61. Untitled 18.10 neuroleptic malignant syndrome. Overview 18. 18.10.01 DiagnosticCriteria of Caroff et al for the neuroleptic malignant syndrome. Overview http://www.medal.org/docs_ch18/doc_ch18.10.html

Neuroleptic Malignant Syndrome Overview: The Neuroleptic Malignant Syndrome is difficult (1) to define precisely (2) to separate from other related syndromes and (3) to even specify precipitating agents. It appears to be related to changes in central dopaminergic activity. One suggestion has been to rename it the drug-induced central hyperthermic syndrome (Heyland Can Med Assoc J. 1991; 145: 817-819). This is an area likely to be modified over the coming years. Table of Contents, Chap. 18 Diagnostic Criteria of Caroff et al for the Neuroleptic Malignant Syndrome Overview: The Neuroleptic Malignant Syndrome (NMS) is a syndrome which may occur in patients receiving neuroleptic agents. Its presentation and symptoms may vary but the classic tetrad is fever rigidity altered sensorium and autonomic dysfunction. It can be fatal if unrecognized. Caroff et al specified diagnostic criteria to aid in its recognition. Diagnostic Criteria for NMS (1) treatment with neuroleptic agent prior to onset • within 7 days for oral agents • within 2-4 weeks for depot forms (3) muscle rigidity (4) 5 or more of the following • change in mental status • tachycardia • hypertension or hypotension • tachypnea or hypoxia • diaphoresis (excessive sweating) or sialorrhea (excessive flow of saliva) • tremor • incontinence • creatine phosphokinase (CK) elevation or myoglobinuria • leukocytosis • metabolic acidosis (5) exclusion of other drug-induced systemic or neuropsychiatric illnesses Differential diagnosis:

62. Myoglobinuria; Rhabdomyolysis myoglobinuria. neuroleptic malignant syndrome (NMS). Drugs Butyrophenones;Lithium; Phenothiazines; Pimozide; Promethazine; Thioxanthines; http://www.neuro.wustl.edu/neuromuscular/msys/myoglob.html

Front Search Index Links ... Patient Info MYOGLOBINURIA - RHABDOMYOLYSIS Myoglobinuria Malignant hyperthermia General features Pathophysiology Specific causes Myoglobinuria: Acquired causes Drugs Hypokalemia Idiopathic recurrent Infections ... Other: Occasional myoglobinuria Polymyositis: Anti-MAS syndrome Serotonin syndrome Snake venoms Thyroid: Hyper or Hypo Toxins Trauma Myoglobinuria: Familial causes ... Malignant hyperthermia (MHS) loci : Ryanodine Receptor; 19q13 : Na channel (SCNA4); 17q11 : Ca channel (CACNL2A); 7q21 : Ca channel (CACNA1S); 1q32 Mitochondrial Myoadenylate deaminase deficiency Sickle cell anemia Other familial causes MYOGLOBINURIA: General features Myoglobinuria results from necrosis, especially acute, of muscle fibers (rhabdomyolysis) Mechanisms of muscle injury Rise in free intracellular calcium: Due to Damage to muscle sarcolemma Failure of energy supply within muscle cell Destroys myofibrillar, cytoskeletal, and membrane proteins Lysosomal digestion of muscle fiber contents ensues Typical clinical features Muscle Common: Weakness; Pain; Tenderness; Muscle swelling

63. Health Library - Neuroleptic Malignant Syndrome Your Health. Search. neuroleptic malignant syndrome. Synonyms Disorder SubdivisionsGeneral Discussion Resources National Organization for Rare Disorders. http://yourhealth.stlukesonline.org/Library/HealthGuide/IllnessConditions/topic.

