Video of dantrolene effectiveness on neuroleptic malignant syndrome associated muscular rigidity and tremor
© BioMed Central Ltd 2007
Published: 1 June 2007
Neuroleptic malignant syndrome (NMS) is an uncommon but potentially fatal adverse reaction to neuroleptic drugs, including amisulpride [1, 2]. NMS most commonly presents with increased body temperature, muscular rigidity of a 'lead pipe' nature, altered mental status and autonomic dysfunction. Other extrapyramidal movement disorders such as tremor and cogwheel phenomena are also frequently present. The treatment of NMS includes discontinuation of contributing drugs and supportive therapy, but specific treatment with dantrolene, bromocriptine, nondepolarizing neuromuscular paralysis and benzodiazepines, among other such agents, has been reported only anecdotally. A recent analysis of published case reports  evaluated the efficacy of dantrolene in NMS; it found that dantrolene, given as monotherapy, might be helpful in managing this syndrome if the premedication was a neuroleptic monotherapy. We present video evidence of the effectiveness of dantrolene in reducing muscular rigidity, tremor and cogwheel phenomena in a patient with NMS.
Additional File 1: A video file showing rigid skeletal muscles of a 'lead pipe' nature, cogwheel phenomena and resting tremor in a patient with NMS caused by amisulpride treatment. (MOV 6 MB)
Additional File 2: A video file skeletal muscle hypotonia without cogwheel phenomena and tremor after dantrolene treatment in a patient with NMS caused by amisulpride treatment. (MOV 3 MB)
The diagnosis of NMS in this patient is based on identifying the characteristic clinical manifestations in association with a typical history of therapy with amisulpride, which antagonizes dopaminergic D2/D3 receptor subtypes. The patient also developed renal failure, which may participate in amisulpride accumulation because amisulpride is eliminated unchanged in urine.
Dantrolene might be useful in managing skeletal muscle rigidity because it relaxes skeletal muscles by inhibiting release of calcium from the sarcoplasmic reticulum, thereby reducing actinmyosin contractile activity. In the videos presented (Additional data files 1 and 2) the effect of dantrolene on muscular rigidity of a 'lead pipe' nature, cogwheel phenomena and tremor are clearly visible. However, the usefulness of dantrolene in NMS remains questionable, and this is but one of a number of anecdotal reports. Nevertheless, it offers an additional visual impression of the effectiveness of dantrolene on rigidity and tremor caused by NMS.
To conclude, we speculate that prompt reduction in NMS-associated muscular rigidity by dantrolene contributed to a decrease in body temperature. Our reporting of this case was approved by the Hospital Committee for Medical Ethics (University Medical Centre Ljubljana).
Written consent for publication was obtained from the patient.
- Atbasoglu EC, Ozguven HD, Can Saka M, Goker C: Rhabdomyolysis and coma associated with amisulpride: a probable atypical presentation of neuroleptic malignant syndrome. J Clin Psychiatry 2004, 65: 1724-1725.View ArticlePubMedGoogle Scholar
- Bottlender R, Jager M, Hofschuster E, Dobmeier P, Moller HJ: Neuroleptic malignant syndrome due to atypical neuroleptics: three episodes in one patient. Pharmacopsychiatry 2002, 35: 119-121. 10.1055/s-2002-31518View ArticlePubMedGoogle Scholar
- Reulbach U, Dutsch C, Biermann T, Sperling W, Thuerauf N, Kornhuber J, Bleich S: Managing an effective treatment for neuroleptic malignant syndrome. Crit Care 2007, 11: R4. 10.1186/cc5148PubMed CentralView ArticlePubMedGoogle Scholar