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Neuroleptic Malignant Syndrome

Asma Tariq, M.D, Rebecca R K Kawagoe, M.S., D.O. and Mariam Bassali, M.P.H., M.D. Reviewed 05/2023
 


BASICS

DESCRIPTION

  • Neuroleptic malignant syndrome (NMS) is a life-threatening condition that may develop during treatment with neuroleptic medications; 2/3 of cases develop within the first 2 weeks of ...

DIAGNOSIS

Neuroleptic malignant syndrome is a diagnosis of exclusion. There is a lack of consensus on clinical diagnostic criteria. 

HISTORY

  • Unpredictable and variable presentation, especially in early ...

TREATMENT

GENERAL MEASURES

  • NMS is a medical emergency. Discontinue offending agent immediately (1)[B].

  • Treat hyperthermia aggressively with cooling baths, ice packs, or antipyretic medications.

  • Provide ...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • Allow at least 15 days after recovery before considering a rechallenge neuroleptic; rechallenge should not be with the medication implicated in the original NMS e...

REFERENCES

1
Oruch R, Pryme IF, Engelsen BA, et al. Neuroleptic malignant syndrome: an easily overlooked neurologic emergency. Neuropsychiatr Dis Treat. 2017;13:161–175. doi: 10.2147/NDT.S118438. PMID:...

ADDITIONAL READING

  • Perry  PJ, Wilborn  CA. Serotonin syndrome vs neuroleptic malignant syndrome: a contrast of causes, diagnoses, and management. Ann Clin Psychiatry.  ...

CODES

ICD10

G21.0 Malignant neuroleptic syndrome 

SNOMED

15244003 Neuroleptic malignant syndrome (disorder) 

CLINICAL PEARLS

  • NMS is a medical emergency that normally requires critical care for management.

  • 2/3 of NMS cases occur within the first 2 weeks of starting a neuroleptic therapy.

  • Early clinical suspicio...

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