Médico Residente, Hospital Universitario 12 de Octubre, Área 11 Salud Mental, Madrid, España.
Rev Psiquiatr Salud Ment. 2011 Jul;4(3):169-76. doi: 10.1016/j.rpsm.2011.04.005. Epub 2011 Jul 2.
In the era of new antipsychotic drugs the severe symptomatology known by the name of neuroleptic malignant syndrome (NMS) continues to have a high incidence and mortality. We review its origin, pathophysiology, diagnostic criteria and staging, particularly with electroconvulsive therapy (ECT), and proposing a less restrictive use and more adjusted to the updated knowledge of this technique. In particular, we consider the justified use of bilateral lead placement, a frequency of three sessions per week, and loads calculated for age, which would ensure effective seizures with an early response, thus avoiding the use of repeated sub-seizure stimuli to calculate the threshold by titration. We believe there is little evidence on the fear of the risk of increasing malignant hyperthermia in NMS due to the substances used in anaesthesia, but is justified to use non-depolarising relaxants due to the risk of hyperkalaemia on being exposed to succinylcholine. Finally we believe it is essential to familiarise the other specialists involved in the treatment with ECT, to increase the availability of the technique and our training in this to the currently available complexity.
在新型抗精神病药物时代，以神经阻滞剂恶性综合征（NMS）命名的严重症状仍然具有较高的发病率和死亡率。我们回顾了其起源、病理生理学、诊断标准和分期，特别是与电休克治疗（ECT）相关的内容，并提出了一种限制较少且更符合该技术最新知识的使用方法。具体而言，我们考虑使用双侧导联放置、每周三次治疗和根据年龄计算的负荷，这将确保有效发作和早期反应，从而避免使用重复的亚发作刺激来通过滴定计算阈值。我们认为，由于麻醉中使用的物质，NMS 中恶性高热风险增加的担忧几乎没有证据，但由于琥珀胆碱暴露时会发生高钾血症，使用非去极化松弛剂是合理的。最后，我们认为必须让参与 ECT 治疗的其他专家熟悉该技术，并提高该技术的可用性，以及我们在这方面的培训，以应对当前的复杂性。
