Benzodiazepine administration appeared to be well tolerated. Before NMS has also been associated with other psychotropic agents that block central dopamine pathways (e.g., metoclopramide) and with abrupt cessation of dopamine agonists. complications with first generation neuroleptic medications, researchers have more recently developed a second generation. Muscle fibres from patients susceptible to malignant hyperthermia contract in response to these drugs at a lower concentration than those from normal patients. The factor common to all drug causes is a decrease in dopaminergic transmission; however, the reaction is not allergic but rather idiosyncratic. Rigidity may begin to decrease during the first few hours followed by a decrease in temperature, along with normalization of arterial pressure. The longer you wait to go back on antipsychotic drugs, the less likely you'll be to get NMS again. Renal failure is a strong predictor of mortality, representing a mortality risk of approximately 50%. If these medicines don't help, your doctor might try electroconvulsive therapy. Consistent diagnostic criteria have been used only in some clinical studies.2931 Three major symptoms indicate a high probability of the presence of NMS: hyperthermia, rigidity and an elevated creatine phosphokinase concentration, reflecting rhabdomyolysis34 (Table 1). A. Francis, S. Chandragiri, S. Rizvi, M. Koch, G. Petrides, Research output: Contribution to journal Article peer-review. Rigidity and fever abated within 24-48 hours, while secondary features of NMS were relieved within 64 hours. Neuroleptic Malignant Syndrome: Symptoms and Treatments Copyright 2017 Elsevier B.V., All rights reserved. Unable to load your collection due to an error, Unable to load your delegates due to an error. A decrease in mortality from NMS has been reported in recent years. The records were reviewed for resolution of clinical signs of NMS. NMS is very rare. Would you like email updates of new search results? ", OrphaNet: "Neuroleptic Malignant Syndrome.". 18 Fleischbacker WW, Unterweger B, Kane JM, Hinterhuber H. The neuroleptic malignant syndrome and its differentiation from lethal catatonia. Always consult a medical provider for diagnosis and treatment. 2 Adnet PJ, KrivosicHorber RM, Adamantidis MM et al. Conclusions: Current concepts. In most cases, the condition develops within the first 2 weeks of treatment with the drug; however, it may develop any time during the therapy period. It is characterized by distinctive clinical features including a change in mental status, generalized rigidity, hyperpyrexia, and dysautonomia. GARD is not currently aware of organizations specific to this disease. WebNeuroleptic malignant syndrome (NMS) is a rare and life-threatening reaction to the use of almost any kind of neuroleptic (antipsychotic) medication. Learn about symptoms, cause, support, and research for a rare disease. The search using PubMed included articles with the key words neuroleptic malignant syndrome, antipsychotics, neuroleptics, diagnosis, and treatment of neuroleptic malignant syndrome published in English from January 2000 to 2017. Neuroleptic malignant syndrome is characterized by altered mental status, muscle rigidity, hyperthermia, and autonomic hyperactivity that occur when certain neuroleptic drugs are used. Gray R, Moore Iii A, Berry F, Afroze F, Cherukupalli D. Turk J Anaesthesiol Reanim. Am J Psychiatry. Clipboard, Search History, and several other advanced features are temporarily unavailable. Death often occurs, but full recovery can result Araki and colleagues5 showed, using a caffeine skinned fibre technique, that there was abnormal contracture in six NMS patients similar to that seen in malignant hyperthermia. Resource(s) for Medical Professionals and Scientists on This Disease: Symptoms of this disease may start to appear at any time in life. Tanen, D. (2021). sharing sensitive information, make sure youre on a federal The oral dosage has ranged from 50 to 200 mg day1. ", National Organization for Rare Disorders: "Neuroleptic Malignant Syndrome. FOIA Neuroleptic Malignant Syndrome PubMed Central Carbamazepine has been used successfully in two patients: NMS completely resolved within 8 h.48, Electroconvulsive therapy (ECT) has improved some of the syndromes components, notably fever, sweating and level of consciousness.25. Other disorders can cause similar findings. Neuroleptic malignant syndrome (NMS) is a rare and life-threatening condition that can occur after changes in specific medications, most commonly after increases in psychiatric drugs. The older antipsychotic drugs include: Doctors call