Neuroleptic malignant syndrome: symptoms, causes and treatment.

Abusing medications can have severe consequences.

The use of antipsychotic medication in the field of mental health is one of the most commonly used remedies when intervening in patients with some type of disorder or disease in which there are a series of psychotic symptoms. Likewise, its prescription for mood disorders and personality disorders is becoming more and more common.

However, sometimes the use of this antipsychotic medication is associated with certain side effects, which interfere with the correct functioning of the central nervous system. One rare disease associated with the effects of this medication is the neuroleptic malignant syndrome, which can lead to a number of side effects.which can lead to numerous complications in the body and even death.

Definition of neuroleptic malignant syndrome

Neuroleptic malignant syndrome is a rare condition caused by an adverse response to the effects of antipsychotic medication in the first instance, or other associated drugs in the second. This response may be caused by the action of the medication or by its abrupt withdrawal.

This unusual syndrome is distinguished by causing complications such as dysautonomia, elevation of body temperature, changes in the state of consciousness and even death in those cases in which it is not intervened in time.

This syndrome tends to affect to a greater extent young, male persons who are administered a prolonged-release neuroleptic drug.. As well as in Parkinson's patients whose dosage is moderated or whose usual dopaminergic treatment is cancelled.

Symptomatology

Symptomatology associated with neuroleptic malignant syndrome tends to appear within the first three days after the patient begins treatment.. These symptoms begin with the appearance of a feeling of anxiety which is preceded by alterations in the state of consciousness.

The most characteristic manifestations of this syndrome are hyperthermia and muscular rigidity. With regard to hyperthermia, the person may suffer fevers between 38.5º and more than 40º, this being considered an indispensable requisite for the diagnosis of this condition.

On the other hand, muscular rigidity may cause complications such as dysarthria or difficulty in articulating sounds, swallowing problems and excessive secretion of saliva. As well as hypoventilation and asphyxia or breathing difficulties.

Other symptoms found in people suffering from this syndrome include:

• Tachycardias
• Diaphoresis or excessive sweating
• Skin pallor
• Incontinence
• Hypertension
• Obnubilation, dullness or coma
• Impaired reflexes
• Generalized convulsions
• Tremors
• Renal failure

Causes of this syndrome

The main theories within the study of neuroleptic malignant syndrome point to the different effects that neuroleptics may have on the proper articulation of the pyramidal system and on the hypothalamus.

The hypothesis most supported by the scientific and medical community proposes that a decrease in the dopaminergic activity of the central nervous system may interfere with the correct functioning of the basal nuclei and the hypothalamus.

• The basis of this theory is supported by two justifications:
• The syndrome originates after the administration of antidopaminergic medication.
• Dopamine is a neurotransmitter that mediates central nervous system pathologies including alterations in muscle tone and thermoregulation.

Likewise, other symptoms such as muscle stiffness, slowness of movement, mutism and twitching or palpitations are likely to be caused by an instability or alteration of the dopaminergic system in the hypothalamus. in the hypothalamus.

Finally, the administration of dopamine agonist drugs, such as bromocriptine, has been found to be effective in reducing the symptoms associated with neuroleptic malignant syndrome.

Diagnosis and differential diagnosis

There are a number of well-established criteria for the diagnosis of this disorder. These criteria are classified as major and minor and the person must meet at least three major criteria or two major and four minor criteria.

Major criteria

Major criteria include hyperthermia, muscle tension, increased creatine kinase enzyme (CPK).

Minor criteria

Tachycardia, abnormal Blood pressure, increased respiratory rate, changes in consciousness, sweating and leukocytosis.

However, there is disagreement within the medical community on whether increased creatine kinase (CPK) is a major criterion. From this point of view, a series of alternative diagnostic criteria have been devised according to which for an effective diagnosis the person must have these three symptoms:

• Hyperthermia or elevation of temperature above 37.5º, with no other pathology to justify it.
• Severe extrapyramidal manifestations such as muscular tension, dysphagia, excessive secretion of saliva, alterations in ocular movement, arching of the spine or teeth grinding.
• Autonomic nervous system depression

Since the mortality potential of neuroleptic malignant syndrome is considerably high, other conditions or illnesses should be ruled out and the person should be diagnosed as quickly as possible..

For the differential diagnosis, the possibility that the person suffers from any of the following disorders should be ruled out:

Symptoms originating from the development of a central nervous system infection.

• Lethal catatonia
• Malignant hyperthermia caused by anesthetic medication or muscle relaxants.
• Heat stroke
• Atropinism or intoxication due to overdose of anticholinergic medication.

Treatment

In cases where the syndrome is caused by the effects of neuroleptics, it will be necessary, first of all, to withdraw the medication and provide supportive and supportive care both to lower the body temperature and to reverse the arterial hypotension through the restoration of fluids and the use of vasoactive drugs.

In most cases in which the syndrome is detected early, supportive intervention is effective and sufficient. supportive intervention is effective and is sufficient for the syndrome to remit and lead the patient to a recovery without any sequelae..

• The reference medication used to treat neuroleptic malignant syndrome includes:
• Anticholinergic drugs to treat extrapyramidal symptoms.
• Dantrolene sodium to relax the musculature and end muscle tension.
• Benzodiazepines to reduce anxiety and lower agitation levels.
• Clozapine to restore neuroleptic medication.

Prognosis and possible complications

By the time medication is stopped and treatment for neuroleptic malignant syndrome is started, the evolution of symptoms should be positive, i.e. the patient should progressively improve.

However, there are a number of relatively common complications that could hinder such recovery. These difficulties include:

• Renal failure
• Respiratory failure or pulmonary embolism.
• Setbacks such as liver failure, heart failure or seizures.

Despite the severity of the symptoms and the possible complications the person may be able to overcome the disease as long as it is treated in time.. Otherwise, the probability of death increases considerably, the most common causes of death being heart failure, pneumonia, pulmonary embolism, sepsis and hepatorenal failure.