Neuroleptic Malignant Syndrome

Neuroleptic Malignant Syndrome

Medications are used to create a balance among an imbalance. Sometimes things don’t always go as planned, unfavorable reactions can occur to certain drugs but it isn’t always a common occurrence. Neuroleptic Malignant Syndrome is a rare neurological disorder that is basically an adverse reaction to a neuroleptic or anti-psychotic drug. (5) It is commonly classified with hyperthermia, dehydration, cardiovascular instability, hypoxemia, and muscular rigidity. These symptoms have been categorized as NMS whenever a neuroleptic has been prescribed. NMS is a relatively new disorder that was termed in 1960. (1) NMS is not a specific disorder but a group of symptoms that define what it is.

A patient suffering from NMS will most likely be found to have hyperthermia, muscle rigidity, high WBC, dehydration, fluctuations in blood pressure, high respiration rates, and tachycardia. If these symptoms are not found, then it isn’t NMS. NMS has been commonly mistaken for serotonin syndrome, which has some of the same symptoms. Other symptoms that are specific to NMS include oculogyric crises, which are incapacitating attacks of upward eye movement, excessive sweating, and tremors. The symptoms are the most important part of the disorder.[1]

To diagnose NMS, the physician needs to be tremendously suspicious of certain key symptoms that play only to NMS. The way to tell that NMS is present is by making absolute sure that the key symptoms were not present prior to the start of the drug. If the symptoms weren’t present prior to the start of the drug cycle, then once the drug has been discontinued the symptoms should disappear as well. (2) For the prognosis, if the disorder is discovered early and treated as such, then there is a high chance of recovery, with a 5% mortality rate. Some patients have a chance of having permanent impediments such as dementia, parkinsonism, and ataxia. Those who have experienced renal failure and other incredible problems had a 50% mortality rate. The key is to take early action.

There is no known cure for NMS, but the only certain treatment is to take care of the symptoms present. Firstly the offending drug must be discontinued immediately to ensure a positive recovery. After the patient has been placed in intensive care and the neuroleptic drug has been discontinued, it is safe to proceed with feeding intravenously hydration and electrolytes for metabolism. Hyperthermia needs to be reduced in anyway possible. (2) The patient needs to be started, if they haven’t already, on dopamine agonist. The dopamine agonist will help boost dopamine levels which have severely dropped due to the neuroleptic. Other than treat the symptoms, there is nothing else to be done but let time take its course. (2)

Neuroleptic Malignant syndrome is a neurological disease. By previous evidence, it does not sound like a debilitating disorder that affects brain functioning. Neuroleptic and anti-psychotic drugs are meant to block the uptake of the neurotransmitter dopamine. When too much dopamine is blocked, it can lead to Parkinson like symptoms. D2 receptors that have been blocked in the hypothalamus, nigrostriatal pathway, and spinal cord all lead to the symptoms of muscle rigidity and tremors. Because the hypothalamus has been blocked there is a raise in temperature and impairment in heat-dissipating mechanisms. NMS affects not only the CNS, but also the sympathetic nervous system. When D2 receptors have been blocked in certain areas there may be tonic inhibitions that can lead to hyperactivity in the sympathoadrenal and deregulations which cause autonomic dysfunction. This is why dopamine agonists are used in the drug therapy during treatment. D2 levels need to be raised to let normal functioning levels become the way they were previously.