64. Neuroleptic Malignant Syndrome-like Conditions With An Aldosteronism-like Distur neuroleptic malignant syndromelike conditions with an aldosteronism-like disturbanceof serum electrolytes induced by a combination of amoxapine and http://www.pulsus.com/clin-pha/03_02/taji_ed.htm

forgot your password? Adverse Drug Reactions Summer 1996, Volume 3, Number 2: 83-89 Neuroleptic malignant syndrome-like conditions with an aldosteronism-like disturbance of serum electrolytes induced by a combination of amoxapine and pravastatin Y Tajima, R Nakagawa Order Full Text -For a nominal fee order online and receive a copy of this article either by email, fax or mail État évoquant le syndrome malin des neuroleptiques avec un déséquilibre des électrolytes du sérum ressemblant à un hyperaldostéronisme, induit par une combinaison d’amoxapine et de pravastatine RÉSUMÉ : Order Full Text -For a nominal fee order online and receive a copy of this article either by email, fax or mail

65. Neuroleptic Malignant Syndrome neuroleptic malignant syndrome PubMed Medline search on neuroleptic malignantsyndrome. Support Groups. No specific support groups found disclaimer. http://www.ion.ucl.ac.uk/library/patient/neurolep.htm

Neuroleptic Malignant Syndrome Medline NLM definition : A potentially fatal syndrome associated primarily with the use of neuroleptic agents (see ANTIPSYCHOTIC AGENTS) which are in turn associated with dopaminergic receptor blockade (see RECEPTORS, DOPAMINE) in the BASAL GANGLIA and HYPOTHALAMUS, and sympathetic dysregulation. Clinical features include diffuse MUSCLE RIGIDITY; TREMOR; high FEVER; diaphoresis; labile blood pressure; cognitive dysfunction; and autonomic disturbances. Serum CPK level elevation and a leukocytosis may also be present. (From Adams et al., Principles of Neurology, 6th ed, p1199; Psychiatr Serv 1998 Sep;49(9):1163-72) PubMed Medline search on neuroleptic malignant syndrome Support Groups No specific support groups found

66. Searchalot Directory For Neuroleptic Malignant Syndrome Related Web Sites. Emergency Medicine An in depth look at neuroleptic malignantsyndrome beginning with an introduction. Authored by Theodore Benzer MD. http://www.searchalot.com/Top/Health/ConditionsandDiseases/NeurologicalDisorders

Home Search News Email Greetings Weather ... Global All the Internet About AltaVista AOL Search Ask Jeeves BBC Search BBC News Business Dictionary Discovery Health Dogpile CheckDomain CNN Corbis eBay Education World Employment Encyclopedia Encarta Excite Fast Search FindLaw FirstGov Google Google Groups Infomine iWon Librarians Index Looksmart Lycos Metacrawler Microsoft Northern Light Open Directory SearchEdu SearchGov Shareware Teoma Thesaurus Thunderstone WayBackMachine Webshots WiseNut Yahoo! Yahoo! Auctions Yahoo! News Yahooligans Zeal Sponsored Links Top Health Conditions and Diseases Neurological Disorders ... Basal Ganglia : Neuroleptic Malignant Syndrome Related Web Sites Emergency Medicine - An in depth look at neuroleptic malignant syndrome beginning with an introduction. Authored by Theodore Benzer MD. Neuroleptic Malignant Syndrome Information Service - Information about the service as well as the disease itself. Includes research, a hot line and references. Neuroleptic Malignant Syndrome - Clinical features, the pathophysiology and treatment. Virtual Hospital: Clinical Psychopharmacology Seminar - Neuroleptic malignant syndrome: Includes an introduction, the etiology, clinical features, complications, incidence, risk factors and treatment.

