Abstract
There has recently been interest in neuroleptic malignant syndrome (NMS) as the disorder has been better characterized. Nms is still poorly recognized, however, by most physicians. Hyperpyrexia, rigidity, altered consciousness, autonomic instability, and enzymatic evidence of muscle breakdown after drug intake are the cardinal features. The authors of this article review the proposed pathogenesis, complications, and treatment of NMS.
Keywords: neuroleptic malignant syndrome, rigidity, neuroleptics
Full text
PDF



Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Allan R. N., White H. C. Side effects of parenteral long-acting phenothiazines. Br Med J. 1972 Jan 22;1(5794):221–221. doi: 10.1136/bmj.1.5794.221. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Ansseau M., Reynolds C. F., 3rd, Kupfer D. J., Poncelet P. F., Franck G., Dresse A. E., Reznik M. Central dopaminergic and noradrenergic receptor blockade in a patient with neuroleptic malignant syndrome. J Clin Psychiatry. 1986 Jun;47(6):320–321. [PubMed] [Google Scholar]
- Ansseau M., Reynolds C. F., 3rd, Kupfer D. J., Poncelet P. F., Franck G., Dresse A. E., Reznik M. Central dopaminergic and noradrenergic receptor blockade in a patient with neuroleptic malignant syndrome. J Clin Psychiatry. 1986 Jun;47(6):320–321. [PubMed] [Google Scholar]
- Araki M., Takagi A., Higuchi I., Sugita H. Neuroleptic malignant syndrome: caffeine contracture of single muscle fibers and muscle pathology. Neurology. 1988 Feb;38(2):297–301. doi: 10.1212/wnl.38.2.297. [DOI] [PubMed] [Google Scholar]
- Bismuth C., de Rohan-Chabot P., Goulon M., Raphael J. C. Dantrolene--a new therapeutic approach to the neuroleptic malignant syndrome. Acta Neurol Scand Suppl. 1984;100:193–198. [PubMed] [Google Scholar]
- Blue M. G., Schneider S. M., Noro S., Fraley D. S. Successful treatment of neuroleptic malignant syndrome with sodium nitroprusside. Ann Intern Med. 1986 Jan;104(1):56–57. doi: 10.7326/0003-4819-104-1-56. [DOI] [PubMed] [Google Scholar]
- Burke R. E., Fahn S., Mayeux R., Weinberg H., Louis K., Willner J. H. Neuroleptic malignant syndrome caused by dopamine-depleting drugs in a patient with Huntington disease. Neurology. 1981 Aug;31(8):1022–1025. doi: 10.1212/wnl.31.8.1022. [DOI] [PubMed] [Google Scholar]
- Caroff S. N., Rosenberg H., Fletcher J. E., Heiman-Patterson T. D., Mann S. C. Malignant hyperthermia susceptibility in neuroleptic malignant syndrome. Anesthesiology. 1987 Jul;67(1):20–25. doi: 10.1097/00000542-198707000-00004. [DOI] [PubMed] [Google Scholar]
- Caroff S. N. The neuroleptic malignant syndrome. J Clin Psychiatry. 1980 Mar;41(3):79–83. [PubMed] [Google Scholar]
- Coons D. J., Hillman F. J., Marshall R. W. Treatment of neuroleptic malignant syndrome with dantrolene sodium: a case report. Am J Psychiatry. 1982 Jul;139(7):944–945. doi: 10.1176/ajp.139.7.944. [DOI] [PubMed] [Google Scholar]
- Ewert A. L., Kloek J., Wells B., Phelps S. Neuroleptic malignant syndrome associated with loxapine. J Clin Psychiatry. 1983 Jan;44(1):37–38. [PubMed] [Google Scholar]
- Fabre S., Gervais C., Manuel C., Vic Dupont V. Le syndrome malin des neuroleptiques: à propos de 7 cas. Encephale. 1977;3(4):321–326. [PubMed] [Google Scholar]
- Fielding S., Szewczak M. R. Pharmacology of nomifensine: a review of animal studies. J Clin Psychiatry. 1984 Apr;45(4 Pt 2):12–20. [PubMed] [Google Scholar]
