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Paradoxical Autonomic Response to Procyclidine in the Neuroleptic Malignant Syndrome

Published online by Cambridge University Press:  18 September 2015

Martin V. Balzan
Martin V. Balzan*
Affiliation:
Department of Medicine, Saint Luke’s Hospital, Malta
*
Department of Medicine, Saint Luke’s Hospital, Guardamangia, Malta
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Abstract

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Background

Neuroleptic Malignant Syndrome (NMS) is an adverse reaction to dopamine receptor antagonists, characterised by hyperpyrexia, extrapyramidal rigidity and impaired autonomic function. It might result from central dopamine receptor blockade that causes severe muscle contraction.

Method

Case Study.

Results

High dose intravenous therapy with the anticholinergic drug, procyclidine hydrochloride, temporarily diminished the muscle rigidity and reversed most of the autonomic features in a patient with NMS occurring after a single intramuscular dose of the dopamine antagonist metoclopramide. Paradoxically, however, the heart rate decreased and bowel movements increased with this atropine-like drug.

Conclusion

Since the degree of tachypnoea, tachycardia, and bowel hypotonia closely paralleled the severity of the muscle rigidity, it is suggested that these autonomic features of NMS result from sustained muscle contraction rather than a direct effect of neuroleptic drugs on the central nervous system.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 22 , Issue 3 , August 1995 , pp. 244 - 246
Copyright
Copyright © Canadian Neurological Sciences Federation 1995

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