67. 1Up Health > Health Links Directory > Conditions And Diseases: Neurological Diso Sites. Emergency Medicine An in depth look at neuroleptic malignant syndromebeginning with an introduction. Authored by Theodore Benzer MD. http://www.1uphealth.com/links/basal-ganglia-neuroleptic-malignant-syndrome.html

Home Contact Us Privacy Caring For Your Well Being Alternative Medicine Clinical Trials Health News Poisons ... Health Topics A-Z Search 1Up Health Health Directory Addictions Alternative Animal ... Weight Loss By Demography Child Health Teen Health Men's Health Women's Health ... Basal Ganglia : Neuroleptic Malignant Syndrome Description See Related Categories Health: Conditions and Diseases: Rare Disorders Sites Emergency Medicine An in depth look at neuroleptic malignant syndrome beginning with an introduction. Authored by Theodore Benzer MD. Neuroleptic Malignant Syndrome Clinical features, the pathophysiology and treatment. Neuroleptic Malignant Syndrome Information Service Information about the service as well as the disease itself. Includes research, a hot line and references. NINDS Neuroleptic Malignant Syndrome Information Page Compiled by the National Institute of Neurological Disorders and Stroke. NORD - Neuroleptic Malignant Syndrome Offers synonyms, a general discussion and further resources. Virtual Hospital: Clinical Psychopharmacology Seminar Neuroleptic malignant syndrome: Includes an introduction, the etiology, clinical features, complications, incidence, risk factors and treatment.

68. Glossary Definition neuroleptic malignant syndrome is a serious disorder that can be caused bythe use of antipsychotic drugs. It affects the movements of the body. http://cebmh.warne.ox.ac.uk/cebmh/elmh/schizophrenia/glossary/nms.html

//tmtC_Resize_Window tmt_Resize_WindowX = 200; tmt_Resize_WindowY = 300; self.resizeTo(tmt_Resize_WindowX,tmt_Resize_WindowY);//tmtC_Resize_WindowEnd Neuroleptic malignant syndrome : is a serious disorder that can be caused by the use of antipsychotic drugs. It affects the movements of the body. People who have this syndrome may have muscle stiffness, a fast heartbeat, a high temperature and sometimes be tired. These symptoms can happen very quickly. CLOSE THIS WINDOW

69. Health Library - Neuroleptic Malignant Syndrome Advanced Search. neuroleptic malignant syndrome. Synonyms Disorder SubdivisionsGeneral Discussion Resources National Organization for Rare Disorders. http://www.stjudemedicalcenter.org/library/healthguide/IllnessConditions/topic.a

70. National Parkinson Foundation, Inc. neuroleptic malignant syndrome (NMS). by Abe Lieberman MD Neurolepticmalignant syndrome (NMS) is an unusual reaction to neuroleptic http://www.parkinson.org/nmsyndrome.htm

Neuroleptic malignant syndrome (NMS) by Abe Lieberman MD Neuroleptic malignant syndrome (NMS) is an unusual reaction to neuroleptic drugs (drugs used as major tranquillizers) and to abrupt withdrawal of levodopa. The NMS is characterized by high fever, ., unresponsiveness, rigidity, and autonomic nervous system dysfunction. Laboratory abnormalities include elevated serum creatine phosphokinase (a muscle enzyme) and myoglobinuria (breakdown products of muscle in the urine). The symptoms of NMS may develop from a few days to a few weeks following neuroleptic drug use or a few days after stopping levodopa. The symptoms are progressive. NMS occurs in 1% of patients who receive neuroleptic drugs and is attributed by some to a dopamine receptor blockade in the basal ganglia and hypothalamus, and by others to a disturbance of calcium uptake in skeletal muscle. The morality rate associated with NMS, when not recognized and treated is at least 20%. Treatment consists of the withdrawal of the neuroleptic drug (if this is the cause of the NMS syndrome), or the reinstitution of levodopa (if this is the cause of the NMS syndrome), supportive care, and the use of a dopamine agonist or sodium dantrolene. The NMS will not be recognized if it is not considered when a high fever, rigidity, and autonomic nervous system dysfunction (rapid heart rate, high blood pressure, rapid respirations) occur while using neuroleptic drugs or after stopping levodopa. When these symptoms occur the first thought is to look for infections or metabolic disturbances and not consider the symptoms as arising from the use of neuroleptic drugs or after stopping levodopa. NMS may result from dopamine receptor blockade in the basal ganglia and hypothalamus. This blockade can then result in inhibition of calcium uptake in skeletal muscle, which can then result in rigidity. The rigidity may be so severe as to result in immobility, which may lead to high fever, shortness of breathing, decreased oxygen saturation and death.

