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Surprising findings on neuromalignant syndrome: Why are high-risk antipsychotics so stressful?
Neuromalignant syndrome (NMS) is a rare but potentially fatal reaction that may occur with the use of antipsychotics or other drugs that block the effects of dopamine. Symptoms of this syndrome include high fever, confusion, muscle stiffness, changing blood pressure, sweating and rapid heartbeat. If not treated quickly, complications may include muscle breakdown (rhabdomyolysis), hyperkalemia, kidney failure, or seizures. Although any drug that belongs to the antipsychotic drug family has the potential to trigger this condition, the risk appears to be higher with typical antipsychotics than with atypical antipsychotics, especially first-generation antipsychotics such as haloperidol.
If diagnosed and treated promptly, many patients can eventually be restarted on low-dose antipsychotic medications.
The initial symptoms of NMS usually appear within a few days after starting to take the relevant drugs, and may not appear until up to 30 days later. This allows clinicians to sometimes misidentify symptoms as symptoms of mental illness, leading to delays in treatment. The main cause of this disease is the blocking of dopamine receptors, which causes a series of physiological reactions and requires rapid medical intervention to improve the prognosis.
Specific symptoms of neurological malignant syndrome
Symptoms of NMS include but are not limited to:
- Body temperature rise greater than 38°C (100.4°F)
- Confusion or change of consciousness
- Excessive sweating
- Muscle stiffness
- Autonomic nervous system imbalance
Symptoms of NMS may intensify within 48 hours and, at peak intensity, quickly become a life-threatening condition.
These symptoms are sometimes misunderstood because they resemble psychosis or other similar conditions (eg, malignant hyperthermia, serotonin syndrome), leading to misdiagnosis and delayed treatment. Many symptoms (eg, muscle spasms, tremors) may not be ignored in the early stages of NMS, further emphasizing the importance of early intervention.
Causes of NMS
NMS is usually caused by antipsychotic drugs, but other drugs that block the effects of dopamine may also cause the syndrome. Studies show that people who use highly potent antipsychotics, such as haloperidol, or benzothiazines, such as chlorpromazine, are at higher risk. Sudden dose reduction of dopamine agonists during chronic use can also trigger NMS.
Latest research shows that the occurrence of NMS is related to a substantial reduction in dopamine activity, and may be related to the body's physical response in situations of fear and anxiety.
Risk factors
A history of antipsychotic use, dehydration, and the risk of rapidly escalating drug doses in the short term are important risk factors for NMS. Additionally, research suggests that younger men (especially those under 40) and postpartum women may be at higher risk.
Diagnosis and Treatment
Early diagnosis and treatment are the keys to improving patient prognosis. While diagnosing NMS can be challenging, medical professionals must be able to recognize the condition promptly and differentiate it from other neurological disorders.
If not treated promptly, the mortality rate of NMS can be as high as 20%.
Targeted therapy includes stopping the causative drug, cooling the body to relieve high fever, and, if necessary, using drugs such as dantrolene, bromide, and tranquilizers to control the condition. Complications related to NMS (such as muscle breakdown) should also be actively managed to avoid kidney damage.
Prognosis and epidemiology
With early recognition and aggressive treatment, the prognosis of NMS is usually good. Past data show that the mortality rate of NMS was once as high as 38%, but in the past two decades, this rate has dropped to less than 10%. Although the incidence of NMS varies among different groups, current research shows that its incidence ranges from approximately 0.2% to 3.23%.
Today, NMS is still a health issue of great concern. As the medical community’s understanding of the disease continues to deepen, whether this potentially dangerous symptom can be managed more effectively still requires further exploration and research.
