[The neuroleptic malignant syndrome]

Malignant neuroleptic syndrome (MNS) together with agranulocytosis represents a relatively rare but the most difficult idiosyncratic reaction to the therapy with neuroleptics. The most prominent symptoms are as follows: hyperthermia, muscular rigidity, vegetative dysfunction and disturbance in consciousness. MNS usually occurs unexpectedly and unpredictably during the first days of the treatment with neuroleptics and most frequently it takes a remarkably rapid course. About 15-20% of the cases are lethal. The aim of the successful treatment is the early recognition of MNS preferably in the prodromal phases which can by the employment of adequate therapy interfere the evolution into the full clinical picture, i.e. to the lethal outcome. Efficient therapy includes: 1) interruption in the administration of neuroleptics, 2) regulation of water disbalance and electrolyte metabolism, 3) application of drugs which activate dopaminergine transmission insufficiency (bromocriptine, predominantly) or other disturbances induced by it in other neuronal systems which is obtained by the administration of anticholinergic antiparkinsonics and benzodiazepines (GABA effect), and 4) electroconvulsion. All aspects of MNS from the standpoint of actual level of knowledge are presented in this paper. The authors' own experience with the nine MNS cases registered at their clinic is also set forth. By the improvement in diagnostic and therapy no death due to MNS has been observed over the last few years.