Neuroleptic Malignant Syndrome

  • Kathryn RosenblattEmail author


Neuroleptic malignant syndrome (NMS) is a rare and potentially life-threatening drug-induced neurologic emergency characterized by fever, muscle rigidity, altered mental status, and autonomic dysfunction. NMS is believed to be a result of dopamine deficiency from excessive dopaminergic blockade by antipsychotic medication and several anti-emetics, and less often by withdrawal of dopamine agonist therapy. Successful treatment requires prompt recognition, cessation of offending agents, aggressive supportive care, and administration of certain pharmacotherapies and interventions, such as dantrolene, bromocriptine, and electroconvulsive therapy (ECT). While NMS is easily recognized in its severe form, early identification can be challenging because it is heterogeneous in onset and progression and several medical conditions exhibit similar symptoms. The variability in NMS presentation makes controlled trials and collection of data difficult, and consequently, many aspects remain controversial, including pathophysiological mechanisms, risk factors, diagnostic criteria, prognosis, and treatment.


Acute dysautonomia Altered mental status Antipsychotics/adverse effects Central anticholinergic syndrome Fever Malignant hyperthermia Medication-induced movement disorder Muscular rigidity Neuroleptic malignant syndrome Serotonin syndrome 


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Authors and Affiliations

  1. 1.Anesthesiology and Critical Care Medicine, Divisions of Neuroanesthesia and Neurosciences Critical CareJohns Hopkins Hospital, Johns Hopkins University School of MedicineBaltimoreUSA

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