Neuroleptic Malignant Syndrome

The syndrome speaks to a blending of hyperthermia, muscle tightness, and autonomic dysregulation which may emerge as a significant complication of using antipsychotic drugs. The more recent atypical antipsychotics that are not categorized correctly as neuroleptics, may result in neuroleptic malignant syndrome. On the whole, over the past three decades a number of different drugs have been affiliated with the syndrome that cause lowered dopamine receptor activation.

Neuroleptic malignant syndrome is the most uncommon of the neuroleptic induced movement disorders. It is the gravest of all, and has to be treated as an emergency in many instances. There are now reports that it takes place with every drug that impact on the central dopaminergic system. There has been a case mentioned where there has been neuroleptic malignant syndrome in an individual on a trycyclic drug.

Estimation has been made that half to one percent of persons who had contact with neuroleptics are going to develop the syndrome. The patients that develop the syndrome early after the first exposure make up the majority. Within two weeks, 90 percent will  develop the syndrome, after the initiation of neuroleptic. This may take place with all neuroleptics however haldol and trifluperazine are the most widely known. Clozaphine and metoclopramide has also produced cases.

There are a number of obvious risk factors for development of the syndrome presently. However the small amount of occurrences, and the resulting hardship in studying the syndrome in a controlled fashion allow clinical characteristics, conditions of predisposition, prognosis, and treatment hard to give meaning to.

The death rate for NMS is very hard to quantify because of the design of the literature on cases among other things. In some instances cases of a mortality rate of 76 percent has been stated. On the other hand most cases have been reported as ranging between 10 to 20 percent. If the factor of report bias is weighted, then the actual cases of the syndrome may be even less. Studies additionally indicate that mortality rate had gone down over the past twenty years. The cases tend to be higher in persons who experience severe muscle necrosis, and the consequent rhabdomyolysis.

Who may be affected?

The incidents of neuroleptic malignant syndrome are generally higher in males than in females. The data does not indicate any racial, or geographic differentiation. Persons over forty years of age experience higher incidence of the syndrome. The variation in the incidence may be a reflection of a population with a larger antipsychotic medication usage level. There are other suggestions pertaining to age, that the development of the condition may take place in those who have used these drugs for a longer time. Cases of the syndrome in children are very uncommon but there is the suggestion that symptoms are along similar lines with what is identified in adults.

Some of the clinical features of NMS include tremor, incontinence, delirium growing into lethargy, or coma, rigidity, shutting gait, psychomotor agitation, and a number of others. Proper diagnosis must eliminate all other medical conditions with similar symptoms.

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