the newer antipsychotic drugs "atypical antipsychotics." After recovery, most people can start taking antipsychotic medicine again. Neuroleptic Malignant Syndrome A dopamine injection into the preopticanterior hypothalamus causes a reduction in core temperature.14 Since neuroleptic drugs block dopamine receptor sites, the hyperthermia associated with NMS may result from a blockade of hypothalamic dopamine sites. None of these signs are exclusive to this condition, and other important diagnoses (e.g., sepsis) should be excluded first. Use to remove results with certain terms WebNeuroleptic malignant syndrome is a rare but serious adverse effect of antipsychotic medication. The syndrome was first characterized in the 1960s, soon after the introduction of the first antipsychotic drugs. Constipation is the reduced frequency of bowel movements, typically fewer than three per week. Department of Anesthesiology and Emergency Medicine, University Hospital, Lille, France. World J Clin Cases. The Elective Rotation: A Critical Care Hospital Pharmacy Podcast: Arch Gen Psychiatry. Symptoms commonly include hyperpyrexia, muscle rigidity, autonomic dysfunction and NMS can come back after youre treated. Neuroleptic malignant syndrome: Video & Anatomy | Osmosis o [ pediatric abdominal pain ] Neuroleptic malignant syndrome develops infrequently in patients taking neuroleptic or other drugs that decrease dopaminergic transmission. Duma SR, Fung VS. Drug-induced movement disorders. Bookshelf Adjunctive drug therapy can be used, although efficacy has not been shown in clinical trials. These signs do not differ from those of other patients with schizophrenia but they seldom last for >2 weeks. PMID: 29325237 DOI: 10.4088/PCC.17r02185 Abstract Objective: To provide an overview of neuroleptic malignant syndrome (NMS) for the general practitioner with the most up-to-date information on etiology, workup, and management. Also, temperature elevations and muscle rigidity are usually less severe than in neuroleptic malignant syndrome, onset may be rapid (eg, < 24 hours), and nausea and diarrhea may precede serotonin syndrome. Neuroleptic Malignant Syndrome - BrainFacts WebThe authors assessed the ability of lorazepam and other benzodiazepines to affect the course of neuroleptic malignant syndrome (NMS). Affected people may experience high fever, muscle stiffness, sweating, unstable blood pressure, altered mental status, and autonomic dysfunction. Rapid cooling, control of agitation, and other aggressive supportive measures. Neuroleptics, also known as antipsychotic medications, are used to treat and manage symptoms of many psychiatric disorders. They fall into two classes: first-generation or typical antipsychotics and second-generation or atypical antipsychotics. Neuroleptic drugs block dopamine receptors in the nervous system. What is EPS side effect? Alcoholic patients are at greater risk of developing NMS during treatment of delirium or its prevention by droperidol or tiapride.2 Abnormalities of muscle metabolism in alcoholic patients are caused by ethanol toxicity and malnutrition.8 This may sensitize the muscle to the action of neuroleptics. All received lorazepam or related benzodiazepines within 24 hours of NMS onset or hospital admission. AB - The authors assessed the ability of lorazepam and other benzodiazepines to affect the course of neuroleptic malignant syndrome (NMS). 1998 Aug;155(8):1113-6. NMS usually gets better in 1 to 2 weeks. Neuroleptic malignant syndrome As awareness increases, the mortality rate decreases. 6 Things to Know About the Shingles Vaccine. Adnet and colleagues3 found that if cut fibre specimens depolarize with time after biopsy, these preparations become less sensitive to caffeine, and so one must be cautious when interpreting the results of in vitro caffeine contracture test. In some cases, stopping or switching medications quickly can also cause NMS. The serum iron concentration might be decreased. Malignant hyperthermia susceptibility in neuroleptic malignant syndrome. Washington, DC: American Psychiatric Press; 1989. Sep 19, Electroconvulsive Therapy. Treatment consists of immediate cessation of the offending medication and provision of supportive measures (hydration and cooling). Exploring the role of ketone bodies in the diagnosis and treatment of psychiatric disorders. Patients of all ages can be affected. Use ClincalTrials.gov button below to search for studies by disease, terms, or country. title = "Is lorazepam a treatment for neuroleptic malignant syndrome?". Heather Smith has a BS in Nursing and has been working in the field since 2014 in hospital and home health settings. Epub 2015 Jun 2. Neuroleptic Malignant Syndrome - PMC - National Center for Our study does not justify abandoning precautions against malignant hyperthermia in NMS patients. 