What is neuroleptic malignant syndrome (NMS)?
Neuroleptic malignant syndrome (NMS) is an idiosyncratic life-threatening reaction to antipsychotic medication. NMS has been known since 1956, shortly after the introduction of the first phenothiazines and is derived from the French syndrome malin des neuroleptiques. It occurs at 0.01-0.02 percent of patients treated with antipsychotic drugs. In 10 percent of the fatal cases.
Neuroleptic malignant syndrome (NMS) causes
NMS is caused by antipsychotic drugs, both traditional (older) antipsychotics and the atypical (newer) antipsychotics. NMS can also develop in people using dopaminergic (eg anti-parkisonmiddelen). Usually, when the dosage is lowered.
Risk factors
- High dose of the anti-psychotic medication
- Rapid or large increase in dosage
- Restlessness, agitation
- dehydration
- Excessive self
- Existing disturbances in the dopamine and iron metabolism
Meuroleptic malignant syndrome (NMS) symptoms
The two most characteristic symptoms are: high fever / heavy sweating and severe muscle stiffness / spasm. Often accompanied by rapid heartbeat / breathing, drooling, tremors and seizures.
In general, NMS develops within two weeks after starting with antipsychotic medication, but the disease can develop at any time during the use of the medication. In about 16 percent of the cases within 24 hours, 66 percent in the first week, and nearly all cases, within 30 days.
Neuroleptic malignant syndrome (NMS) diagnosis
The diagnosis is made on the basis of the highly elevated body temperature and muscle stiffness. Also, there must be two signs, symptoms or laboratory results that are not caused by another medicine / drug, neurological disorder or general medical condition.
The increased tension in the muscles generally leads to rhabdomyolysis (muscle breakdown) with usually a strong increase in creatine kinase, aldolase, transaminases and lactic. Often, the patient has metabolic acidosis, hypoxia, decreased serum iron, increased catecholamines and leukocytosis.
Changes in mental status and other neurological disorders usually occur (in 80 percent of cases) rather than the two classic symptoms.
A number of matters must be excluded: infections of the central nervous system, particularly viral encephalitis. These infections can simulate NMS. It should also be ruled out an advanced psychotic state of catatonic stupor, or acute lethal catatonia.
Neuroleptic malignant syndrome (NMS) treatment
When these symptoms are observed, a hospitalization necessary where the doctor the triggering medication stops or reduces serious. The patient intensive symptom control and medical monitoring should then be provided and to be treated for any additional medical problems for which an adequate form of treatment is available. There is no general standard pharmacological treatment for neuroleptic malignant syndrome (NMS).
Supporting measures
- Correction of electrolyte
- Cooling of the patient
- Monitoring of heart, kidney and lung functions
- Control of coagulation disorders
- 1-2 mg Lorazepam, parenterally. In a mild extending NMS.
- Amantadine 200-400 mg / day.
- Bromocriptine 2.5 mg 2 to 3 times per day.
- Dantrolene 1-2.5 mg / kg of body weight, followed by 1 mg / kg every 6 hours. In extreme cases.
The resumption of antipsychotic medication should only in extreme cases be done with great care because there is a risk of recurrence of neuroleptic malignant syndrome.