Neuroleptic malignant syndrome

Abstract

Neuroleptic malignant syndrome (NMS) is a potentially fatal adverse event associated with the use of antipsychotics (AP). The objective of this study was to investigate the profile of cases of NMS and to compare our findings with those published in similar settings. A series of 18 consecutive patients with an established diagnosis of NMS was analyzed, gathering data on demography, symptoms and signs. Two thirds of all cases involved woman with a past medical history of psychiatric disorder receiving relatively high doses of AP. The signs and symptoms of NMS episodes were similar to those reported in other series and only one case had a fatal outcome, the remaining presenting complete recovery. As expected, more than two thirds of our cases were using classic AP (68%), however the clinical profile of these in comparison with those taking newer agent was similar. Newer AP also carry the potential for NMS. Key words: atypical antipsychotics, typical antipsychotics, neuroleptic malignant syndrome.Síndrome neuroléptica maligna RESUMO A síndrome neuroléptica maligna (SNM) é um evento adverso potencialmente fatal associado ao uso de antipsicóticos (AP). O objetivo deste estudo foi investigar as características clínicas de cases da SNM e comparar nossos resultados com os publicados na literatura. Uma série de 18 pacientes com diagnóstico confirmado de SNM foram analisados, associando dados demográficos, apresentação clínica, diagnóstico e tratamento. Dois terços dos casos envolveram mulheres com antecedentes psiquiátricos que recebeceram doses relativamente altas de AP. Os sinais e sintomas foram semelhantes àqueles já relatados na literatura e a maioria dos pacientes teve uma recuperação completa, exceto por um caso com desfecho fatal. Houve predomínio de pacientes que usam medicamentos neurolépticos clássicos (68%), porém não houve diferença nas manifestações destes casos em relação àqueles que usavam AP novos. AP mais novos também têm o potencial de causar SNM. Palavras-Chave: neurolépticos atípicos, neurolépticos típicos, síndrome neuroléptica maligna.

Neuroleptic Malignant Syndrome Requiring Neurological Intensive Care Unit Follow-up: Review with Nine Cases

“…Nadir görülmesine rağmen, acil müdahale edilmesi gereken ve hayatı tehdit eden komplikasyonlara yol açabilmektedir. Lökositoz, kreatinin kinaz ve karaciğer fonksiyon testlerinde yükseklik gibi laboratuvar bulguları da sıklıkla klinik tabloya eşlik etmektedir (1)(2)(3)(4)(5). Dopaminerjik ajanların ya da antipsikotiklerin ani kesilmesine ya da dopamin antagonisti kullanımına bağlı olarak oluşan santral dopaminerjik hipoaktivite NMS'yi başlatan başlıca nedendir (1,4,6).…”

Movement disorders emergencies: a review

“…Classically, the causative agents include the "classic" neuroleptics, however after the widespread use of newer agents, the "atypical" agents have also been implicated 21 . Additionally, NMS has been described during treatment with other dopamineblocking drugs or after abrupt withdrawal of dopaminergic agents 1,8,9,11,22,23 .…”

“…A number of factors are believed to increase the risk of NMS, including abrupt starting or dose escalation, depot formulations, male gender, young age, concomitant use of lithium and selective serotonine reuptake inhibitors (SSRIs), high ambient temperatures, hyponatremia, dehydration, physical exhaustion, mental retardation, extrapyramidal syndromes, psychomotor agitation and a previous episode of NMS 24 . NMS occurs in all age groups, from 9 months to 78 years, with mean ages around the fourth and fifth decades across studies [20][21][22][23][24] . Mortality remains relatively high, varying from 20 to 30% of cases [20][21][22] .…”

“…NMS occurs in all age groups, from 9 months to 78 years, with mean ages around the fourth and fifth decades across studies [20][21][22][23][24] . Mortality remains relatively high, varying from 20 to 30% of cases [20][21][22] . Most cases that survive acute NMS recover without sequelae; however, some patients remain with cognitive deficits and motor abnormalities, including rigidity, tremor and dystonic contractures 25 .…”

“…These main findings can be associated with other signs such as action and/or rest tremor, dystonia, chorea, myoclonus, seizures, ataxia, hyporeflexia and extensor plantar reflexes 19,20 . Additionally, NMS may be associated with laboratory changes that include raised serum CK (>1000 IU/L), impaired liver, renal and coagulation status tests, leukocytosis, electrolyte disturbances, proteinuria and rhabdomyolysis with myoglobinuria [20][21][22] . The most important differential diagnoses in most cases are serotonergic syndrome, malignant hyperthermia and malignant catatonia [20][21][22][23][24][25] .…”