15 Delacour JL, Daoudal P, Chapoutot JL, Rocq B. Traitement du syndrome malin des neuroleptiques par le dantrolne. Highly respected database from the National Institutes of Health Copyright 2023 Healthgrades Marketplace, LLC, Patent US Nos. The excess heat production, in association with a decrease in heat dissipation, produces hyperthermia, which is one of the main signs of the syndrome. In order to make a diagnosis, the physician who is evaluating a patient with suspected NMS should carry out the following tests in addition to a careful history and physical examination: creatine phosphokinase concentration; white blood cell count; renal function; EEG; CT scan; lumbar puncture; and serum lithium concentration. Neuroleptic malignant syndrome (NMS) is a rare, life-threatening adverse drug event associated with dopamine blocking agents (e.g., antipsychotic medications).The clinical presentation often comprises a constellation of fever, autonomic instability, leukocytosis, tremor, elevated enzymes, and rigidity.While NMS is a diagnosis of exclusion, 31 Kelkar VV, Jindal MN. Its characterized by symptoms like very high fever, rigid muscles, and WebNeuroleptic Malignant Syndrome (NMS) THINK MEDICAL EMERGENCY Increased risk of NMS when: Antipsychotic medication recently started or dosage rapidly increased (but can also occur during long-term treatment on a stable dose). Neuroleptic malignant syndrome. Patients taking neuroleptics may also be receiving treatment with monoamide oxidase inhibitors. Disorders that can be mistaken for NMS include rhabdomyolysis from other causes, central nervous system infections, a cerebral mass, tetanus and lithium toxicity. Lowdose heparin seems to be indicated to prevent venous thrombosis in an immobilized patient. Highly respected database from the National Institutes of Health PubMed Central In Neuroleptic malignant syndrome Mathematical analysis suggests that 59 consecutive NMS patients would have to test negative, with a similar in vitro protocol, in order to exclude statistically any crossreactivity between malignant hyperthermia and NMS. [1] Symptoms include high fever, confusion, rigid muscles, variable blood pressure, sweating, and fast heart rate. WebKey Points. NMS is a rare but potentially lethal consequence of the use of antipsychotic medications that requires familiarity with the condition in order to rapidly recognize its onset and appropriately intervene. Unauthorized use of these marks is strictly prohibited. In Caroffs review of 60 cases,12 supportive therapy was the predominant treatment modality. Indeed, a graded scale of specific signs and symptoms for the diagnosis of NMS and a spectrum of clinical severity are two issues that await resolution.122 Many diagnostic criteria have been proposed, but no single set of criteria has been adopted for general use. Records of inpatients who met both stringent This suggests that neuroleptics may be a necessary, but not exclusive, cause of the syndrome.1234, Very recently, an experimental model for NMS has been developed. . Gragnani A, Cezillo MV, Oliveira AF, Ferreira LM. Available toll-free Monday through Friday from 12 pm to 6 pm Eastern Time. HHS Vulnerability Disclosure, Help Its characterized by symptoms like very high fever, rigid muscles, and rapid heartbeat. These medications work by blocking dopamine receptors o. Dopamine is a chemical in your nervous system that transfers messages between cells, and research suggests 30 Keck PE, Harrisson G, Pope JR, McElroy SL. [5]Hasan S, Buckley P. Novel antipsychotics and the neuroleptic malignant syndrome: a review and critique. The exact underlying cause of Neuroleptic malignant syndrome is unknown. Third Party materials included herein protected under copyright law. http://www.ncbi.nlm.nih.gov/pubmed/17541044?tool=bestpractice.com Neuroleptic Malignant Syndrome - PubMed Pain on the left side is a common symptom and could indicate a variety of conditions, ranging from injury to infection. This often results in acute myoglobinuric renal failure. Another passion of hers is regenerative farming. 