Progression of Symptoms in Neuroleptic Malignant Syndrome

Velamoor, Varadaraj R.; Norman, Ross; Caroff, Stanley N.; Mann, Stephan C.; Sullivan, Kenneth A.; Antelo, R.Eduardo

doi:10.1097/00005053-199403000-00007

Cited by 136 publications

(69 citation statements)

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“…An infectious aetiology was absent. The period before that could be viewed as a preliminary phase to NMS, supported by the occurrence of restlessness despite increasing doses of alimemazine, subfebrile temperatures and increased epileptic symptoms [4,12]. Velamoor et al [12] found that in 70.5% of the described clinical pictures, the sequence of symptoms was as follows: (1) mental changes, (2) rigidity, (3) hyperthermia, and (4) autonomic dysfunction, consistent with our patient.…”

Section: Discussionsupporting

confidence: 87%

Neuroleptic malignant syndrome in a 4-year-old girl associated with alimemazine

et al. 2002

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Section: Discussionsupporting

confidence: 87%

Neuroleptic malignant syndrome in a 4-year-old girl associated with alimemazine

et al. 2002

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“…Occasionally, tremor, which can be coarse, as well as chorea, myoclonus and mobile dystonia develop. First symptoms include rigidity and mental status deterioration, autonomic dysfunction and hyperthermia usually develop later [65]. Elevated CPK and urinary myoglobin support the diagnosis of NMS, but are unspecific.…”

Section: ■ Neuroleptic Malignant Syndromementioning

confidence: 99%

“…Occasionally, it may show a peracute course. Abortive forms exist [65]. Depending on the duration of action of the causative agent NMS may persist up to 10 days after discontinuation of neuroleptics.…”

Section: ■ Neuroleptic Malignant Syndromementioning

confidence: 99%

Diagnosis and management of acute movement disorders

Dressler

2005

J Neurol

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Most movement disorders, reflecting degenerative disorders, develop in a slowly progressive fashion. Some movement disorders, however, manifest with an acute onset. We wish to give an overview of the management and therapy of those acute-onset movement disorders.Drug-induced movement disorders are mainly caused by dopamine-receptor blockers (DRB) as used as antipsychotics (neuroleptics) and antiemetics. Acute dystonic reactions usually occur within the first four days of treatment. Typically, cranial pharyngeal and cervical muscles are affected. Anticholinergics produce a prompt relief. Akathisia is characterized by an often exceedingly bothersome feeling of restlessness and the inability to remain still. It is a common side effect of DRB and occurs within few days after their initiation. It subsides when DRB are ceased. Neuroleptic Malignant Syndrome is a rare, but life-threatening adverse reaction to DRB which may occur at any time during DRB application. It is characterised by hyperthermia, rigidity, reduced consciousness and autonomic failure. Therapeutically immediate DRB withdrawal is crucial. Additional dantrolene or bromocriptine application together with symptomatic treatment may be necessary. Paroxysmal dyskinesias are childhood onset disorders characterised by dystonic postures, chorea, athetosis and ballism occurring at irregular intervals. In Paroxysmal Kinesigenic Dyskinesia they are triggered by rapid movements, startle reactions or hyperventilation. They last up to 5 minutes, occur up to 100 times per day and are highly sensitive to anticonvulsants. In Paroxysmal Non-Kinesiogenic Dyskinesia they cannot be triggered, occur less frequently and last longer. Other paroxysmal dyskinesias include hypnogenic paroxysmal dyskinesias, paroxysmal exertional dyskinesia, infantile paroxysmal dystonias, Sandifer's syndrome and symptomatic paroxysmal dyskinesias. In Hereditary Episodic Ataxia Type 1 attacks of ataxia last for up to two minutes, may be accompanied by dysarthria and dystonia and usually respond to phenytoin. In Type 2 they can last for several hours, may be accompanied by vertigo, headache and malaise and usually respond to acetazolamide. Symptomatic episodic ataxias can occur in a number of metabolic disorders, but also in multiple sclerosis and Behcet's disease.

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“…At any rate, it is practically very important to be aware of sequential progression of symptoms of NMS in order to facilitate prompt recognition and interventions to abort the symptoms in its incipient stage. Analysis of the temporal sequence of the four predominant clinical features of NMS has indicated that either altered mental status or muscle rigidity precedes hyperthermia and autonomic dysfunction in the majority of fulminant NMS cases, most typically with the following order: (1) changes in mental status; (2) muscle rigidity; (3) hyperthermia; and (4) autonomic dysfunction (Velamoor et al, 1994). Woodbery & Woodbery (1992) proposed five discrete stages toward the progression of NMS, from stage I or drug-induced parkinsonism to stage V (the severest form of fulminant NMS).…”

Section: Clinical Course and Outcomementioning

confidence: 99%

Encephalopathy Associated with Psychotropic Drug Therapy

Odagaki¹

2012

Miscellanea on Encephalopathies - A Second Look

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Progression of Symptoms in Neuroleptic Malignant Syndrome

Cited by 136 publications

References 0 publications

Neuroleptic malignant syndrome in a 4-year-old girl associated with alimemazine

Neuroleptic malignant syndrome in a 4-year-old girl associated with alimemazine

Diagnosis and management of acute movement disorders

Encephalopathy Associated with Psychotropic Drug Therapy

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