Today we discussed neuroleptic malignant syndrome and serotonin syndrome. A few points:
Neuroleptic malignant syndrome:
Syndrome of altered mental status, fever (often over 40), marked rigidity, CK elevation (usually over 1000), and autonomic instability (including hypertension, arrhythmias, tachycardia).
Seen in the context of
1) New or altered dose of antipsychotic medication (usually "typicals")
2) Withdrawal of dopaminergic medications (e.g. antiparkinsonians)
Treatment is discontinuation of drug (or restarting if withdrawal), possibly dantrolene or bromocriptine)
There is an extensive differential diagnosis of components of this presentation, the most important of which to exclude are CNS infections (meningitis, encephalitis), other systemic infections, seizures, intoxications, withdrawal states.
Serotonin syndrome
Related, but distinct disorder that results from overstimulation of serotonin receptors.
It occurs in the setting of substances that either increase serotonin release (e.g. ecstasy, cocaine, amphetamines), or inhibit serotonin reuptake (SSRIs, SNRIs, tricyclics, MAOIs)
Presentation can include mental status change, diarrhea, flushing, diaphoresis, tremor, restlessness.
Physical exam may show fever, hyperreflexia, myoclonus, rigidity, autonomic instability.
Tx: Stop serotonergic substance. If severe, aggressive cooling, benzos, cyproheptadine (antihistamine with antiserotonin effect)
NMS vs. serotonin syndrome differences
Serotonin syndrome may have shivering, hyperreflexia, myoclonus, flushing (all uncommon in NMS)
NMS tends to have more prominent CK elevation, rigidity and higher temperatures
Poison control consultation is an important component of managing both of these situations.
Links
It occurs in the setting of substances that either increase serotonin release (e.g. ecstasy, cocaine, amphetamines), or inhibit serotonin reuptake (SSRIs, SNRIs, tricyclics, MAOIs)
Presentation can include mental status change, diarrhea, flushing, diaphoresis, tremor, restlessness.
Physical exam may show fever, hyperreflexia, myoclonus, rigidity, autonomic instability.
Tx: Stop serotonergic substance. If severe, aggressive cooling, benzos, cyproheptadine (antihistamine with antiserotonin effect)
NMS vs. serotonin syndrome differences
Serotonin syndrome may have shivering, hyperreflexia, myoclonus, flushing (all uncommon in NMS)
NMS tends to have more prominent CK elevation, rigidity and higher temperatures
Poison control consultation is an important component of managing both of these situations.
Links
Click here for a CMAJ review of NMS
Click here for a CMAJ review of serotonin syndrome
Back in July 2001 I was told by the doctor that prescribed me paxil (paroxetine) I would get diahrea at first but it would gradually go away.
ReplyDeleteThe diahrea was really loss of control of bowl funtion which evenually turned into constipation after about 3 week off severe diahrea; October that year my CNS developed a pinched nerve feeling I became very paranoid then one day when climaxing at sex severe tension like head aches ensued which never stopped till the paxil was discontinued July 2002 the head aches were the onset of NMS; Malignant Neoplasm Brain is what NMS really is I have a dead sister, 2 dead aunts, 2 crippled sisters, 1 crippled nephew, a niece and nephew with ADHD and at least 4 unemployable cousins. Yet my European and Jewish friends are fine with these medications.
In my dealings with Ontario Government I refer to it as the invisible holocaust. I have a BBA in Accouting Finance and a certificate in computer studies but presenile dementia prevents me from working in my occupation (reconciliation accountant). I'm a member of 5 choirs having been trained as a child to sing. I know I must take it to the Ombudsman of Ontario but this slaughter has continued now a decade into the 21 century. I guess the best thing for me is to take the attitude if you are stupid enought to take these pills you deserve to die.