parkinsons-2016_keynote

6 / 6

Volume 6 Issue 6(Suppl) J Alzheimers Dis Parkinsonism
ISSN: 2161-0460 JADP, an open access journal
Page 33
Parkinsons 2016
December 05-07, 2016
conferenceseries.com
December 05-07, 2016 Phoenix, USA
2nd International Conference on
Parkinson’s Disease & Movement Disorders
Clinical conundrum of neuroleptic malignant syndrome - A new look and a newAVS-CUV criterion
Statement of the Study: The research question is whether the understanding of clinical conundrum of neuroleptic malignant
syndrome would become clearer when schizophrenia and affective disorders are studied separately.
Methods: Twenty schizophrenics and thirty affected 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 affective disorders was 43 years (15-
73 yrs). NMS developed within 9 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 hours) compared to affective disorders (16.8 hours). The altered sensorium occurred within
9.6 hours in schizophrenia and 25.69 hours in affective disorder. The rigidity occurred in 38.8 hours in schizophrenia and
84.9 hours in affective disorder. Rigidity followed fever and altered sensorium in both the conditions. Autonomic symptoms
occurred within 48 hours in schizophrenia and 107 hours in affective disorder. The correlation analysis showed significant
correlation betweenNMS 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 affective
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). The misclassification rate in the case of Schizophrenia is 15% and affective disorder is around 7%. AVS-CUV criterion
can be used confidently in NMS. AVS –CUV Criterion; clinically define; 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: 1. NMS developed earlier and took a longer time to resolve in schizophrenics compared with affective disorders
2. Mortality occurred only in schizophrenics
3. New AVS- CUV criteria has been added to the world literature
Biography
Srinivas Avathvadi Venkatesan serves as an Emeritus Professor at The Tamil Nadu Dr. M.G.R. Medical University; Former Adjunct Prof. IIT Madras and Visiting
Professor at Cleveland – Ohio – USA; Hershey Medical College, USA. He has been rewarded with many National & international awards like AINA AWARD-
Association of Indian Neurologists in America-2001, he presented more than 60 papers in national conferences and 25 in international conferences. His published
works include 30 papers & 15 chapters.
Srinivas Avathvadi Venkatesan
Hershe Medical College, USA; Indian Academy of Neurology, India
S A Venkatesan, J Alzheimers Dis Parkinsonism 2016, 6:6(Suppl)