Neuroleptic Malignant Syndrome

Everyone is more or less mad on one point - Rudyard Kipling

Neuroleptic Malignant Syndrome
Neuroleptic Malignant Syndrome

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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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  Neuroleptic Malignant Syndrome

This is an awesome, focused review of neuroleptic malignant syndrome (NMS). 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.

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.

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