- Figà-Talamanca L., Gualandi C., Di Meo L., Di Battista G., Neri G., Lo Russo F. Hyperthermia after discontinuance of levodopa and bromocriptine therapy: impaired dopamine receptors a possible cause. Neurology. 1985 Feb;35(2):258–261. doi: 10.1212/wnl.35.2.258. [DOI] [PubMed] [Google Scholar]
- Fink R. A. Myoglobinuria in neuroleptic malignant syndrome. Arch Intern Med. 1985 Sep;145(9):1736–1736. [PubMed] [Google Scholar]
- Frances A., Susman V. L. Managing an acutely manic 17-year-old girl with neuroleptic malignant syndrome. Hosp Community Psychiatry. 1986 Aug;37(8):771-2, 788. doi: 10.1176/ps.37.8.771. [DOI] [PubMed] [Google Scholar]
- Friedman J. H., Feinberg S. S., Feldman R. G. A neuroleptic malignantlike syndrome due to levodopa therapy withdrawal. JAMA. 1985 Nov 15;254(19):2792–2795. [PubMed] [Google Scholar]
- Gibb W. R., Lees A. J. The neuroleptic malignant syndrome--a review. Q J Med. 1985 Aug;56(220):421–429. [PubMed] [Google Scholar]
- Goekoop J. G., Carbaat P. A. Treatment of neuroleptic malignant syndrome with dantrolene. Lancet. 1982 Jul 3;2(8288):49–50. doi: 10.1016/s0140-6736(82)91189-8. [DOI] [PubMed] [Google Scholar]
- Goulon M., de Rohan-Chabot P., Elkharrat D., Gajdos P., Bismuth C., Conso F. Beneficial effects of dantrolene in the treatment of neuroleptic malignant syndrome: a report of two cases. Neurology. 1983 Apr;33(4):516–518. [PubMed] [Google Scholar]
- Granato J. E., Stern B. J., Ringel A., Karim A. H., Krumholz A., Coyle J., Adler S. Neuroleptic malignant syndrome: successful treatment with dantrolene and bromocriptine. Ann Neurol. 1983 Jul;14(1):89–90. doi: 10.1002/ana.410140117. [DOI] [PubMed] [Google Scholar]
- Greenberg L. B., Gujavarty K. The neuroleptic malignant syndrome: review and report of three cases. Compr Psychiatry. 1985 Jan-Feb;26(1):63–70. doi: 10.1016/0010-440x(85)90050-1. [DOI] [PubMed] [Google Scholar]
- Guzé B. H., Baxter L. R., Jr Current concepts. Neuroleptic malignant syndrome. N Engl J Med. 1985 Jul 18;313(3):163–166. doi: 10.1056/NEJM198507183130306. [DOI] [PubMed] [Google Scholar]
- Hamburg P., Weilburg J. B., Cassem N. H., Cohen L., Brown S. Relapse of neuroleptic malignant syndrome with early discontinuation of amantadine therapy. Compr Psychiatry. 1986 Jul-Aug;27(4):272–275. doi: 10.1016/0010-440x(86)90002-7. [DOI] [PubMed] [Google Scholar]
- Henderson V. W., Wooten G. F. Neuroleptic malignant syndrome: a pathogenetic role for dopamine receptor blockade? Neurology. 1981 Feb;31(2):132–137. doi: 10.1212/wnl.31.2.132. [DOI] [PubMed] [Google Scholar]
- Hermesh H., Huberman M., Radvan H., Kott E. Recurrent neuroleptic malignant syndrome due to tiapride and haloperidol: the possible role of D-2 dopamine receptors. J Nerv Ment Dis. 1984 Nov;172(11):692–695. doi: 10.1097/00005053-198411000-00008. [DOI] [PubMed] [Google Scholar]
- Hughes J. R. ECT during and after the neuroleptic malignant syndrome: case report. J Clin Psychiatry. 1986 Jan;47(1):42–43. [PubMed] [Google Scholar]
- Huidobro-Toro J. P., Way E. L. Rapid development of tolerance to the hyperthermic effect of beta-endorphin, and cross-tolerance between the enkephalins and beta-endorphin. Eur J Pharmacol. 1980 Jul 25;65(2-3):221–231. doi: 10.1016/0014-2999(80)90395-7. [DOI] [PubMed] [Google Scholar]
- Irwin G. E., Jr, Simon J. E. Neuroleptic malignant syndrome. J Emerg Med. 1984;1(3):207–211. doi: 10.1016/0736-4679(84)90073-8. [DOI] [PubMed] [Google Scholar]
- Lazarus A. Treatment of neuroleptic malignant syndrome with electroconvulsive therapy. J Nerv Ment Dis. 1986 Jan;174(1):47–49. doi: 10.1097/00005053-198601000-00008. [DOI] [PubMed] [Google Scholar]
