What is it about ?
Neuroleptic malignant syndrome (NMS) is a very rare but extremely serious side effect of antipsychotics or metoclopramide (Primperan®). Antipsychotics or neuroleptics are used to treat psychosis. Psychosis is a psychiatric illness in which the person loses touch with reality. She suffers from hallucinations, delusions and chaotic thoughts. Metoclopramide is an anti-vomiting medicine.
What is its frequency?
Neuroleptic malignant syndrome is very rare: it occurs in only 0.01 to 0.02% of people taking neuroleptics; it affects men more often than women and usually before the age of 40.
How to recognize it?
The first symptoms appear a few days to a few weeks after the start of treatment, regardless of the dose. A pronounced generalized stiffness suddenly develops, accompanied by fever and kidney failure. A decrease in consciousness is also possible.
The autonomic nervous system may be disturbed: changes in blood pressure, rapid heartbeat, rapid breathing, excessive sweating, and disturbance of urinary function (accidental loss of urine or inability to urinate). As the term “evil” suggests, evolution can be fatal.
How is the diagnosis made?
In a person taking neuroleptics or metoclopramide, the doctor will consider the possibility of NMS if symptoms such as fever, neurological abnormalities such as muscle stiffness, inability to eat or swallow, disturbance of consciousness and disturbances of the autonomic nervous system. .
He will also do a blood test. An abnormal blood result may suggest NMS.
The doctor will distinguish it from other illnesses that can cause disturbances in consciousness and fever, such as meningitis, malignant hyperthermia (anesthesia-related disorder) and neurological conditions due to excessive consumption of other drugs.
Serotonin syndrome is a condition that resembles NMS and is caused by the simultaneous use of selective serotonin reuptake inhibitors (SSRIs) (a special type of antidepressant) and tramadol (a strong pain reliever) or triptans (migraine medications)
What can you do ?
The first thing to do is to stop the medicine. Inform your doctor, and be sure to drink enough.
What can the doctor do?
The doctor will start by judging the seriousness of the situation. The less serious cases do not require hospitalization. The main action to take is therefore to stop the drug. In addition, the doctor will make sure that you drink enough and check your temperature and blood values.
Severe cases with disturbance of consciousness and kidney function are treated in hospital.
It takes two to four weeks after recovery to resume treatment with a neuroleptic of a different chemical class. For this, the doctor will seek the advice of a neurologist.
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