48 Thomas P, Maron M, Rascle C et al. 1994 Jan-Feb;12(1):43-7. doi: 10.1016/0736-4679(94)90011-6. Please enable it to take advantage of the complete set of features! He is an author of several references cited in this topic. It has been suggested that the amine reuptake inhibitory properties of tricyclic antidepressants could interact dangerously with the sympathomimetic properties of monoamine oxidase inhibitors. Some pages on this website provide links that require Adobe Reader to view. The condition is serious, but its treatable. Benzodiazepines, given IV in high doses, can be used to control agitation. PFB has no patents or stock in any company. Brought to you by Merck & Co, Inc., Rahway, NJ, USA (known as MSD outside the US and Canada) dedicated to using leading-edge science to save and improve lives around the world. These results compared favorably with prior reports of 5-day to 10-day recovery periods. [1] These negative findings may indicate that the in vitro contracture response to neuroleptic agents does not correlate with clinical evidence of NMS. 2012 May;24(2):155-62. The .gov means its official. Neuroleptic malignant syndrome (NMS) is a potentially life-threatening complication of treatment with antipsychotic drugs, or abrupt withdrawal of dopamine agonists. Khaldi S, Kornreich C, Choubani Z, Gourevitch R. Encephale. Fortunately, NMS is less common than it used NMS is an uncommon, idiosyncratic, life-threatening complication of treatment with antipsychotic medications. This suggests that nonspecific muscle damage secondary to metabolic factors, drug exposure, abnormalities in central nervous system activity or testing procedures may have contributed to the abnormal responses observed in vitro in muscle obtained from survivors of NMS episodes. Trusted Source WebAbstractIn Brief. But it may occur when the medicine causes a malfunction in the system that regulates the body's temperature. Many other clinical signs of lesser frequency have been reported, including opisthotonos, grand mal seizures, Babinskis signs, chorea and trismus. Conditions that these medications can treat include psychosis, treatment-resistant schizophrenia, bipolar disorder, schizoaffective disorder, and agitation. Rabbits treated with haloperidol and exposed to high ambient temperature may be useful in elucidating the pathogenesis of NMS.46, The molecular basis for NMS is unclear, but studies suggest that genetic factors are involved in its pathogenesis.27 Involvement of the serotonergic system in NMS has been suggested, but polymorphisms in the 5HT1A and 5HT2A receptor genes do not determine susceptibility to NMS.28 Other studies do not support an association between NMS and the mutations in the ryanodine receptor gene reported with malignant hyperthermia.38. If youre not treated, you can get serious problems, like: Your doctor will look for the two main symptoms of NMS: a high temperature and stiff muscles. PubMed Central Risk factors for neuroleptic malignant syndrome. 17 Denborough MA, Collins SP, Hopkinson KC. Records of inpatients who met both stringent research criteria and criteria under the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, (DSM-IV) (n=11) or DSM-IV criteria alone (n=5) for NMS were identified. Neuroleptic Malignant Syndrome - Injuries; Poisoning - MSD FOIA N1 - Copyright: Neuroleptic malignant syndrome A Guide to Neuroleptic Malignant Syndrome. UR - http://www.scopus.com/inward/record.url?scp=0033858703&partnerID=8YFLogxK, UR - http://www.scopus.com/inward/citedby.url?scp=0033858703&partnerID=8YFLogxK, Powered by Pure, Scopus & Elsevier Fingerprint Engine 2023 Elsevier B.V, We use cookies to help provide and enhance our service and tailor content. 2019 Feb 15;49(1):84-91. But stronger drugs, like fluphenazine and haloperidol, are more likely to trigger it. This article will explain what neuroleptic malignant syndrome (NMS) is. FDA approved to treat and manage various conditions. In most cases, the disorder develops within the first 2 weeks of treatment with the drug; however, the disorder may develop any time during the therapy period. Neuroleptic malignant syndrome To be diagnosed with it, you also need to have a few other warning signs, like a fast heartbeat, low or high blood pressure, and sweating. 8184, MSC 9663Bethesda, MD 20892-9663nimhinfo@nih.govhttp://www.nimh.nih.govTel: BethesdaFax: 301-443-4279, U.S. Department of Health and Human Services5600 Fishers Lane, CDER-HFD-240Rockville, MD 20857http://www.fda.govTel: Rockville. Am J Psychiatry. Aprospective survey of neuroleptic malignant syndrome in a shortterm psychiatric hospital. Benzodiazepine administration appeared to be well tolerated. Efficacy was evaluated in each case by determining the delay in the clinical response and time to complete recovery. Dantrolene 0.25 to 2 mg/kg IV every 6 to 12 hours to a maximum of 10 mg/kg/24 hours can be given for hyperthermia. Neuroleptics cannot be removed by dialysis, and blood concentrations decline only slowly. Data sources: note = "Copyright: Copyright 2017 Elsevier B.V., All rights reserved.". Go to source history of exposure to antipsychotic medications, history of abrupt withdrawal of dopaminergic drugs, exposure to dopamine antagonists and other antipsychotics. During this treatment, youre asleep and pain-free. [4]Lazarus A, Mann SC, Caroff SN. Go to source Pharmacopsychiatry 53(2):51-59, 2020 doi: 10.1055/a-1046-1044. 