Neuroleptic malignant syndrome

Early recognition of this drug-induced condition can prevent death.     

Neuroleptic malignant syndrome

Neuroleptic malignant syndrome (NMS) is a rare but potentially life-threatening complication of neuroleptic therapy. Its occurrence is not familiar to most emergency physicians. Early recognition and appropriate management of NMS may prevent significant morbidity and mortality.     

Neuroleptic malignant syndrome

Neuroleptic malignant syndrome is an uncommon, occasionally lethal reaction to drug therapy. Patients taking neuroleptic medication are usually the victims of this complex disorder, but others, such as patients with Parkinson's disease, are also at risk. The classic presentation includes autonomic instability, rigidity, hyperthermia, confusion and other neurologic symptoms. Family physicians may be the first to see these patients and must be able to make the diagnosis quickly to avoid delay in treatment.     

Neuroleptic malignant syndrome

Neuroleptic malignant syndrome may occur in patients taking neuroleptics and other psychotropic drugs. The syndrome is characterized by hyperthermia, muscular rigidity, altered consciousness and autonomic instability. Cerebrospinal fluid examination is normal. Treatment includes intensive supportive measures and the use of dantrolene or bromocriptine, or both.     

Neuroleptic malignant syndrome

The neuroleptic malignant syndrome (NMS) is a rare but potentially lethal disorder associated with the administration of neuroleptic agents. This syndrome may be underdiagnosed because it is poorly understood and often unrecognized. It affects all age groups and has a 20% mortality. Presenting features include extrapyramidal symptoms, altered mental consciousness, autonomic dysfunction, and hyperthermia. The underlying explanation for these manifestations is a disturbance of the dopaminergic system within the basal ganglia and hypothalamus. Dantrolene (Dantrium), amantadine (Symmetrel), and bromocriptine mesylate (Parlodel) have been efficacious in conjunction with supportive therapy. I report three cases successfully treated with bromocriptine and supportive therapy.     

Neuroleptic malignant syndrome]

The neuroleptic malignant syndrome (NMS) is presumably caused by neuroleptic blockade of dopamine receptors, mainly in the basal ganglia and hypothalamus. Symptoms include hyperthermia, muscular rigidity, and elevated serum creatine phosphokinase level, also autonomic dysfunction and, facultatively, impairment of consciousness. Clinical features, differential diagnosis and pathogenesis are discussed, as well as therapy with standard drugs as well as intravenous lisuride.     

Neuroleptic malignant syndrome associated with prochlorperazine

Neuroleptic malignant syndrome occurred in a patient with AIDS being treated with prochlorperazine. We believe this to be the first report of this association. Recognition and specific treatment were delayed in part because of overlap in signs and symptoms of the underlying infectious process. The true incidence of prochlorperazine-induced NMS is unknown, and this reaction may be underrecognized in patients who often have other significant medical illnesses.     

Neuroleptic malignant syndrome induced by metoclopramide

Neuroleptic malignant syndrome (NMS) associated with metoclopramide is rare. NMS probably results from neuroleptic-induced dopamine receptor blockade. We describe a case and have found only seven reports of metoclopramide-induced NMS in the literature.     

Neuroleptic malignant syndrome associated with metoclopramide

The case of neuroleptic malignant syndrome presented was associated with the use of metoclopramide, a dopamine-blocking agent, which is normally used in nonpsychiatric patients. The patient was successfully treated with dantrolene and bromocriptine. Nonpsychiatrist physicians should be aware of this complication of metoclopramide, as it is potentially fatal.     

Neuroleptic malignant syndrome associated with carbamazepine

We have described the case of a patient who had symptoms of the neuroleptic malignant syndrome after treatment with carbamazepine. The symptoms resolved after carbamazepine therapy was stopped, which suggests carbamazepine as their cause.