Neuroleptic Malignant Syndrome is a serious complication that can occur during treatment with antispychotic drugs. It manifests itself, inter alia, fever, muscle stiffness and impaired consciousness. If NMS is not properly diagnosed in time, it can lead to the death of the patient. What else is worth seeing about the neuroleptic malignant syndrome?

Neuroleptic Malignant Syndrome( ZZNorNeuroleptic Malignant Syndrome- NMS) is the most serious complication that can occur as a result of the use of antispychotic drugs, i.e. drugs that are used in the treatment of mental disorders, e.g. schizophrenia, but also other psychoses in the course of which there are delusions, hallucinations, disturbances in activity, consciousness and emotionality. NMS usually occurs at the beginning of treatment, but sometimes also when the drug is discontinued too abruptly and then restarted. It is admittedly a rare (it affects at most 0.02-3% of patients), but a very serious and potentially fatal (5-20% of patients) complication of neuroleptic treatment, which results from blocking dopaminergic transmission in the nigrostriatal system - although it is not fully known. another mechanism by which neuroleptic malignant syndrome develops.

Neuroleptic Malignant Syndrome: Symptoms

NMS symptoms can be divided into three groups:

  1. Disorders of the autonomic system: hyperthermia (body temperature above 38 degrees Celsius), changes in pressure, arrhythmias, tachycardia (increase in heart rate by 30 / min), breathing disorders, dyspnoea, dysuria, pallor, drooling, sweating changes in the skin, inability to keep urine and stools.
  2. Motor disorders - from agitation, through slowing down, to akinesia, wax catalepsy, muscle tension disorders, stiffness, trismus, involuntary movements, chorea, tremors, convulsions, forced positioning of the eyeballs.
  3. Disturbances of consciousness - from haze, through delirium, mutism, to stupor and coma.

The studies showed an increase in the activity of creatine phosphokinase (CPK over 1000 IU / ml), as well as aminotransferases, leukocytosis (15000 / mm3) and myoglobinuria.

Neuroleptic Malignant Syndrome: What Drugs Can Cause?

Maliciousneuroleptic syndrome can be caused by:

  • typical neuroleptics, e.g. haloperidol (Decaldol, Haloperidol), fluphenazine (Mirenil), chlorpromazine (Fenactil) - most often cause NMS,
  • atypical neuroleptics, e.g. clozapine (Clozapol, Leponex), risperidone (Rispolept), olanzapine (Zyprexa) and quetiapine (Seroquel) - less likely to cause NMS,

moreover:

  • antiemetics, e.g. prochlorperazine (Chloropernazinum), metoclopramide,
  • anticonvulsants, e.g. carbamazepine (Amizepin, Neurotop retard, Tegretol, Tegretol CR, Timonil),
  • anti-depressants, e.g. aripiprazole (Abilify), fluoxetine (Bioxetin, Fluoxetin, Prozac, Seronil), venlafaxine (Efectin, Efectin ER),
  • combined use of quetiapine and fluvoxamine (Fevarin),
  • drugs, e.g. amphetamines, cocaine.

Neuroleptic Malignant Syndrome can also trigger:

  • abrupt withdrawal of the drug,
  • increasing the dose too quickly,
  • intramuscular form of the drug,
  • combination therapy, e.g. a neuroleptic with lithium s alts or with carbamazepine.

More susceptible to developing NMS are young people aged 20-40 (but cases of NMS in infants, children and the elderly have also been reported), debilitated, and men (this complication affects them twice as often as women) .

Neuroleptic Malignant Syndrome: Diagnosis and Prognosis

In order to properly make a diagnosis of NMS, it should be differentiated from:

  • heat-related diseases,
  • malignant hyperthermia,
  • lethal catatonic syndrome (fatal catatonia),
  • heatstroke,
  • thyroid crisis,
  • serotonin syndrome,
  • systemic infection,
  • pheochromocytoma,
  • tetanus,
  • seizure,
  • acute porphyria,
  • withdrawal syndrome.

Death of a patient usually occurs as a result of late diagnosis of NMS, as a result of complications from the circulatory, respiratory and renal systems. The symptoms of the syndrome progress very quickly, so it's important to get a diagnosis and start treatment as soon as possible - improvement usually occurs within two weeks. Patients who previously used neuroleptics with prolonged duration of action and with brain damage are treated longer and more difficult. Most patients recover to full capacity without any residual neurological symptoms.

Neuroleptic Malignant Syndrome: Treatment

Immediately after diagnosis, the drug that caused the NMS should be discontinued and symptomatic treatment initiated as wellnursing the patient to prevent possible complications. Treatment should take place in a psychiatric ward or, in more severe cases, in an intensive care unit. Symptomatic treatment consists of administering antipyretics and electrolyte balancing drugs, and adequate hydration. It is common to include dopamine agonists and drugs that lower muscle tone.

After the correction, the neuroleptic can be restarted, but you have to take into account the possibility of NMS recurrence (which is quite common - 30%). Therefore, at this time, atypical neuroleptics, such as clozapine (the safest), quetiapine and aripiprazole, are preferred, while classic and prolonged-acting neuroleptics are not recommended. The dose of the drug should be increased gradually, observing the patient and monitoring the results of his tests (CPK, transaminases, urea, creatinine). A two-week period without treatment with a neuroleptic is recommended and at the same time psychoeducation of the patient and his family. Electroconvulsive therapy is sometimes proposed, but this therapy is only used in patients who are unresponsive to other treatments because of the risk of complications from both the electroconvulsive shock itself and its associated procedures. According to some reports, mortality after electroconvulsive treatment is lower than in patients treated with other methods.

Neuroleptic Malignant Syndrome: Complications

Complications from neuroleptic malignant syndrome are common and dangerous to he alth, potentially fatal. To avoid them, you need to make a correct diagnosis as soon as possible and start treatment. Among the most serious complications after RNA, we can distinguish:

  • acute renal failure,
  • cardiomyopathy,
  • myocardial infarction,
  • respiratory failure,
  • liver failure,
  • sepsis (sepsis),
  • deep vein thrombosis.

Category:

Neurology