24 Henderson VW, Wooten GF. Neuroleptic malignant syndrome (NMS) is a rare, but life-threatening, idiosyncratic reaction to neuroleptic medications that is characterized by fever, muscular Much of this research focuses on finding ways to prevent and treat the disorder. Disclosure: Avery Callahan declares no relevant financial relationships with ineligible companies. These medications are most often used to treat Parkinsons disease, and can include: Other medications, such as lithium and certain antinausea medications, have also triggered NMS. Neuroleptic malignant syndrome (NMS) is a potentially life-threatening complication of treatment with antipsychotic drugs, or abrupt withdrawal of dopamine Highly respected database from the National Institutes of Health Benzodiazepine administration appeared to be well tolerated. WebNeuroleptic malignant syndrome is a rare neurological condition that is caused by an adverse reaction to neuroleptic (tranquilizer) or antipsychotic drugs. Doctors use neuroleptic drugs to manage symptoms and treat many psychiatric disorders. 42 Sachdev P, Mason C, HadziPavlovic D. Casecontrol study of neuroleptic malignant syndrome. Neuroleptic malignant syndrome - BMJ Best Practice Some other disorders have symptoms that are similar to NMS. NMS is more common in men than in women. These criteria for guidance in the diagnosis of NMS are commonly used in clinical research studies.213 Similarly, Pope, Keck and McElroy39 have published definite and probable criteria for NMS. Classic heat stroke is a lifethreatening condition in which heat gain from metabolism and the environment exceeds heat loss by evaporation and convection. Use of this content is subject to our disclaimer. Rigidity and fever abated within 24-48 hours, while secondary features of NMS were relieved within 64 hours. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Washington, DC: American Psychiatric Press; 1989. The risk of developing NMS has been reported to last for 1020 days after oral neuroleptics are discontinued and even longer when associated with depot forms of the drugs. The https:// ensures that you are connecting to the Caroff SN, Mann SC. be a risk factor, although research into this subject is still ongoing. The most common symptoms of NMS include very high fever, rigid muscles, and changes in mental state. Other symptoms like excessive sweating, rapid heartbeat, and tremors may also be present. Because its so serious, NMS requires quick recognition and treatment. Symptoms of neuroleptic malignant syndrome begin most often during the first 2 weeks of treatment with neuroleptic drugs but may occur earlier or after many years. Potential benefits from their use cannot, therefore, be excluded. Complete resolution was achieved more quickly with bromocriptine (10 days) or dantrolene (9 days; 23 mg kg1 day1 i.v. Neuroleptic malignant syndrome is characterized by altered mental status, muscle rigidity, hyperthermia, and autonomic hyperactivity that occur when certain Similar signs may be seen with overdosage of monoamine oxidase inhibitors. Neuroleptic malignant syndrome. Highly respected database from the National Institutes of Health official website and that any information you provide is encrypted National Library of Medicine Need a Telehealth Visit? All received lorazepam or related benzodiazepines within 24 hours of NMS onset or hospital admission. Patient organizations can help patients and families connect. Other nonspecific laboratory abnormalities have been reported, such as mildly elevated hepatic enzymes (transaminase, lactic dehydrogenase and alkaline phosphatase). 1993 Jan;77(1):185-202. These drugs are commonly prescribed for the treatment of schizophrenia and other neurological, mental, or emotional disorders. 