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Glutamate receptor antagonists for neuroleptic malignant syndrome and akitetic hyperthermic Parkinsonian crisis

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Journal of Neural Transmission - Parkinson's Disease and Dementia Section

Summary

Schizophrenia and Parkinson's disease have been considered inversely related neuropsychiatric disorders since the former has been attributed to increased dopaminergic transmission while the latter is thought to result from loss of dopaminergic neurons. It is in line with this concept that the classical neuroleptic (anti-schizophrenic) drugs cause as a side effect a drug-induced type of Parkinsonism. Most etiopathogenetic models hold that the “neuroleptic malignant syndrome” may result from “overtherapy” of schizophrenia, causing too widespread a block of dopaminergic transmission. The same clinical condition can be triggered by rapid discontinuation of dopaminergic medication in Parkinson's disease. Further, neuroleptic malignant syndrome shares key clinical features such as extrapyramidal motor disturbances and hyperthermia with a severe form of clinical deterioration in Parkinson's disease patients, the akinetic Parkinsonian crisis. Both conditions, neuroleptic malignant syndrome and Parkinsonian crisis, are resistant to anticholinergic treatment but may well respond to drugs with N-methyl-D-aspartate (NMDA) antagonistic properties such as amantadine and memantine. We advocate the use of NMDA receptor antagonists in these medical emergencies and link their clinical efficacy to the common pathophysiological pathway of increased excitatory aminoacid neurotransmitter activity in neuroleptic malignant syndrome, Parkinsonian crisis, and dopamine agonist withdrawal states.

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  1. J. Kornhuber

    Present address: Department of Psychiatry, University of Würzburg, Füchsleinstrasse 15, D-97080, Würzburg, Federal Republic of Germany

  2. M. Weller

    Present address: National Institute of Mental Health, Clinical Neuroscience Branch, Building 10, Room 3N256, 20892, Bethesda, MD, USA

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  1. Department of Psychiatry, University of Würzburg, Füchsleinstrasse 15, D-97080, Würzburg, Federal Republic of Germany

    M. Weller & P. Riederer

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Kornhuber, J., Weller, M. & Riederer, P. Glutamate receptor antagonists for neuroleptic malignant syndrome and akitetic hyperthermic Parkinsonian crisis. J Neural Transm Gen Sect 6, 63–72 (1993). https://doi.org/10.1007/BF02252624

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