Serotonin syndrome versus neuroleptic malignant syndrome: a challenging clinical quandary

Dosi, Rupal; Ambaliya, Annirudh; Joshi, Harshal; Patell, Rushad

doi:10.1136/bcr-2014-204154

Cited by 42 publications

(28 citation statements)

References 7 publications

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“…Serotonin syndrome and neuroleptic malignant syndrome (NMS) are relatively rare adverse drug reactions to psychotropic medications . Malignant hyperthermia is a rare inherited hypermetabolic condition characterized by uncontrolled calcium release from the sarcoplasmic reticulum of skeletal muscle, usually from exposure to inhaled general anesthetics and/or the depolarizing neuromuscular blocking agent succinylcholine .…”

Section: Differential Diagnosismentioning

confidence: 99%

Rethinking status dystonicus

Ruiz-López

Fasano

2017

Movement Disorders

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Status dystonicus is a movement disorder emergency that has been a source of controversy in terms of terminology, phenomenology, and management since it was first described in 1982. Here we argue that the current use of the term status dystonicus falls well short of the precision needed for either clinical or academic use. We performed a critical review on this topic, describing possible pathophysiological mechanisms and areas of uncertainties. This review also addresses the problems derived by the extreme clinical heterogeneity of this condition, as the lack of an objective criterion useful for the definition, or the fact that status dystonicus may present not only in the context of a known dystonic syndrome. We propose a new possible definition that includes not only dystonia but also other hyperkinetic movements in the wide range of movement disorders that can be seen during an episode. The new definition keeps the term status dystonicus and highlights the fact that this is a medical emergency based on the impairment of bulbar and/or respiratory function requiring hospital admission as the principal feature. Furthermore, the new definition should not consider as necessary unspecific features as patient's condition at baseline, the distribution of dystonia, occurrence of systemic symptoms such as fever or laboratory findings. We hope that this proposal will stimulate the debate on this subject among our peers, further developing a clinical and pathophysiological understanding of status dystonicus. © 2017 International Parkinson and Movement Disorder Society.

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Section: Differential Diagnosismentioning

confidence: 99%

Rethinking status dystonicus

Ruiz-López

Fasano

2017

Movement Disorders

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“…Moreover, serotonin and noradrenaline and those pharmacologic agents, which influence their levels (monoamine oxidase inhibitors, tricyclics and selective serotonin reuptake inhibitors), play equally ambiguous [9,61,62] roles in the regulation of the HPA axis and mood disorders [61][62][63][64]. To clarify the mediation of their activity, and to shed light on their similarly unpredictable and dangerous side-effect spectrum [64,65] further studies are also required.…”

Section: Discussionmentioning

confidence: 99%

Evidence of the dopamine-2 receptor mediated inhibition of the hypothalamic-pituitary-adrenal system; a rodent model of hypercortisolism in chronic neuropsychiatric disorders

Thurzó¹,

Jászberényi²,

Bagosi³

et al. 2017

Transl Brain Rhythmicity

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The purpose of this study was to examine the role of dopaminergic mediation in the hypothalamic-pituitary-adrenal (HPA) response challenged by ether stress. First the effects of the D1 selective (SCH-23390) and the D2 selective (haloperidol) dopamine antagonists on ether stress evoked corticosterone responses were tested. The activation of the HPA axis was assessed by measuring plasma corticosterone levels. Low doses of haloperidol (25 nmol/kg, intraperitoneally) failed to affect either basal or stimulated corticosterone secretion, while SCH-23390 elicited moderate inhibition of stimulated release. However, to our surprise higher doses of haloperidol (250 nmol/kg) raised basal secretion and even potentiated the HPA response evoked by ether stress. Therefore to elucidate the role of D 2 mediation, the intrinsic activity of the D 2 antagonist was tested in further experiments. Haloperidol (from 25 nmol/kg to 2.5 mmol/kg) alone elicited a dose-dependent activation of the HPA system reflected by both corticosterone and ACTH serum levels. This D 2 -antagonist-evoked HPA activation could be prevented by pre-administration of the CRH antagonist, α-helical CRH 9-41 . These findings provide unequivocal evidence that D 2 receptor can exert inhibitory control over the HPA axis.

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“…7 Numerous other agents, including antimicrobial agents (linezolid), antiemetics (ondansetron), and analgesics (fentanyl) have also been implicated given their potential serotonergic properties. 8,9 Ingesting cyclobenzaprine, bupropion, and venlafaxine simultaneously, as well as a possible contribution with administration of fentanyl during transport, certainly would place the patient at increased risk of developing SS.…”

Section: Dr Nasuh Malas (Assistant Professor Pediatric Consultation-mentioning

confidence: 99%

A Previously Healthy Adolescent With Acute Encephalopathy and Decorticate Posturing

Kawai¹,

DeMonbrun²,

Chambers³

et al. 2017

Pediatrics

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A 14-year-old previously healthy female was transferred from a local emergency department after being found unresponsive at home. Parental questioning revealed she had fever and pharyngitis 2 weeks before presentation. Past mental health history was negative, including concern for past or present suicidal ideation/attempts, suspected substance use, or toxic ingestion. In the emergency department, she was orotracheally intubated due to a Glasgow Coma Scale of 3. She was hemodynamically stable and euglycemic. Electrocardiogram showed sinus tachycardia. She underwent a noncontrast head computed tomography that was normal and subsequently underwent a lumbar puncture. She had a seizure and was given a loading dose of diazepam and fosphenytoin that led to cessation of extremity movements. She was subsequently transferred to the PICU for additional evaluation. Initial examination without sedation or analgesia demonstrated dilated and minimally responsive pupils, intermittent decorticate posturing, and bilateral lower extremity rigidity and clonus, consistent with a Glasgow Coma Scale of 5. Serum studies were unremarkable with the exception of mild leukocytosis. Chest radiograph only showed atelectasis. She was empirically started on antibiotics to cover for meningitis pending final cerebral spinal fluid test results. The pediatric neurology team was consulted for EEG monitoring, and the patient was eventually sent for computed tomography angiogram and magnetic resonance angiogram/venogram. We will review diagnostic evaluation and management of an adolescent patient with acute encephalopathy with decorticate posturing of unclear etiology.

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Serotonin syndrome versus neuroleptic malignant syndrome: a challenging clinical quandary

Cited by 42 publications

References 7 publications

Rethinking status dystonicus

Rethinking status dystonicus

Evidence of the dopamine-2 receptor mediated inhibition of the hypothalamic-pituitary-adrenal system; a rodent model of hypercortisolism in chronic neuropsychiatric disorders

A Previously Healthy Adolescent With Acute Encephalopathy and Decorticate Posturing

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