Neuroleptic malignant syndrome
Neuroleptic malignant syndrome is a rare but dangerous condition seen in patients taking antipsychotic medication. It carries a mortality of up to 10% and can also occur with atypical antipsychotics. It may also occur with dopaminergic drugs (such as levodopa) for Parkinson's disease, usually when the drug is suddenly stopped or the dose reduced.
Features
A raised creatine kinase is present in most cases. A leukocytosis may also be seen
Management
*thought to work by decreasing excitation-contraction coupling in skeletal muscle by binding to the ryanodine receptor, and decreasing the release of calcium from the sarcoplasmic reticulum
Features
- more common in young male patients
- onset usually in first 10 days of treatment or after increasing dose
- pyrexia
- rigidity
- tachycardia
A raised creatine kinase is present in most cases. A leukocytosis may also be seen
Management
- stop antipsychotic
- IV fluids to prevent renal failure
- dantrolene* may be useful in selected cases
- bromocriptine, dopamine agonist, may also be used
*thought to work by decreasing excitation-contraction coupling in skeletal muscle by binding to the ryanodine receptor, and decreasing the release of calcium from the sarcoplasmic reticulum