Neuroleptic Malignant Syndrome

Background:
1. May occur in Parkinson’s disease patients with sudden decrease in dosage of dopaminergic agents

2. Most commonly within 3-9 days of initiation of therapy but can occur at any time during treatment or with dose increase

3. Thought to be an idiosyncratic drug reaction., NOT thought to be related to dose or duration of treatment

4. Can occur with typical and atypical/newer antipsychotics, but greater risk with high potency dopamine antagonists, such as haloperidol (Haldol)

Pathophysiology:
1. Dopaminergic depletion or blockade in basal ganglia (tone) and hypothalamus (thermoregulation)

2. Primary skeletal muscle defect similar to malignant hyperthermia.

Clinical features:
1. MAJOR = fever (>38.5)
2. Rigidity or stiffness
3. ­CK (>1000)

Other signs:
4. Sweating
5. Tremors

Treatment:
1. ABCs
2. Withdrawal of neuroleptic meds
3. Aggressive hydration
4. Cooling / reduction of fever / antipyretics