Treatment of neuroleptic malignant syndrome with direct hemoperfusion

Neuroleptic malignant syndrome (NMS) is an uncommon but serious and fatal idiosyncratic reaction to neuroleptics. It is difficult to correct this abnormalities successfully. There has been several reports on the treatment of NMS with dantrolene and/or bromocriptine. But these therapy are not effective in every cases. We have experienced ten cases of NMS. Six of them were presented with respiratory distress. Seven patients were treated with direct hemoperfusion and the remainder were managed by dantrolene, bromocriptine and other drugs. Patients treated with direct hemoperfusion two to four times could got a good improvement within several days and recovered. As to the patients treated by drugs. One of them who was not serious recovered with bromocriptine after twenty days. Two patients needed hemodialysis. NMS is occur not only by the use of neuroleptics but also by the break of them. So, this syndrome is do not develop by the high concentration of neuroleptics merely. NMS differed from ordinary drug intoxication. The etiology of NMS has unknown. But two major theories are present. One is dopaminergic blockade theory the other is direct toxic effect on skeltal muscles. We speculate that direct hemoperfusion remove metabolites of neuroleptics or normalize the alteration in the central nervous system.