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Neuroleptic Malignant Syndrome - Causes, Symptoms, Diagnosis, and Treatment

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Neuroleptic malignant syndrome (NMS) is an uncommon and dangerous reaction to certain antipsychotic drugs (drugs used to treat mental health disorders).

Medically reviewed by

Dr. Abhishek Juneja

Published At December 22, 2022
Reviewed AtDecember 22, 2022

Introduction:

Neuroleptic malignant syndrome (NMS) is a serious reaction that occurs as a result of the intake of certain drugs which are used to treat mental health disorders. It is often seen when a person starts a new drug or increases the dosage of the current drug. Malignant hyperthermia is a condition that is similar to NMS. People with malignant hyperthermia show severe reactions to the medications used during surgery. Most of the symptoms of both disorders are similar to each other. However, malignant hyperthermia is a condition that is present from birth. Researchers believe that even though this can occur in patients from any age group, it is seen more in male patients who are under forty years of age. It is a very rare disorder, and the possibility of getting this condition is believed to be one or two out of every ten thousand persons who take antipsychotic drugs.

What Is Neuroleptic Malignant Syndrome?

Neuroleptic malignant syndrome is a severe and rare emergency condition that occurs as a result of a reaction to neuroleptic medications. These are antipsychotic medications that are used to treat and manage schizophrenia (a mental condition in which a person interprets reality abnormally), bipolar disorder (a person experiences extreme mood swings that consists of emotional highs and lows), and other mental health conditions. It causes symptoms like high fever, stiff muscles, and changes in mental state.

What Are the Causes of Neuroleptic Malignant Syndrome?

  • Intake of drugs that are used to treat mental health conditions (for example, depression).

  • Even though it has not been proven, researchers believe that genetic susceptibility (inherited increase in the chance of developing a disease) could be a possibility of developing NMS.

  • Sudden withdrawal of medications used to treat Parkinson’s disease (a disease that affects the nervous system and body parts that are under the control of nerves).

  • Usage of high doses of depot preparations (special preparation of medicine in an injection form that is released into the body at a slow pace over several weeks). This is done to avoid the frequent administration of medicine).

  • Certain drugs are used to treat nausea (uneasiness of the stomach, which is followed by an urge to vomit) and vomiting.

  • The sudden change from one antipsychotic drug to another.

  • A previous history of neuroleptic malignant syndrome increases the risk of a similar future reaction.

What Are the Symptoms of Neuroleptic Malignant Syndrome?

The symptoms may begin to appear within hours or days following exposure to a particular drug. The symptoms commonly seen are as follows:

  • Rise in body temperature (102 to 104 degrees Fahrenheit).

  • Fluctuations in blood pressure levels (sudden fall and rise in BP).

  • Excessive sweating and salivation (the act of saliva production in the mouth).

  • Tremors (rhythmic shaking of body parts which is uncontrollable by the patient).

  • Difficulty in swallowing

  • Changes in the mental state with confusion, agitation (state of anxiety), and altered consciousness.

  • Muscles become stiff.

  • Urinary incontinence (sudden inability to control the urge to urinate).

  • Fast or abnormal heartbeat.

  • Untreated cases may lead to severe complications like heart, kidney, and lung failure.

  • Sudden difficulty in speaking.

How Is Neuroleptic Malignant Syndrome Diagnosed?

There is no specific test to diagnose Neuroleptic malignant syndrome. However, if a person shows the symptoms of NMS, the following diagnostic tests are performed:

  • Blood Test (Complete Blood Count): It is done to check if a person has leukocytosis (a rise in the number of white blood cells in the blood, which generally takes place during an infection). Urea and electrolyte in the blood show metabolic disturbance (abnormal chemical reactions in the body), which may be due to acute kidney injury (kidneys stop functioning properly).

  • Comprehensive Metabolic Panel (CMP): A blood sample test that measures fourteen different substances present in the blood. This is done to check for the body’s chemical balance and metabolism (the process of body-transforming the food eaten into energy).

  • Electroencephalogram (EEG): It is a test to measure brain activity. In people with NMS, this test shows a non-generalized slow wave.

  • Lumbar Puncture: This procedure is carried out by the doctor by inserting a hollow needle into the space surrounding the spinal cord in the lower back to obtain the cerebrospinal fluid (the fluid that circulates within and around the brain and spinal cord). In patients with NMS, CSF shows an elevation in protein levels.

  • Liver Function Test: It shows increased levels of lactate dehydrogenase (a type of protein that plays an important role in converting food into usable energy).

  • Chest X-Ray: If sepsis (the body’s extreme reaction to infection) is suspected, a chest X-ray should be taken.

What Are the Treatment Options for Neuroleptic Malignant Syndrome?

  • If NMS is caused due to a particular drug, intake of that drug should be discontinued. If it is caused due to the sudden withdrawal of a drug, the drug intake should be restarted.

  • In case of a recent drug overdose, activated charcoal can be administered to prevent absorption.

  • IV fluids should be administered in patients suffering from dehydration.

  • Decreasing the body temperature by cooling the body using cooling blankets or ice packs.

  • Severe cases may experience difficulty in breathing. Ventilatory support should be provided to such patients.

  • Drugs that relax the stiffened muscles are given.

  • In patients with high blood pressure (BP), medications are given to lower their BP.

  • Electroconvulsive Therapy: This is done when medicines are of no help in treating the patient. During this procedure, the patient is asleep and pain-free. A small electric current is made to pass through the brain to initiate a seizure (electrical disturbance in the brain). This would help in relieving the symptoms.

  • In severe cases of kidney damage, dialysis may be required.

  • Agitated patients may be intravenously administered medications that can help with anxiety.

  • If a blood clot is identified, it should be treated using blood clot medications like Heparin.

Conclusion:

Neuroleptic malignant syndrome is a very serious condition. Hence, getting prompt medical care is very important. NMS is much easier to treat in the early phase. Therefore, it is very important to look out for any symptoms after the intake of medications used to treat mental health problems. With speedy diagnosis and treatment, many people with NMS recover. The majority of the patients can restart their medicines after a few weeks of recovery. Hence, early recognition of the disease and immediate treatment will help the patient to recover and lead a healthy life.

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Dr. Abhishek Juneja
Dr. Abhishek Juneja

Neurology

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