Neuroleptic Malignant syndrome caused by dopamine‐depleting drugs in a patient with Huntington disease

Abstract

Prior reports of neuroleptic malignant syndrome (NMS) concerned patients with psychiatric disorders, usually schizophrenia, who were taking dopamine receptor blocking agents. We report the syndrome in a patient with Huntington disease who was treated with dopamine-depleting agents. He had a negative evaluation for malignant hyperthermia (MH), and we suggest that NMS differs from MH. The occurrence of NMS caused by dopamine-depleting agents suggests that anticholinergic properties of phenotiazines are not the only cause. Central dopaminergic systems probably participate in thermoregulation, and dopamine depletion probably plays a pathogenetic role in this syndrome.

Neuroleptic malignant syndrome: Successful treatment with bromocriptine

“…In MH, however, a genetically determined disturbance exists in the contraction of skeletal muscle (Britt 1974), whereas the pathogenesis of NMS is thought to be related to central dopaminergic blockade resulting in a dopaminergic hypoactivity. The latter is consistent with the fact that the neuroleptic potential for inducing NMS seems to parallel antidopaminergic potency and agrees with the observations that NMS can be caused by dopamine-depleting drugs (Burke et al 1981) after discontinuation of a levodopa/carbidopa combination (Toru et al 1981) or other antiparkinson drugs (Henderson and Wooten 1981).…”

Levodopa withdrawal syndrome identical to neuroleptic malignant syndrome

“…Similar features also developed in a patient with Huntington disease treated with dopamine depleting drugs -methyltyorsine and tetrabenazine (Burke et al, 1981), and in two patients with idiopathic Parkinson's disease in whom levodopa was withdrawn (Toru et al, 1981;Sechi et al, 1984).…”

Tetrabenazine in Huntington's Disease Chorea

“…[27][28][29] Kenney et al 30 retrospectively reviewed the charts of 518 patients treated with TBZ to determine whether a history of depression predisposes hyperkinetic patients treated with TBZ to a recurrence or worsening of this symptom. Of those patients with no history of depression, 28 (11.4%) of 246 were newly diagnosed with depression.…”