Summary about Disease
Neuroleptic Malignant Syndrome (NMS) is a rare, life-threatening reaction to certain medications, most commonly antipsychotics (neuroleptics). It is characterized by fever, muscle rigidity, altered mental status, and autonomic dysfunction. It requires immediate medical attention.
Symptoms
High fever (often above 104°F or 40°C)
Severe muscle rigidity ("lead-pipe" rigidity)
Altered mental status (confusion, agitation, stupor, coma)
Autonomic dysfunction (fluctuating blood pressure, rapid heart rate, increased sweating, incontinence)
Tremor
Difficulty swallowing (dysphagia)
Elevated creatine phosphokinase (CPK) levels
Causes
NMS is primarily caused by medications that block dopamine receptors in the brain. These include:
Antipsychotic medications (both typical and atypical)
Anti-nausea medications (e.g., metoclopramide, promethazine)
Sudden withdrawal from dopaminergic medications used to treat Parkinson's disease
Medicine Used
Dopamine agonists: Bromocriptine or Amantadine may be used to restore dopamine activity.
Muscle relaxants: Dantrolene may be used to reduce muscle rigidity.
Benzodiazepines: To manage agitation.
Supportive care: Intravenous fluids, cooling blankets, and monitoring of vital signs are crucial.
Is Communicable
No, Neuroleptic Malignant Syndrome is not communicable. It is a reaction to medication, not an infectious disease.
Precautions
Careful monitoring of patients starting or changing antipsychotic medications.
Prompt recognition and treatment of early symptoms.
Avoidance of dehydration.
Consideration of risk factors (e.g., dehydration, agitation, high doses of medication).
Judicious use of neuroleptic medications, especially in high-risk individuals.
How long does an outbreak last?
There is no "outbreak" as NMS is not contagious. The duration of NMS varies depending on the severity and the medication involved. Symptoms can persist for 5-10 days after oral medications are discontinued, and up to a month with depot injections.
How is it diagnosed?
Diagnosis is based on clinical presentation, including:
History of neuroleptic medication use
Presence of characteristic symptoms (fever, rigidity, altered mental status, autonomic dysfunction)
Elevated CPK levels
Ruling out other conditions (e.g., infection, heatstroke, central nervous system disorders)
Timeline of Symptoms
The timeline can vary, but generally:
Onset: Can occur within hours to days of starting or changing medication.
Early Symptoms: Often include muscle stiffness, tremor, and mild fever.
Progressive Symptoms: Fever rises, mental status worsens, and autonomic dysfunction becomes more pronounced.
Peak: Symptoms typically peak within 72 hours.
Resolution: Can take 5-10 days after oral medications are stopped, or longer with depot injections.
Important Considerations
NMS is a medical emergency requiring immediate hospitalization.
Early recognition and treatment are critical to improving outcomes.
Patients who have experienced NMS are at increased risk for recurrence if re-exposed to neuroleptic medications.
Careful consideration of alternative treatments is necessary for patients with a history of NMS who require antipsychotic medication.
Malignant Hyperthermia is a differential diagnosis and has some overlapping symptoms.