Neuroleptic malignant syndrome: an easily overlooked neurologic emergency

Ramadhan Oruch,1 Ian F Pryme,2 Bernt A Engelsen,3 Anders Lund4 1Department of Pharmacology and Toxicology, School of Pharmacy, Benghazi University, Benghazi, Libya; 2Department of Biomedicine, 3Department of Clinical Medicine, Section of Neurology, 4Department of Clinical Medicine, Section of Psych...

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Autores principales:	Oruch R, Pryme IF, Engelsen BA, Lund A
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2017
Materias:	Neuroleptic malignant syndrome dopamine receptors rhabdomyolysis renal shutdown hyperpyrexia sarcoplasmic reticulum. Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/c431170cea9b4762b3ce7699f12cc8d5
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spelling	oai:doaj.org-article:c431170cea9b4762b3ce7699f12cc8d52021-12-02T00:23:57ZNeuroleptic malignant syndrome: an easily overlooked neurologic emergency1178-2021https://doaj.org/article/c431170cea9b4762b3ce7699f12cc8d52017-01-01T00:00:00Zhttps://www.dovepress.com/neuroleptic-malignant-syndrome-an-easily-overlooked-neurologic-emergen-peer-reviewed-article-NDThttps://doaj.org/toc/1178-2021Ramadhan Oruch,1 Ian F Pryme,2 Bernt A Engelsen,3 Anders Lund4 1Department of Pharmacology and Toxicology, School of Pharmacy, Benghazi University, Benghazi, Libya; 2Department of Biomedicine, 3Department of Clinical Medicine, Section of Neurology, 4Department of Clinical Medicine, Section of Psychiatry, University of Bergen, Bergen, Norway 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: neuroleptic malignant syndrome, dopamine receptors, rhabdomyolysis, renal shutdown, hyperpyrexia, sarcoplasmic reticulumOruch RPryme IFEngelsen BALund ADove Medical PressarticleNeuroleptic malignant syndromedopamine receptorsrhabdomyolysisrenal shutdownhyperpyrexiasarcoplasmic reticulum.Neurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurology. Diseases of the nervous systemRC346-429ENNeuropsychiatric Disease and Treatment, Vol Volume 13, Pp 161-175 (2017)
institution	DOAJ
collection	DOAJ
language	EN
topic	Neuroleptic malignant syndrome dopamine receptors rhabdomyolysis renal shutdown hyperpyrexia sarcoplasmic reticulum. Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
spellingShingle	Neuroleptic malignant syndrome dopamine receptors rhabdomyolysis renal shutdown hyperpyrexia sarcoplasmic reticulum. Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429 Oruch R Pryme IF Engelsen BA Lund A Neuroleptic malignant syndrome: an easily overlooked neurologic emergency
description	Ramadhan Oruch,1 Ian F Pryme,2 Bernt A Engelsen,3 Anders Lund4 1Department of Pharmacology and Toxicology, School of Pharmacy, Benghazi University, Benghazi, Libya; 2Department of Biomedicine, 3Department of Clinical Medicine, Section of Neurology, 4Department of Clinical Medicine, Section of Psychiatry, University of Bergen, Bergen, Norway 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: neuroleptic malignant syndrome, dopamine receptors, rhabdomyolysis, renal shutdown, hyperpyrexia, sarcoplasmic reticulum
format	article
author	Oruch R Pryme IF Engelsen BA Lund A
author_facet	Oruch R Pryme IF Engelsen BA Lund A
author_sort	Oruch R
title	Neuroleptic malignant syndrome: an easily overlooked neurologic emergency
title_short	Neuroleptic malignant syndrome: an easily overlooked neurologic emergency
title_full	Neuroleptic malignant syndrome: an easily overlooked neurologic emergency
title_fullStr	Neuroleptic malignant syndrome: an easily overlooked neurologic emergency
title_full_unstemmed	Neuroleptic malignant syndrome: an easily overlooked neurologic emergency
title_sort	neuroleptic malignant syndrome: an easily overlooked neurologic emergency
publisher	Dove Medical Press
publishDate	2017
url	https://doaj.org/article/c431170cea9b4762b3ce7699f12cc8d5
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_version_	1718403765194719232

Neuroleptic malignant syndrome: an easily overlooked neurologic emergency

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