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Neuroleptic Malignant Syndrome

NMS is hard to diagnose because it's rare. There is no gold standard with respect to its definition, and it requires a medication history (which we typically don't do very well in the emergency department). A tricky cause of NMS is the removal of a dopamine agonist. For this reason, carbidopa/levodopa should never be discontinued during hospital admission - or ED boarding.

Supportive care is more important than antidotal therapy during NMS management. The most acute cause of death from NMS is hyperthermia, which is induced both by D2 receptor antagonism leading to rigidity and impaired thermoregulation from the striatum and hypothalamus. Any life-threatening hyperthermia should be…

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Previously Featured

Serotonin Syndrome and Neuroleptic Malignant Syndrome: Pearls & Pitfalls

Serotonin syndrome (SS) and neuroleptic malignant syndrome (NMS) are two types of pathologies that often give a very confusing picture. They are both associated with psychiatric diseases and are often seen in the setting of polypharmacy...

Antipsychotics and Neuroleptic Malignant Syndrome

1% of pts given neuroleptics. Excessive blockade of dopaminergic receptors. Altered mental status, hyperthermia, muscle rigidity (lead pipe) and autonomic dysfunction. patients are often sweaty, drooling, and in rhabdo as well. Can happen anytime while taking the meds.

Antipsychotic dose escalation as a trigger for Neuroleptic Malignant Syndrome (NMS)

“Neuroleptic malignant syndrome” (NMS) derives from the French “syndrome malin des neuroleptiques” and was first described in 1960 by Delay and colleagues in association with haloperidol. It is a potentially fatal idiosyncratic reaction to any medication which affects the central dopaminergic system, most commonly antipsychotics, with between 0.5% and 1% of patients exposed to these drugs developing the condition...

Neuroleptic Malignant Syndrome

Although uncommon, NMS remains a critical consideration in the differential diagnosis of patients presenting with fever and mental status changes because it requires prompt recognition to prevent significant morbidity and death.

Neuroleptic Malignant Syndrome CCC

Important differences between serotonin syndrome and neuroleptic malignant syndrome: (1) NMS is a idiosyncratic reaction after prolonged exposure to neuroleptics or after withdrawal of a dopamine receptor agonist. (2) NMS usually develops over days or weeks (3) NMS usually accompanied by hyperthermia, severe muscle rigidity and rhabdomyolysis (not mydriasis, diarrhoea, hyperreflexia, myoclonus) (4) NMS frequently associated with multi-organ failure

Neuroleptic Malignant Syndrome: A Review from a Clinically Oriented Perspective

A clinical perspective is provided whereby the clinical presentation and phenomenology of NMS is detailed, while the diagnosis of NMS and its differential is expounded. Current therapeutic strategies are outlined and the role for both pharmacological and non-pharmacological treatment strategies in alleviating the symptoms of NMS are discussed.

Neuroleptic malignant syndrome: an easily overlooked neurologic emergency

Neuroleptic malignant syndrome is an unpredictable iatrogenic neurologic emergency condition, mainly arising as an idiosyncratic reaction to antipsychotic agent use. It is characterized by distinctive clinical features including a change in mental status, generalized rigidity, hyperpyrexia, and dysautonomia. It can be lethal if not diagnosed and treated properly.

Neuroleptic Malignant Syndrome: Answers To 6 Tough Questions

Diagnosis and treatment of neuroleptic malignant syndrome (NMS) are controversial because this potentially life-threatening syndrome is rare and its presentation varies.

Neuroleptic Malignant Syndrome: Still A Risk, But Which Patients May Be In Danger?

Regardless of drug selection, it is important to recognize early and mild signs of NMS. Any case can progress to a fulminant form that is more difficult to treat.

Second-Generation Antipsychotics and Neuroleptic Malignant Syndrome: Systematic Review and Case Report Analysis

Neuroleptic malignant syndrome (NMS) is a rare, unpredictable adverse reaction associated with antipsychotic use. It is generally characterized by rigidity, tremor, fever, dysregulated sympathetic nervous system hyperactivity, alterations of mental status, leukocytosis, and creatine kinase (CK) elevation.

Three Case Reports of Neuroleptic Malignant Syndrome

The authors report three cases of neuroleptic malignant syndrome (NMS) induced by atypical antipsychotics (olanzapine and clozapine) which showed classic features of NMS including muscular rigidity and prominent fever.

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Clinical Advisor

Although this syndrome has been characterized as an idiosyncratic drug reaction, there is some evidence to suggest that it is caused by a pharmacologically explained decrease in central dopaminergic activity. The most common etiologic agents for this syndrome are the classic antipsychotic medications such as haloperidol and chlorpromazine; however, many dopamine antagonists have been indicated, including atypical antipsychotic medications such as olanzapine, as well as metoclopramide, promethazine, and similar agents.

MedFriendly

Two key signs of NMS include rigid muscles (in about 90% of case) and hyperthermia.

NORD

Some clinicians believe that neuroleptic malignant syndrome may be related to malignant hyperthermia, a genetic disorder characterized by an abnormal reaction to anesthesia drugs.

Patient

NMS is most common after initiation or increase in dosage of neuroleptic therapy and in 90% of cases this occurs within 10 days. The onset is usually gradual over 1 to 3 days and tends to occur within four weeks of starting or increasing neuroleptic medication.

StatPearls

Neuroleptic malignant syndrome (NMS) is a life-threatening syndrome associated with the use of dopamine-receptor antagonist medications or with rapid withdrawal of dopaminergic medications. NMS has been associated with virtually every neuroleptic agent but is more commonly reported with the typical antipsychotics like haloperidol and fluphenazine.

UpToDate

Because of the class of agents with which NMS is associated, dopamine receptor blockade is central to most theories of its pathogenesis. Central dopamine receptor blockade in the hypothalamus may cause hyperthermia and other signs of dysautonomia. Interference with nigrostriatal dopamine pathways may lead to Parkinsonian type symptoms such as rigidity and tremor.