrome (NMS) is a rare but potentially life-threatening neuropsychiatric emergency. The aim of our study was to update our bedside procedures by investigating NMS cases managed in the intensive care unit (ICU).
Methods: This retrospective study included all NMS patients admitted to our hospital between January 2012 and December 2019. The variables analyzed included demographics, diagnosis, therapeutics, and outcomes.
Results: This study included 20 patients, with an average age of 36.6 years. The male to female ratio was 1:4. No patient had a history of NMS, and 60% of the patients had schizophrenia. First-generation neuroleptics (NLs) were the most commonly prescribed drugs (80%). The mean time between the introduction of NLs and onset of symptoms was 7.6 days. Rigidity was observed in 90% of the patients, hyperthermia and neuropsychic syndrome in 65%, and dysautonomia in 50%. The creatine phosphokinase level in all patients was four times the normal value. Mechanical ventilation was required in 20% of the patients and hemodialysis in one patient. None of the patients received specific therapy. The mean duration of ICU stay was 10 days. The mortality rate was 10%,, mainly associated with renal failure. The analysis of the predictors of mortality was limited by the size of our cohort.
Conclusion: NMS is a rare condition requiring multidisciplinary implementation of contextualized and updated procedures. Early detection and supportive treatment could improve the prognosis in resource-limited settings, where specific treatments are not available. Predictive risk factors should be investigated in larger multicenter cohorts.
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KEYWORD
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Neuroleptic malignant syndrome, Intensive care unit, Antipsychotics, Mortality, Treatment
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