71. National Parkinson Foundation, Inc. Olanzapine induced neuroleptic malignant syndrome a case review. Three databaseswere searched using the terms olanzapine and neuroleptic malignant syndrome. http://www.parkinson.org/olanzapine.htm

Olanzapine induced neuroleptic malignant syndrome - a case review Ale Kogoj *, Ingrid Velikonja University Psychiatric Hospital, SI 1260 Ljubljana-Polje, Slovenia email: Ale Kogoj ales.kogoj@mf.uni-lj.si *Correspondence to Ale Kogoj, University Psychiatric Hospital, Studenec 48, SI 1260 Ljubljana-Polje, Slovenia. Abstract This article is intended for educational purposes only.

72. Australian Adverse Drug Reactions Bulletin, May 1997 1995. MMWR 1995; 44 892900 (JAMA 1996; 275 96-98). Top of page.2. CLOZAPINE INDUCED neuroleptic malignant syndrome. Clozapine http://www.health.gov.au/tga/docs/html/aadrbltn/aadr9705.htm

TGA Adverse Drug Reactions Australian Adverse Drug Reactions Bulletin Australian Adverse Drug Reactions Bulletin Vol. 16, No. 2 (May 1997) What to Report? Contents Kombucha tea Clozapine induced neuroleptic malignant syndrome The Achilles heel of fluoroquinolones Paraesthesia with NSAIDS ... Drugs of current interest Prepared by the ADVERSE DRUG REACTIONS ADVISORY COMMITTEE (ADRAC), a subcommittee of the Australian Drug Evaluation Committee. ADRAC is Dr Tim Mathew (Chair), Dr Ross Bradbury, Dr Paul Desmond, Dr Cecilie Lander, Professor Gillian Shenfield, Dr Dana Wainwright, Professor Lindon Wing. 1. KOMBUCHA TEA Kombucha tea has become increasingly popular in recent years because it has been claimed to have a large number of beneficial effects including the prevention of cancer, relief of arthritis, treatment of insomnia, stimulation of the immune system and even the regrowth of hair. The tea is brewed from the Kombucha mushroom which is actually a symbiotic yeast and bacteria aggregate surrounded by a permeable membrane. The "mushroom", which grows like a round flat gray fungus about the size of a dinner plate, is fermented in sugared tea to obtain the Kombucha tea. The mushrooms are sold or distributed by naturopaths and other alternative practitioners and are often passed on from person to person. The tea has been described to contain a mixture of many substances including alcohol, glucuronic acid, acetic acid, heparin and lactic acid. In the last year, ADRAC has received two reports of hepatotoxicity in association with Kombucha tea. There have also been reports of both hepatotoxicity and lactic acidosis in the United States.

73. PD INDEX: A Directory Of Parkinson's Disease Information On The Internet on the Internet Information sources under area DRUG THERAPY for topics beginningwith N neuroleptic malignant syndrome and drug withdrawal An algorithm for http://www.pdindex.org/isc1n.htm

PD INDEX: A Directory of Parkinson's Disease Information on the Internet Information sources under area DRUG THERAPY for topics beginning with "N": neuroleptic malignant syndrome and drug withdrawal An algorithm for the management of Parkinson's disease. C Olanow MD, W Koller MD PhD. 1998 Drug-induced and tardive movement disorders. G Vernon RN, MS Neuroleptic malignant syndrome. EMedicine.com. T Benzer MD PhD neuroleptic medicines - See antipsychotic drugs neuroprotection Dementia: overview of pharmacotherapy. EMedicine.com. R Caselli MD. (not PD-specific) See also antioxidants Display all topics for this area Go to top of page Go to home page ... Go to alphabetical topic index

