Neuroleptic Malignant Syndrome

Strawn, Jeffrey R.; Keck, Paul E.; Caroff, Stanley N.

doi:10.1176/ajp.2007.164.6.870

Cited by 401 publications

(295 citation statements)

References 24 publications

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“…Another important finding was the associated progressive and sustained reduction in creatine kinase levels and a statistically significant reduction in the degree of muscle rigidity within 24 hours of its administration in NMS. The study group comprised of severely sick (high APACHE score) patients with multiple comorbidities, which might explain the high mortality in this series compared to patients in other reports [12] [20] [21] [26].…”

Section: Discussionmentioning

confidence: 99%

Dantrolene in the Treatment of Refractory Hyperthermic Conditions in Critical Care: A Multicenter Retrospective Study

Pawar¹,

Rosenberg²,

Adamson³

et al. 2015

OJAnes

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Purpose: To examine the use of intravenous dantrolene in hospitalized patients. Materials and Methods: Medical Records of patients treated with intravenous dantrolene between 2007 and 2012 at 6 teaching hospitals were reviewed. Temperature, muscle rigidity, creatine kinase levels, and mortality were assessed in association with dantrolene use. Results: Twenty-five patients received intravenous dantrolene, 9 patients with neuroleptic malignant syndrome (NMS), 8 with hyperthermia due to sepsis, 4 with NMS and sepsis, 2 for malignant hyperthermia (MH), and 2 with hypermetabolic syndrome associated with juvenile diabetic ketoacidosis. Dantrolene was administered as a bolus of 1 -3 mg/kg. Core temperature decreased after dantrolene administration in all groups but significant only for MH, NMS cases (Pre 102.3 ± 0.9˚F vs. Post 99.5 ± 0.9˚F; p < 0.001), in Sepsis cases (Pre 104.3 ± 1.5˚F vs. Post 100.6 ± 1.0˚F; p < 0.001). Mean rigidity scores decreased in all groups but significant only for NMS cases, and mean CK did not change significantly in any group. Conclusion: Dantrolene was associated with reductions in temperature and rigidity in hyperthermia of diverse origins in patients admitted to Intensive care settings.

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Section: Discussionmentioning

confidence: 99%

Dantrolene in the Treatment of Refractory Hyperthermic Conditions in Critical Care: A Multicenter Retrospective Study

Pawar¹,

Rosenberg²,

Adamson³

et al. 2015

OJAnes

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“…Diagnosis of NMS is largely based on clinical history and the presence of specific clinical symptoms (14). Unlike the patient introduced here, NMS occurs less in patients on stable dose of antipsychotic drugs for long periods of time or those with appropriate long-term compliance (20,21).…”

Section: Discussionmentioning

confidence: 99%

“…In a systematic report of NMS induced by SGAs, little significant risk factors were identified, such as male gender, confusion, dehydration, delirium, and extra pyramidal symptoms in a study (12) while in another study, factors such as non-white race, the number of anti-psychotic drugs, consumption of aripiprazole and increasing/fluctuant dosing patterns have been mentioned in this regard (13). Furthermore, NMS can be described as a complex dysregulation cascade in multiple neurochemical and neuroendocrine systems that can be potentially placed in the end stage of a hyper-metabolic syndrome (14). The exact pathogenic mechanism underlying NMS is still relatively unknown.…”

Section: Introductionmentioning

confidence: 96%

“…Functional imbalance continued and maintained by different feed-forward cycles lead to the involvement of a larger number of systems, a progressive damage to muscle tissue, and multi-organ failure (14,15). Hypo-dopaminergic hypothesis is fundamentally based on the fact that the risk of inducing NMS in parallel is associated with the antipsychotic ability to create extrapyramidal symptoms (EPSs) syndrome and the degree of inhibition of dopamine receptor activity, especially subtype D2, in the nigrostriatal pathway (8,16).…”

Section: Introductionmentioning

confidence: 99%

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Ileus as a Sign of Neuroleptic Malignant Syndrome: A Case Report and Review of the Literature

Elyasi

Azizi

Shirzad

et al. 2018

Iran J Psychiatry Behav Sci

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Introduction: Neuroleptic malignant syndrome (NMS) is a rare and unpredictable adverse reaction associated with the use of firstgeneration and second-generation antipsychotics. Atypical antipsychotics may create atypical forms of NMS due to their different pharmacological characteristics. Decreased dopaminergic tone in the brain is coincided with a dysregulation of autonomic nervous system in this syndrome. This study reports on a case, in which current views occurred during the course of the disease is among rare symptoms. This paper reports on an NMS case, in which current views and symptoms that occurred during the course of the disease were rare symptoms that are not usually found in NMS. Case Presentation: The patient was a 43-year-old male with schizoaffective disorder under treatment with clozapine and risperidone. He had lead pipe muscle rigidity, stupor, fever and autonomic dysfunction, increased levels of creatinine phosphokinase, leukocytosis, and microglobulina. Levenson's criteria is widely accepted for diagnosis of NMS. Six days after admission to the psychosomatic ward, the patient had ileus. Due to lack of response to neomycin and GI rest and embedding NG tube, the patient underwent therapeutic sigmoidoscopy and colonoscopy for decompression. Conclusions: Diagnosis of NMS is largely based on clinical history and the presence of specific clinical symptoms. Antipsychotics polypharmacy increases the NMS risk. Mechanisms underlying the development of ileus in the patient are speculative and multifactorial. Paralytic ileus can be one of the autonomic dysfunctions in NMS. Furthermore, NMS is categorized in differential diagnosis of acute abdomen caused by the pseudo-obstruction. All physicians should be aware of this possibility when faced with patients under treatment with neuroleptics.

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“…Klozapin hem tipik, hem de atipik antipsikotiklerden daha zayıf D2 reseptör tutulumuna sahip olmasına rağmen, ender olarak NMS'ye yol açabilir. Bu da NMS patofizyolojisinin çoklu nörokimyasal ve nöroendokrin sistem bozulmasını içeren bir durum olduğunu dü-şündürmektedir (6) .…”

Section: Discussionunclassified