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Das maligne neuroleptische Syndrom

Neuroleptic malignant syndrome

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Zusammenfassung

Hintergrund

Das maligne neuroleptische Syndrom (MNS) ist eine insgesamt seltene unerwünschte Arzneimittelwirkung (UAW) einer psychopharmakologischen Behandlung. Die Letalität ist in den Jahren seit der Erstbeschreibung deutlich gesunken. Die Kenntnis des MNS ist für den klinisch tätigen Arzt wichtig, da es eine rasche Diagnosestellung und Therapieeinleitung erfordert.

Ziel der Arbeit

Im folgenden Aufsatz wird die aktuelle Studienlage zusammengefasst und kritisch gewürdigt. Die sich ergebenden diagnostischen und therapeutischen Empfehlungen werden insbesondere unter dem klinischen Blickwinkel dargestellt.

Material und Methoden

Es wurde eine Literaturübersicht mit den Begriffen „neuroleptic malignant syndrome“ und „malignes neuroleptisches Syndrom“ sowie verschiedenen Psychopharmaka in PubMed durchgeführt. Weiterhin wurde die Datenbank der Arbeitsgemeinschaft für Arzneimitteltherapie bei psychiatrischen Erkrankungen (AGATE) hinsichtlich der gemeldeten UAW „malignes neuroleptisches Syndrom“ ausgewertet.

Ergebnisse

Entgegen der Erstbeschreibungen, die auch zur Namensgebung führten, finden sich mittlerweile zunehmend Fallberichte, die klinisch wie ein MNS imponieren, jedoch offensichtlich von unterschiedlichen Gruppen von Psychopharmaka, nicht nur von Antipsychotika (deutsche Bezeichnung: Neuroleptika), ausgelöst werden. Es existieren Therapieempfehlungen, wobei deren Wirksamkeit nicht durchgehend wissenschaftlich untermauert werden kann. Unbestritten bleibt jedoch, dass eine rasche Therapieeinleitung große Bedeutung hat.

Diskussion

Hinsichtlich der Klassifikation schlagen wir eine Erweiterung der bisherigen Einteilungen vor. Die therapeutischen Maßnahmen bedürfen weiterer wissenschaftlicher Untermauerung, um als Leitlinien empfohlen werden zu können.

Abstract

Background

Neuroleptic malignant syndrome (NMS) is a rare but severe undesired complication of psychopharmacological treatment. The mortality has shown a significant decrease since its first description. Knowledge of NMS is important for every clinician because of the need for rapid diagnosis and treatment.

Objective

This article presents a review and critical appraisal of the current study situation for NMS. Recommendations for diagnostics, differential diagnostics and treatment are presented particularly from a clinical perspective.

Material and methods

A literature review with the keywords “neuroleptic malignant syndrome”, “Malignes neuroleptisches Syndrom” and various psychotropic drugs was performed in PubMed. The database of the Working Group for Pharmaceutical Treatment of Psychiatric Diseases (Arbeitsgemeinschaft für Arzneimitteltherapie bei psychiatrischen Erkrankungen, AGATE) was analyzed with respect to registered cases of the undesired side effect NMS.

Results

In contrast to the first description, which also led to the name, there are now case reports of clinical conditions similar to NMS, which were obviously triggered by several groups of psychotropic drugs not just antipsychotic agents (German: Neuroleptika). Treatment recommendations exist whereby the effectiveness cannot always be scientifically substantiated; however, it is still undisputed that a rapid initiation of treatment is of great importance.

Discussion

The psychiatrist must be familiar with the symptoms of NMS, its differential diagnosis and the therapeutic options for a rapid and effective treatment. Further studies are urgently needed for scientific substantiation of the pathophysiology of NMS and to develop evidence-based guidelines for treatment.

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Authors and Affiliations

  1. Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychiatrie Reichenau, Feursteinstraße 55, 78479, Reichenau, Deutschland

    R. Knorr

  2. Klinische Pharmakologie am Lehrstuhl für Pharmakologie und Toxikologie, Universität Regensburg, Regensburg, Deutschland

    J. Schöllkopf &  E. Haen

  3. Klinische Pharmakologie am Lehrstuhl für Psychiatrie, Universität Regensburg, Regensburg, Deutschland

    E. Haen

  4. Institut AGATE gGmbH, Pentling, Deutschland

    R. Knorr &  E. Haen

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  1. R. Knorr
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Correspondence to R. Knorr.

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Interessenkonflikt

R. Knorr, J. Schöllkopf und E. Haen geben an, dass kein Interessenkonflikt besteht. E. Haen ist Vorsitzender und Geschäftsführer der AGATE (www.amuep-agate.de).

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Knorr, R., Schöllkopf, J. & Haen, E. Das maligne neuroleptische Syndrom. Nervenarzt 89, 300–310 (2018). https://doi.org/10.1007/s00115-017-0463-3

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