Katus Linn E, Frucht Steven J
Department of Neurology, Movement Disorders Division, Mount Sinai Hospital, 5 East 98th Street, 1st floor, New York, NY, 10029, USA.
Curr Treat Options Neurol. 2016 Sep;18(9):39. doi: 10.1007/s11940-016-0423-4.
Serotonin syndrome (SS) and neuroleptic malignant syndrome (NMS) can present similarly and range in severity from mild to life-threatening. Although they are easily misdiagnosed, each is distinct clinically and pathophysiologically. It is important to distinguish between the two, as therapeutic options differ. An accurate and thorough medication history plus knowledge of the various clinical presentations of both syndromes are the first steps in management. After this, removing the offending agents and aggressive supportive care are crucial. This includes controlling muscle rigidity and hyperthermia, providing cardiovascular support, and alleviating agitation. In severe cases, paralysis, sedation, and intubation are required. Agents to reverse either surplus serotonergic activity or dopamine blockage can be useful. However, the diagnosis must be clear, as use of these agents in the incorrect syndrome can worsen symptoms. In pharmacologically refractory cases of NMS, electroconvulsive therapy should be pursued.
血清素综合征（SS）和抗精神病药恶性综合征（NMS）的表现可能相似，严重程度从轻到危及生命不等。尽管它们很容易被误诊，但在临床和病理生理方面各有不同。区分两者很重要，因为治疗方案不同。准确而详尽的用药史以及对这两种综合征各种临床表现的了解是管理的第一步。在此之后，停用致病药物和积极的支持性护理至关重要。这包括控制肌肉强直和高热、提供心血管支持以及缓解躁动。在严重病例中，需要进行麻痹、镇静和插管。逆转血清素能活性过剩或多巴胺阻断的药物可能有用。然而，诊断必须明确，因为在错误的综合征中使用这些药物会使症状恶化。在NMS的药物难治性病例中，应采用电惊厥治疗。
