User:Jaykloo/Neurological Malignant Syndrome Project Proposal

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Introduction
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Neurological Malignant Syndrome is a life threatening, although rare disease. It results from a complication with anti psychotic drugs. Symptoms are high fever, muscle rigidity, altered mental status, and autonomic status changes. Lab tests often show elevated white blood cell counts and creatine kinase counts in blood. Incidents of the disease has declined since its discovery (due to proactive prescription habits), but it is still dangerous to patients being treated with anti psychotics. Because of its rarity and unpredictability, there is no one set course of action to treat the syndrome, but generally, removal of the anti psychotic drug treatment, along with medical management, lead to a positive outcome.

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Signs and Symptoms
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Generally, muscular rigidity is the first symptom of NMS. This is generally followed by a high fever and then complications with the autonomic nervous system. These complications run the range from problems controlling blood pressure to (in very severe cases) comas. In some patients, muscle tremors are also reported. As soon as the first symptoms appear, they intensify rapidly and may reach their peak in three days.

The most accurate lab test to date for NMS is a test for creatine kinase levels in the blood. Creatine kinase levels can be increased from exercise, but they can also exist as a sign that muscle is being broken down.

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Causes and Pathophysiology
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NMS is caused by complications with anti psychotic drugs. The exact physiological events leading to the syndrome are still unknown, but the leading theory is that it is called by a decrease in levels of dopamine. Some anti psychotic drugs are known to blockade dopamine, other studies have shown that when drugs supplying dopamine are withdrawn, symptoms similar to NMS present themselves.

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Differential Diagnosis
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Differentiating NMS from other neurological disorders can be very difficult. It requires expert judgement to separate symptoms of NMS from other diseases. Some of the most commonly mistaken diseases are: encephalitis, toxic encephalopathy, status epilepticus, heat stroke, and malignant hyperthermia. Due to the comparative rarity of NMS, it is often overlooked and immediate treatment for the syndrome is delayed. Drugs such as cocaine and amphetamine also result in similar symptoms.

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Treatment and Management
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The first step of any treatment of NMS is to remove the drug causing the problem. After that, the exact line of treatment varies with the particular case and how severe it is. Volume resuscitation is paramount. Benzodiazepines, dantrolene, and dopaminergic agents are a few pharmaceutical families that can be used to treat various degrees of NMS. If it is recognized early enough, NMS is not fatal, but still, 10% of cases do result in patient death.

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