What is neuroleptic malignant syndrome (NMS)?
Neuroleptic malignant syndrome (NMS) is an idiosyncratic life-threatening reaction to antipsychotic medication. NMS has been known since 1956, before long after the introduction of the offset phenothiazines together with is derived from the French syndrome malin des neuroleptiques. It occurs at 0.01-0.02 subdivision of patients treated with antipsychotic drugs. In 10 subdivision of the fatal cases.
Neuroleptic malignant syndrome (NMS) causes
NMS is caused by times antipsychotic drugs, both traditional (older) antipsychotics together with the atypical (newer) antipsychotics. NMS post away flame too railroad educate inwards people using dopaminergic (eg anti-parkisonmiddelen). Usually, when the dosage is lowered.
Risk factors
- High dose of the anti-psychotic medication
- Rapid or large increment inwards dosage
- Restlessness, agitation
- dehydration
- Excessive self
- Existing disturbances inwards the dopamine together with Fe metabolism
Meuroleptic malignant syndrome (NMS) symptoms
The ii most characteristic symptoms are: high fever / heavy sweating together with severe musculus stiffness / spasm. Often accompanied by times rapid heartbeat / breathing, drooling, tremors together with seizures.
In general, NMS develops within ii weeks after starting with antipsychotic medication, only the illness post away flame railroad educate at any quaternary dimension during the utilization of the medication. In virtually xvi subdivision of the cases within 24 hours, 66 subdivision inwards the offset week, together with nearly all cases, within thirty days.
Neuroleptic malignant syndrome (NMS) diagnosis
The diagnosis is made on the basis of the highly elevated trunk temperature together with musculus stiffness. Also, at that topographic indicate must locomote ii signs, symptoms or laboratory results that are non caused by times exclusively most other medicine / drug, neurological disorder or total full general medical condition.
The increased tension inwards the muscles to a greater extent than oft than non leads to rhabdomyolysis (muscle breakdown) with commonly a stiff increment inwards creatine kinase, aldolase, transaminases together with lactic. Often, the patient has metabolic acidosis, hypoxia, decreased serum iron, increased catecholamines together with leukocytosis.
Changes inwards mental status together with other neurological disorders commonly hap (in fourscore subdivision of cases) rather than the ii classic symptoms.
Influenza A virus subtype A permit on of matters must locomote excluded: infections of the cardinal nervous system, especially viral encephalitis. These infections post away flame re-create NMS. It should too locomote ruled out an advanced psychotic champaign of catatonic stupor, or shrewd lethal catatonia.
Neuroleptic malignant syndrome (NMS) treatment
When these symptoms are observed, a hospitalization necessary where the medico the triggering medication stops or reduces serious. The patient intensive symptom ascendence together with medical monitoring should together with thence locomote provided together with to locomote treated for any additional medical problems for which an adequate cast of handling is available. There is no total full general touchstone pharmacological treatment for neuroleptic malignant syndrome (NMS).
Supporting measures
- Correction of electrolyte
- Cooling of the patient
- Monitoring of heart, kidney together with lung functions
- Control of coagulation disorders
- 1-2 mg Lorazepam, parenterally. In a mild extending NMS.
- Amantadine 200-400 mg / day.
- Bromocriptine 2.5 mg two to 3 times per day.
- Dantrolene 1-2.5 mg / kg of trunk weight, followed by times 1 mg / kg every half-dozen hours. In extreme cases.
The resumption of antipsychotic medication should solitary inwards extreme cases locomote done with swell assistance because at that topographic indicate is a remove chances of recurrence of neuroleptic malignant syndrome.
