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      Síndrome neuroléptico maligno en la urgencia pediátrica Translated title: Neuroleptic malignant syndrome in pediatrics. A case report

      case-report

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          Abstract

          Resumen El síndrome neuroléptico maligno es una urgencia pediátrica con una elevada morbimortalidad, relacionada con alteración de sistema de neurotransmisión dopaminérgico. Se caracteriza por hipertermia junto con hipertonía muscular, alteración autonómica y de los niveles de conciencia. Un diagnóstico precoz es imprescindible para prevenir complicaciones comunes como la broncoaspiración, desgaste, escaras, procesos infecciosos y cambios neuropsiquiátricos. El tratamiento debe incluir en medidas generales de soporte y terapéutica farmacológica sintomática. Pese a que la mayoría de los casos descritos corresponden a población adulta, también se ha descrito en niños y adolescentes. Presentamos un caso de síndrome neuroléptico maligno en un adolescente de 12 años con encefalopatía y tetraparesia espática secundario al cese de la administración de baclofeno.

          Translated abstract

          Abstract Neuroleptic malignant syndrome is a pediatric emergency with high morbidity and mortality, related to an alteration of the dopaminergic neurotransmission system. It is characterized by hyperthermia along with muscular hypertonia, dysautonomia, and altered level of consciousness. An early diagnosis is essential to prevent common complications such as bronchoaspiration, wear, bedsores, infectious processes, and neuropsychiatric changes. Treatment should include general support measures and symptomatic pharmacological therapy. Although most of the cases described correspond to the adulthood, it has also been described in children and adolescents. We present a case of neuroleptic malignant syndrome in a 12-year-old adolescent with encephalopathy and spastic tetraparesis secondary to the cessation of baclofen administration.

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          Most cited references10

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          A rating scale for neuroleptic malignant syndrome.

          H Sachdev (2005)
          The development of a rating scale for neuroleptic malignant syndrome (NMS) is described. The clinical and laboratory features of NMS were categorised into six domains after a thorough literature review and examination of patients. The reliability of this scale was established on 25 NMS patients and 50 control subjects based on chart reviews. A factor analysis supported a six-factor solution. The validity of the scale was indicated by the relationship of the severity rating to duration of illness and outcome. The inter-rater reliability of the scale was established prospectively in 10 subjects. The scale offers a measure of severity of NMS in the clinical setting so as to support the clinical diagnosis, monitor patients and determine their progress. The scale may be applicable not only to NMS or suspected NMS but also to NMS-like syndromes such as lethal catatonia.
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            Treatment of the Neuroleptic Malignant Syndrome in International Therapy Guidelines: A Comparative Analysis

            Introduction The neuroleptic malignant syndrome (NMS) is a potentially life-threatening condition associated to the use of antipsychotics. Since it requires rapid and efficient medical care, high-quality treatment guidelines should be available. In this article, we analyzed and compared different international therapy guidelines for the treatment of schizophrenia, in which NMS treatment recommendations might be contained. Methods We performed an Internet-based search for schizophrenia guidelines via the website of the respective medical society. Guidelines in English, French, Italian, and German from countries whose medical care meets high standards were selected for further analysis and comparison of the NMS treatment recommendations (if present), and their underlying evidence. Results The NMS is mentioned in 12 of 14 guidelines. Only 9 report concrete therapy recommendations (benzodiazepines/dantrolene/bromocriptine/amantadine/intensive care and/or electroconvulsive therapy (ECT)), however, with high heterogeneity. Only 5 guidelines included all possible drug therapy options and ECT, but with differing combination strategies, dosages, application forms, and combinability of options. The level of evidence of the different recommendations was estimated as low. Discussion One-third of the selected guidelines do not report any NMS therapy recommendations. Most guidelines mentioning the NMS do not provide therapy recommendations that include all relevant treatment options. The results show a very high heterogeneity, and the recommendations and statements are of low-evidence levels. The lack of knowledge about the NMS and its treatment may delay the onset of therapy, impair the quality of treatment, and lead to a worse outcome or death.
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              Electroconvulsive Therapy for Neuroleptic Malignant Syndrome: A Case Series.

              Neuroleptic malignant syndrome (NMS) is an uncommon condition associated with significant morbidity and mortality. Data on treatment interventions are limited. In this case series, we sought to describe all NMS cases requiring ECT from a large academic institution over a nearly 2-decade period.
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                Author and article information

                Journal
                pap
                Pediatría Atención Primaria
                Rev Pediatr Aten Primaria
                Asociación Española de Pediatría de Atención Primaria (Madrid, Madrid, Spain )
                1139-7632
                March 2021
                : 23
                : 89
                : 71-74
                Affiliations
                [3] Barcelona orgnameHospital Universitario de la Santa Creu i Sant Pau orgdiv1Servicio de Pediatría España
                [1] Barcelona orgnameHospital Universitario de la Santa Creu i Sant Pau orgdiv1Servicio de Pediatría orgdiv2Sección de Cirugía Pediátrica España
                [2] Barcelona orgnameHospital Universitario de la Santa Creu i Sant Pau orgdiv1Servicio de Pediatría orgdiv2Sección de Cuidados Intensivos Pediátricos España
                Article
                S1139-76322021000100010 S1139-7632(21)02308900010
                8be2b675-31be-4ea8-8709-f6d1f98c570c

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 10, Pages: 4
                Product

                SciELO Spain

                Categories
                Notas Clínicas

                Dopamine,Neuroleptic malignant syndrome,Neuroleptic,Hypertonia,Síndrome neuroléptico maligno,Hipertonía,Fármaco neuroléptico,Dopamina

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