Electroconvulsive therapy as treatment for malignant neuroleptic syndrome

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.