74. NEUROLOGIC MALIGNANT SYNDROME - A CHRONOLOGICAL ANNOTATED BIBLIOGRAPHY may show widespread fasciculations (ref Anderson SA, Weinschenk K Peripheranl neuropathyas a component of the neuroleptic malignant syndrome Am J Med 1987 http://www.oism.info/ospiti/articoli/2002-01.htm

NEUROLOGIC MALIGNANT SYNDROME (NMS) A CHRONOLOGICAL ANNOTATED BIBLIOGRAPHY prepared by John M. Friedberg, MD February 5, 1997 This catastrophic reaction to dopamine blocking agents,especially HALDOL, more recently RESPIRADOL, (but all the so-called major tranquilizers have been implicated) can lead to death in up to 50% of cases, especially if not immediately recognized. The causative agents must be stopped immediately and never started again. Three Principal Indicators: Extreme muscle rigidity - one patient had to have a tenosynovotomy of her Achilles tendons (heel cords cut). Extreme autonomic instability especially rapid heart rate (over 100), temperatures up to 108 (at which point the brain's proteins denature like the white of an egg and there's no return), sweating, high blood pressure (sometimes over 200 systolic), incontinence. Pulmonary emboli may occur. Extreme mental status changes including restlessness, delirium, stupor and coma although patient may be conscious and "locked in." Often mistaken for catatonic schizophrenia (another imaginary "disease of the mind") and treated with even more of the hair of the dog, the anti-psychotic medications and even with electroconvulsive therapy (ECT)!

75. NEUROLOGIC MALIGNANT SYNDROME - A CHRONOLOGICAL ANNOTATED BIBLIOGRAPHY Translate this page fascicolazioni ampiamente diffuse (riferim. Anderson SA, Weinschenk K Peripheranlneuropathy as a component of the neuroleptic malignant syndrome Am J Med http://www.oism.info/ospiti/articoli/2002-01-it.htm

SINDROME NEUROLOGICA MALIGNA (SNM) 1959-1980 Una bibliografia cronologica commentata preparata da John M. Friedberg, MD 5 febbraio 1997 Traduzione a cura di Tristano Ajmone Questa catastrofica reazione agli agenti bloccanti la dopamina, specialmente l'Aldolo, più recentemente il Respiradol , (ma tutti i cosiddetti tranquillanti maggiori sono stati implicati) può condurre alla morte fino al 50% dei casi, specialmente se non riconosciuta immediatamente. [La somministrazione degli] agenti causativi deve essere immediatamente interrotta e mai più ripresa. Tre indicatori principali: estrema rigidità muscolare una paziente dovette ricevere un intervento chirurgico ai tendini di Achille ( recisone delle corde del tallone). estrema instabilità autonomica, specialmente ritmo cardiaco rapido (oltre 100), temperature fino a 42°C (punto in cui le proteine cerebrali denaturano come l'albume dell'uovo e non vi è ritorno), sudorazione, pressione sanguigna alta (a volte oltre 200 sistolica), incontinenza. Può aver luogo embolia polmonare. cambiamenti dello stato mentale estremi inclusi irrequietezza, delirio, stupore e coma nonostante il paziente possa essere conscio e "chiuso in sé stesso." Spesso scambiata per schizofrenia catatonica (un'altra "malattia della mente" immaginaria) e trattata come con il cicchettino che allevia la sbronza, con ulteriori aggiunte di farmaci antipsicotici ed anche con

76. NMS Strategies for Patients who have had neuroleptic malignant syndrome. Atypicalantipsychotics and neuroleptic malignant syndrome. http://www.mhc.com/Algorithms/Schizophrenia/nms.htm

