非典型症狀抗精神病藥物惡性症候群－－病例報告

Neuroleptic Malignant Syndrome with Atypical Clinical Manifestation: A Case Report

自1950年代抗精神病藥物問世後，抗精神病藥物惡性症候群(neuroleptic malignant syndrome, NMS)這個名詞首次於1968年被學者提出，在臨床上使用高效力的抗精神病藥物後，患者出現高體溫、肌肉僵硬，以及自主神經失調等臨床症狀，因此而命名。至今已發現多種藥物皆可能產生這個病症，其死亡率約4%~22%。一般相信造成NMS的可能機轉，是中樞系統的多巴胺活性被阻斷所造成。目前對於抗精神病藥物惡性症候群的診斷定義，以及藥物治療仍有爭議。報告本案例之目的，在探討沒有合併發燒的抗精神病藥物惡性症候群，其臨床症狀表現，並且成功的以支持療法，以及合併使用lorazepam、amantadine等藥物緩解其症狀。在診斷抗精神病藥物惡性症候群時，肌肉僵硬、意識狀態改變，以及自律神經系統失調等徵候，可以在鑑別診斷上有很大的價值。本案例報告再次考驗NMS傳統嚴謹定義的適當性，以及嚴守傳統定義對於延遲治療的可能性。關於藥物治療方面，雖仍有爭議，但謹慎的藥物使用，和最新的文獻回顧，是臨床治療抉擇的最高指導原則。

Neuroleptic medications were first introduced in 1954 and neuroleptic malignant syndrome(NMS) was first described in 1968. As its name implies, NMS is a potentially lethal process related to the use of neuroleptic agents that produce dopaminergic blockade which causess cardinal features, including muscular rigidity, autonomic dysfunction, altered mental status and hyperthermia. Estimates of mortality following NMS range from 4% to 22%.There were also some cases of NMS have been described in patients taking non-neuroleptic medications. Up to now, a general consensus for the diagnostic criteria and medical treatment for NMS has not been established. Herein we report a 42-year-old man developed NMS without fever while taking haloperidol and depot injection. His syndrome was controlled successfully by supportive therpay and early prescription with lorazepam and amantadine. Such atypical case may support either a spectrum concept of NMS and challenge with strict diagnostic criteria of NMS. The use of lorazepam and amantadine seems to provide a safealternative therapy when neuroleptic toxicity is suspected.