21 Gurrera RJ. WebClinically, neuroleptic malignant syndrome resembles malignant hyperthermia Malignant Hyperthermia Malignant hyperthermia is a life-threatening elevation in body temperature usually resulting from a hypermetabolic response to concurrent use of a depolarizing muscle relaxant and a potent, read more . It is intended for informational purposes only. Other dopamine antagonists, such as metoclopramide, should be avoided. In: StatPearls [Internet]. Before Am J Psychiatry. In psychiatric practice, it is mainly associated with antipsychotics. Doctors diagnose this condition by examining your symptoms and your medical history, including any recent changes in medication. Diagnosis is clinical. These drugs are commonly prescribed for the treatment of schizophrenia and other neurological, mental, or emotional disorders. Med Clin North Am. eCollection 2023. A common pathophysiology of NMS and malignant hyperthermia has been suggested.151749 This hypothesis is based mainly on three points: (i) NMS and malignant hyperthermia have clinical features in common, including hyperthermia, rigidity, an elevated creatine kinase concentration and a mortality rate for both NMS and malignant hyperthermia of 1030%; (ii) sodium dantrolene, a peripheral muscle relaxant, has been used successfully in both syndromes; (iii) abnormal results have been found in in vitro contractility tests in patients with NMS or malignant hyperthermia. Timely diagnosis and discontinuation of antipsychotic therapy is the first-line treatment, followed by supportive care and pharmacotherapy. INTRODUCTION Neuroleptic malignant syndrome (NMS) is a life-threatening neurologic emergency associated with the use of antipsychotic (neuroleptic) Neuroleptic malignant syndrome (NMS) is a rare, life-threatening adverse drug event associated with dopamine blocking agents (e.g., antipsychotic medications).The 1 Adityanjee PA, Singh S, Singh G, Ong S. Spectrum concept of neuroleptic malignant syndrome. WebIn this episode, I ll discuss three ways to tell the difference between serotonin syndrome and neuroleptic malignant syndrome. Records of inpatients who met both stringent research criteria and criteria under the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, (DSM-IV) (n=11) or DSM-IV criteria alone (n=5) for NMS were identified. Neuroleptic malignant syndrome. A successful electroconvulsive treatment of neuroleptic malignant syndrome. Neuroleptic malignant syndrome. Many neuroleptic agents are commonly associated with the development of neuroleptic malignant syndrome. 3 Adnet PJ, KrivosicHorber RM, Adamantidis MM, Haudecoeur G, Reyford HG, Dupuis BA. Lorazepam and related benzodiazepines may reduce recovery time in NMS. without exceeding 10 mg kg1 day1) than with supportive therapy (15 days). Exclusion of other disorders and complications. Trusted Source Neuroleptic Malignant Syndrome | National Institute of Neuroleptic malignant syndrome: an easily overlooked neurologic Rigidity and fever abated within 24-48 hours, while secondary features of NMS were relieved within 64 hours. First generation neuroleptics, developed Signs and symptoms. If you believe you or someone you know is experiencing this, you should seek immediate medical care. 41 Rosenberg MR, Green M. Neuroleptic malignant syndrome: review of response to therapy. PMC Disclosure: Leslie Simon declares no relevant financial relationships with ineligible companies. Any antipsychotic drug can cause NMS. 13 Caroff SN, Rosenberg H, Fletcher JE, HeimanPatterson TD, Mann SC. [Prolonged neuroleptic malignant syndrome after Haloperidol injection]. Downs SM, van Dyck PC, Rinaldo P, et al. , it can be life threatening and requires immediate treatment. Your doctor can begin or change your treatment to help you manage depression. In addition, blockade of dopamine receptors in the corpus striatum is thought to cause muscular rigidity, generating heat. 2015 Sep;41(6):1147-51. doi: 10.1016/j.burns.2015.01.015. Classic clinical characteristics include mental status changes, fever, muscle rigidity, and autonomic instability. It has been suggested that the initial dosage should be 2 mg kg1 given intravenously.15 This dose may be repeated every 10 min, up to a total dose of 10 mg kg1 day1. The records were reviewed for resolution of clinical signs of NMS. Of prime importance seems to be the avoidance of marked dehydration in neuroleptictreated patients; this may reduce the prevalence and morbidity of the syndrome. 55 Kenosia AvenueDanbury, CT 06810orphan@rarediseases.orghttp://www.rarediseases.orgTel: DanburyFax: 203-798-2291, National Institute of Mental Health (NIMH), National Institutes of Health, DHHS6001 Executive Blvd. Additional treatment may be considered if supportive interventions fail. Hence, in order to evaluate a possible association between NMS and malignant hyperthermia, several investigators have used such tests on skeletal muscle fibres removed from patients with documented NMS episodes. 10 Burke RE, Fahn S, Mayeux R. Neuroleptic malignant syndrome caused by dopamine depleting drugs in a patient with Huntingtons chorea.