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Oruch R, Pryme IF, Engelsen BA, et al. Neuroleptic malignant syndrome: an easily overlooked neurologic emergency. Neuropsychiatr Dis Treat. 2017;13:161-175doi: 10.2147/NDT.S118438.
Oruch, R., Pryme, I. F., Engelsen, B. A., & Lund, A. (2017). Neuroleptic malignant syndrome: an easily overlooked neurologic emergency. Neuropsychiatric disease and treatment, 13161-175. https://doi.org/10.2147/NDT.S118438
Oruch, Ramadhan, et al. "Neuroleptic malignant syndrome: an easily overlooked neurologic emergency." Neuropsychiatric disease and treatment vol. 13 (2017): 161-175. doi: https://doi.org/10.2147/NDT.S118438
Oruch R, Pryme IF, Engelsen BA, Lund A. Neuroleptic malignant syndrome: an easily overlooked neurologic emergency. Neuropsychiatr Dis Treat. 2017 Jan 16;13:161-175. doi: 10.2147/NDT.S118438. eCollection 2017. PMID: 28144147; PMCID: PMC5248946.
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Neuropsychiatr Dis Treat. 2017 Jan 16;13:161-175. doi: 10.2147/NDT.S118438. eCollection 2017.

Neuroleptic malignant syndrome: an easily overlooked neurologic emergency.

Neuropsychiatric disease and treatment

Ramadhan Oruch, Ian F Pryme, Bernt A Engelsen, Anders Lund

Affiliations

  1. Department of Pharmacology and Toxicology, School of Pharmacy, Benghazi University, Benghazi, Libya.
  2. Department of Biomedicine.
  3. Department of Clinical Medicine, Section of Neurology.
  4. Department of Clinical Medicine, Section of Psychiatry, University of Bergen, Bergen, Norway.

PMID: 28144147 PMCID: PMC5248946 DOI: 10.2147/NDT.S118438

Abstract

Neuroleptic malignant syndrome is an unpredictable iatrogenic neurologic emergency condition, mainly arising as an idiosyncratic reaction to antipsychotic agent use. It is characterized by distinctive clinical features including a change in mental status, generalized rigidity, hyperpyrexia, and dysautonomia. It can be lethal if not diagnosed and treated properly. Mortality and morbidity attributed to this syndrome have recently declined markedly due to greater awareness, earlier diagnosis, and intensive care intervention. In most cases, the syndrome occurs as a result of a rapid increase in a dose of neuroleptic, especially one of the long-acting ones. Pathophysiology behind this syndrome is attributed to a dopamine receptor blockade inside the neurons rendered by the offending drug and excessive calcium release from the sarcoplasmic reticulum of skeletal myocytes. Laboratory tests, although not diagnostic, may assist in assessing the severity of the syndrome and also the consequent complications. The syndrome has been described in all age groups and occurs more in males than in females. Genetics appears to be central regarding the etiology of the syndrome. Stopping the use of the offending agent, cold intravenous fluids, and removal of the causative agent and its possible active metabolites is the cornerstone of treatment. Periodic observation of psychotic patients recently started on antipsychotic medications, especially those being treated with depot preparations, may aid to an early diagnosis of the syndrome and lead to early treatment.

Keywords: dopamine receptors; hyperpyrexia; neuroleptic malignant syndrome; renal shutdown; rhabdomyolysis; sarcoplasmic reticulum

Conflict of interest statement

The authors report no conflicts of interest in this work.

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