Strategies for Patients who have had Neuroleptic Malignant Syndrome The most common clinical symptoms of NMS are hyperthermia, EPS (muscle rigidity, akinesia, tremor), mental status alterations, autonomic signs (diaphoresis, tachycardia, labile blood pressure), and elevated creatine kinase (CK) and leukocytosis. NMS can occur in any patient, and is not specific to any neuropsychiatric diagnosis, but the highest risk may be with individuals with mental retardation and brain infection/inflammation.(1) Since your patient has a history of NMS, the question of the risks of rechallenge is critical, but the data are unsatisfactory. 19 of 45 reports of rechallence with an atypical after NMS on a typical described recurrence of NMS (42%). Another group of 45 rechallenges with a typical after NMS on a typical had 17 recurrences (38%).(4) There was no difference. However, these data could be biased by lack of reporting in the literature of successful rechallenges on the new drugs. Experts still recommend use of atypicals for rechallenges, but expectations of recurrence should be significant and one should be on guard for early signs of the disorder.(4) It is preferable to wait at least two weeks since the last signs and symptoms of the NMS (e.g., fever, rigidity, elevated CK) have disappeared.(5) Longer might be preferable since there is a suggestion of heightened susceptibility in the period immediately after the first occurrence of NMS, which may be in part due to the necessary abrupt withdrawal of the antipsychotic.(4)

77. Drug Toxicity neuroleptic malignant syndrome Search PUBMED for Neuroleptic MalignantSyndrome All Review Therapy Diagnosis; Neuroleptic Malignant http://www.ohsu.edu/cliniweb/C21/C21.613.276.html

Drug Toxicity Back to previous level Akathisia, Drug-Induced Search PUBMED for Akathisia, Drug-Induced: All Review Therapy Diagnosis ... Drug Eruptions [3 more specific term/s, 4 more link/s] Search PUBMED for Drug Eruptions: All Review Therapy Diagnosis ... Fixed Drug Eruption - Back: U. of Iowa Dyskinesia, Drug-Induced Search PUBMED for Dyskinesia, Drug-Induced: All Review Therapy Diagnosis ... Spontaneous Remission Rate of Tardive Dyskinesia: U. of Iowa Neuroleptic Malignant Syndrome Search PUBMED for Neuroleptic Malignant Syndrome: All Review Therapy Diagnosis ... Neuroleptic Malignant Syndrome: U. of Iowa Serotonin Syndrome Search PUBMED for Serotonin Syndrome: All Review Therapy Diagnosis

78. CJNS - Paradoxical Autonomic Response To Procyclidine In The Neuroleptic Maligna Abstract, Close Window Paradoxical Autonomic Response to Procyclidinein the neuroleptic malignant syndrome. Martin V Balzan. Abstract http://www.canjneurolsci.org/22augtoc/paradoxi.htm

Abstract Close Window Paradoxical Autonomic Response to Procyclidine in the Neuroleptic Malignant Syndrome Martin V Balzan Abstract: Background: Neuroleptic Malignant Syndrome (NMS) is an adverse reaction to dopamine receptor antagonists, characterised by hyperpyrexia, extrapyramidal rigidity and impaired autonomic function. It might result from central dopamine receptor blockade that causes severe muscle contraction. Method: Case Study. Results: High dose intravenous therapy with the anticholinergic drug, procyclidine hydrochloride, temporarily diminished the muscle rigidity and reversed most of the autonomic features in a patient with NMS occurring after a single intramuscular dose of the dopamine antagonist metoclopramide. Paradoxically, however, the heart rate decreased and bowel movements increased with this atropine-like drug. Conclusion: Since the degree of tachypnoea, tachycardia, and bowel hypotonia closely paralleled the severity of the muscle rigidity, it is suggested that these autonomic features of NMS result from sustained muscle contraction rather than a direct effect of neuro-leptic drugs on the central nervous system.

79. Mioti: Medical Condition Condition neuroleptic malignant syndrome. NINDS Neuroleptic MalignantSyndrome Information Page. NORD neuroleptic malignant syndrome. http://www.mioti.com/cat/condition/condition.asp?Cat=Neuroleptic

80. Health Library - Neuroleptic Malignant Syndrome Hometown commitment. neuroleptic malignant syndrome. Synonyms Disorder SubdivisionsGeneral Discussion Resources National Organization for Rare Disorders. http://www.phoebeputney.com/library/healthguide/IllnessConditions/topic.asp?hwid

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