Symptoms tend to evolve over 1 to 3 days. While NMS may be more likely to present within the first 2 weeks of exposure and after higher doses, rapid dose escalation, or depot forms of medication, the disorder can present after a single dose or after years of a stable neuroleptic dose. Other features which may or may not be present include:Д¬hange in level of consciousness from delirium and agitation to comaДysautonomia: typically tachycardia, elevated or labile blood pressureДЄ typical patient with NMS will have a history of neuroleptic use (or other associated medications), however, it is important to note that NMS is often idiosyncratic. There are no widely accepted diagnostic criteria, although most published criteria, require the following:Д¬urrent or prior treatment with medications linked to NMS: neuroleptics (both typical and atypical), antiemeticвЂ™s such as metoclopramide or promethazine, or acute withdrawal of dopamine agonists such as carbidopa-levodopaД®xclusion of other potential medical or psychiatric etiologies for the signs and symptoms Since there is no one diagnostic test that defines NMS, the diagnosis rests on strong clinical suspicion, clinical history, and the patientвЂ™s constellation of clinical findings. Diagnostic Confirmation: Are you sure your patient has Neuroleptic Malignant Syndrome? Other neurotransmitter systems are likely also involved including gamma aminobutyric acid (GABA), epinephrine, serotonin, and acetylcholine. Yet, this theory does not fully explain the syndrome as only a small minority of patients taking neuroleptics develop NMS, i.e., dopamine blockade via neuroleptics is necessary but not sufficient to develop the syndrome. Given the strong association of NMS with neuroleptics, the presumed mechanism is of dopaminergic blockade affecting the hypothalamic (fever, dysautonomia) and striatal (muscle rigidity, parkinsonism) dopaminergic receptors. The challenge of the syndrome is that there is no one diagnostic test NMS remains a diagnosis of exclusion. Accompanying laboratory abnormalities may include elevated serum creatinine kinase and white blood cell count.

The classic clinical presentation is a tetrad of fever, muscle rigidity, altered mental status, and autonomic dysfunction. Neuroleptic malignant syndrome (NMS) is a rare, potentially fatal complication of treatment with dopamine antagonists (e.g., neuroleptics such as haloperidol) or less commonly acute withdrawal of dopamine agonists (e.g., ParkinsonвЂ™s medications such as carbidopa-levodopa).

Nms vs serotonin syndrome