Neuroleptic Malignant Syndrome

What is Neuroleptic Malignant Syndrome

Neuroleptic malignant syndrome is a rare disorder that causes a high fever, stiff muscles, and changes in mental status. It occurs in a small number of people who are taking a neuroleptic medicine.

These medicines block the effects of the brain chemical dopamine. This is a life-threatening condition that requires treatment in the hospital right away.

Neuroleptic malignant syndrome is a serious problem that is an emergency. Do not wait to see if the condition will go away. Get medical help right away. Call your local emergency services (911 in the U.S.). Do not drive yourself to the hospital.

What are the causes?

The exact cause of the reaction is not known. It may be caused by an adverse reaction to:

  • Certain antipsychotic (neuroleptic) medicines.
  • Certain medicines for nausea and vomiting.

The disorder may also occur in someone who suddenly stops taking some medicines for Parkinson’s disease or Huntington’s disease (dopaminergic medicines).

What increases the risk?

You are more likely to develop this condition if you are taking neuroleptic or antipsychotic medicines. Your risk may be higher if:

  • You take a certain type of neuroleptic medicine (high potency medicine).
  • Your dose of the medicine is increased over a short period of time.
  • You switch from one neuroleptic medicine to another.
  • You receive the medicine through an injection or IV.
  • You have dehydration, exhaustion, or iron deficiency.

What are the signs or symptoms?

Symptoms of this condition usually develop within the first 2 weeks of taking the medicine. Changes in mental status often appear first. Once the symptoms of this condition develop, they often become worse quickly. Symptoms may include:

  • High fever along with heavy sweating.
  • Stiff muscles. This may make movements difficult.
  • Difficulty swallowing.
  • Uncontrolled shaking of different parts of your body (tremor).
  • Lack of energy (lethargy).
  • Agitation and confusion.
  • Unresponsiveness and reduced level of consciousness (stupor).
  • High blood pressure.
  • Fast heartbeat.
  • Loss of bladder control.

How is this diagnosed?

This condition is diagnosed based on your symptoms and your history of taking neuroleptic or antipsychotic medicines. There is no specific test that can be used to diagnose this condition. However, various tests will be done to rule out other conditions that can cause your symptoms. Tests may include:

  • Blood tests.
  • Urine tests.
  • Cerebral spinal fluid tests.
  • X-rays of your chest.
  • Imaging studies to check the central nervous system (neuroimaging tests).
  • Tests to check the electrical activity in your brain (electroencephalogram or EEG).

How is this treated?

Treatment for this condition includes stopping the medicine that caused the condition. In addition, the symptoms need to be treated in the hospital right away. Treatment may include:

  • Methods to reduce a high fever by quickly cooling your body. Examples include using ice packs or wrapping your body in a cooling blanket. Medicines to reduce fever may also be used.
  • Medicines to increase dopamine levels.
  • Medicines to relax the muscles or to treat changes in your mental status.
  • IV fluids to replace lost fluids.
  • Monitoring in an intensive care unit and treating any complications that arise.

Follow these instructions at home:

  • Take over-the-counter and prescription medicines only as told by your health care provider. 
    • Do not stop or start taking any medicines without talking to your health care provider first.
  • Work closely with your health care provider and mental health professional to monitor the condition for which you were taking the neuroleptic or antipsychotic medicine. This will help ensure that your condition is properly treated after the medicine is stopped.
  • Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

  • You have new symptoms.

Get help right away if:

  • Your symptoms return even after treatment.

Summary

  • Neuroleptic malignant syndrome is a rare disorder that causes a high fever, stiff muscles, and changes in mental status.
  • This is a life-threatening condition that requires treatment in the hospital right away.
  • Work closely with your health care provider and mental health professional to monitor the condition for which you were taking the neuroleptic or antipsychotic medicine. This will help ensure that your condition is properly treated after the medicine is stopped.
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