- Levenson J. L. Neuroleptic malignant syndrome. Am J Psychiatry. 1985 Oct;142(10):1137–1145. doi: 10.1176/ajp.142.10.1137. [DOI] [PubMed] [Google Scholar]
- Martin M. L., Lucid E. J., Walker R. W. Neuroleptic malignant syndrome. Ann Emerg Med. 1985 Apr;14(4):354–358. doi: 10.1016/s0196-0644(85)80104-9. [DOI] [PubMed] [Google Scholar]
- May D. C., Morris S. W., Stewart R. M., Fenton B. J., Gaffney F. A. Neuroleptic malignant syndrome: response to dantrolene sodium. Ann Intern Med. 1983 Feb;98(2):183–184. doi: 10.7326/0003-4819-98-2-183. [DOI] [PubMed] [Google Scholar]
- McCarron M. M., Boettger M. L., Peck J. J. A case of neuroleptic malignant syndrome successfully treated with amantadine. J Clin Psychiatry. 1982 Sep;43(9):381–382. [PubMed] [Google Scholar]
- PRESTON J. Central nervous system reactions to small doses of tranquilizers; report of one death. Am Pract Dig Treat. 1959 Apr;10(4):627–630. [PubMed] [Google Scholar]
- Pope H. G., Jr, Cole J. O., Choras P. T., Fulwiler C. E. Apparent neuroleptic malignant syndrome with clozapine and lithium. J Nerv Ment Dis. 1986 Aug;174(8):493–495. doi: 10.1097/00005053-198608000-00010. [DOI] [PubMed] [Google Scholar]
- Rampertaap M. P. Neuroleptic malignant syndrome. South Med J. 1986 Mar;79(3):331–336. doi: 10.1097/00007611-198603000-00018. [DOI] [PubMed] [Google Scholar]
- Regestein Q. R., Alpert J. S., Reich P. Sudden catatonic stupor with disastrous outcome. JAMA. 1977 Aug 15;238(7):618–620. [PubMed] [Google Scholar]
- Samie M. R. Neuroleptic malignant-like syndrome induced by metoclopramide. Mov Disord. 1987;2(1):57–60. doi: 10.1002/mds.870020108. [DOI] [PubMed] [Google Scholar]
- Sandyk R. Neuroleptic malignant syndrome and the opioid system. Med Hypotheses. 1985 Jun;17(2):133–137. doi: 10.1016/0306-9877(85)90137-9. [DOI] [PubMed] [Google Scholar]
- Schibuk M., Schachter D. A role for catecholamines in the pathogenesis of neuroleptic malignant syndrome. Can J Psychiatry. 1986 Feb;31(1):66–69. doi: 10.1177/070674378603100114. [DOI] [PubMed] [Google Scholar]
- Shalev A., Hermesh H., Munitz H. The role of loading rate in neuroleptic malignant syndrome. Am J Psychiatry. 1986 Aug;143(8):1059–1059. doi: 10.1176/ajp.143.8.1059a. [DOI] [PubMed] [Google Scholar]
- Smego R. A., Jr, Durack D. T. The neuroleptic malignant syndrome. Arch Intern Med. 1982 Jun;142(6):1183–1185. [PubMed] [Google Scholar]
- Somers C. J., McLoughlin J. V. Malignant hyperthermia in pigs: calcium ion uptake by mitochondria from skeletal muscle of susceptible animals given neuroleptic drugs and halothane. J Comp Pathol. 1982 Apr;92(2):191–198. doi: 10.1016/0021-9975(82)90077-9. [DOI] [PubMed] [Google Scholar]
- Straker M. Neuroleptic malignant syndrome: fatalities associated with neuroleptic use and schizophrenia. Psychiatr J Univ Ott. 1986 Mar;11(1):28–30. [PubMed] [Google Scholar]
- Tomson C. R. Neuroleptic malignant syndrome associated with inappropriate antidiuresis and psychogenic polydipsia. Br Med J (Clin Res Ed) 1986 Jan 18;292(6514):171–171. doi: 10.1136/bmj.292.6514.171. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Verhoeven W. M., Elderson A., Westenberg H. G. Neuroleptic malignant syndrome: successful treatment with bromocriptine. Biol Psychiatry. 1985 Jun;20(6):680–684. doi: 10.1016/0006-3223(85)90104-0. [DOI] [PubMed] [Google Scholar]
- Wedzicha J. A., Hoffbrand B. I. Neuroleptic malignant syndrome and hyponatraemia. Lancet. 1984 Apr 28;1(8383):963–963. doi: 10.1016/s0140-6736(84)92421-8. [DOI] [PubMed] [Google Scholar]
