What’s Neuroleptic Malignant Syndrome?

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Neuroleptic malignant syndrome (NMS) is a very serious disease that usually develops from taking neuroleptic drugs. These medications are also called antipsychotics and are often prescribed for mental health conditions that include elements of psychosis such as bipolar I and schizophrenia. Most neuroleptics, including drugs such as Zyprexa® and Giodon® (some of the more recently developed) contain warnings about the potential for developing neuroleptic malignant syndrome.

The condition is best diagnosed early, and treatment usually involves removing a patient from any neuroleptics and possibly being admitted to intensive care while a patient recovers. The main symptoms of neuroleptic malignant syndrome are identified by the mnemonic FEVER, where each letter indicates the following: Fever, Encephalopathy, Unstable Vitals, Elevated Enzymes, and Stiff Muscles. Simply put, the most notable are extremely stiff muscles with high fever. Blood pressure tends to be variable and high, patients may be delirious or unconscious, and blood tests show an elevated level of the enzyme creatine phosphokinase (CPK).

Of course, doctors are most helped when they understand that the patient is taking a neuroleptic drug, especially if the patients are just starting the drug. However, the condition, while rarer, can develop in patients coming off certain medications that treat Parkinson’s disease symptoms, so taking neuroleptics isn’t the only cause of neuroleptic malignant syndrome. As mentioned, most people who develop the condition have never taken a specific drug, but NMS can sometimes develop when people have been taking a certain drug for a long time.

When neuroleptic malignant syndrome is recognized and treated immediately, survival is very good. Failure to recognize and treat the condition can lead to death, but statistics are currently unclear on how often this occurs. Some place the mortality rate as high as 70%, but this must clearly be in the untreated condition, as the outcome is good for people who are hospitalized and treated immediately.

One of the significant challenges in treating people with neuroleptic malignant syndrome is that those just prescribed an antipsychotic may not report the condition, and if the drug doesn’t work effectively, they may already be experiencing delusions or psychotic symptoms. A person may not fully understand the nature of the medications they are taking, especially in the early stages of treatment for a serious psychiatric illness. This may indicate, especially for those experiencing psychotic symptoms, that neuroleptics are best diagnosed in a hospital setting, where patients can be observed until they are mentally stable and able to report dramatic health changes.

If you’ve had an episode of NMS, that doesn’t mean you can’t take a neuroleptic again, even if you do need to be closely observed and slowly introduced to the new drug. There is concern that those who have had NMS may be more likely to develop adverse reactions to anesthesia. Anyone who has previously had NMS should let doctors and surgeons know before any surgery so anesthesiologists can create the safest plan for proceeding with an operation.

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