26^th European Neurology Congress

Statement of the Study: The research question is whether the understanding of clinical conundrum of neuroleptic malignant syndrome (NMS) would become clearer when schizophrenia and affective disorders are studied separately.

 

Methods: Twenty schizophrenics and thirty aff ected disorder cases who developed NMS were studied between 1990 and 2001 prospectively. Modified criteria of Keck was used for the diagnosis of NMS. Only patients who developed fever, altered sensorium, extrapyramidal and autonomic symptoms are included, standard statistical analysis of the data which included factor analysis,

correlation analysis and discriminate analysis were performed.

 

Summary of Results: Mean age of onset in schizophrenia was 32 years (18-58 yrs.) and in aff ective disorders was 43 years

(15-73 yrs.). NMS developed within nine hours of starting therapy and lasted for a mean duration of 23 days. In the affective disorder group, NMS developed over a period 17 hours and lasted for a mean duration of 11 days. Fever occurred in all the cases and earlier is schizophrenia (11.9 hrs.) compared to aff ective disorders (16.8 hrs.). The altered sensorium occurred within 9.6 hours in schizophrenia and 25.69 hours in aff ective disorder. The  rigidity occurred in 38.8 hours in schizophrenia and 84.9 hours in aff ective disorder. Rigidity followed fever and altered sensorium in both the conditions. Autonomic symptoms occurred within 48 hours in schizophrenia and 107 hours in aff ective disorder. Th e correlation analysis showed signifi cant correlation between NMS onset with fever and altered sensorium. Cluster analysis indicated that autonomic and extrapyramidal symptoms cause for the evolution of NMS. The factor analysis of the parameter responsible for MNS in schizophrenics are extrapyramidal symptoms 0.913, autonomic symptoms 0.858, fever 0.779, altered sensorium 0.497, whereas in aff ective disorders extrapyramidal symptoms 0.931, autonomous symptoms 0.955, fever 0.200, altered sensorium 0.181. Four patients died in schizophrenic group.Our discriminant analysis clearly showed the importance of the parameters with the associated probability of discrimination; autonomic symptoms (0.9), extrapyramidal symptoms (0.7), altered sensorium (0.6) and fever (0.3). Th e misclassifi cation rate in the case of schizophrenia is 15% and aff ective disorder is around 7%. AVS-CUV criterion can be used confi dently in NMS. AVSCUV criterion; clinically defi ne autonomic symptoms and signs, extrapyramidal symptoms, altered sensorium, fever. Clinically probable: autonomic symptoms and signs, extrapyramidal symptoms. Clinically possible: altered sensorium with autonomic symptoms or extrapyramidal symptoms.

 

Conclusion: NMS developed earlier and look a longer time to resolve in schizophrenics compared with aff ective disorders. Mortality occurred only in schizophrenics. New AVS-CUV criteria have been added to the world literature.