NEUROLEPTIC MALIGNANT SYNDROME VS SEROTONIN SYNDROME : COMMONALITIES & CONTRASTS

Dr Shubham Verma, Dr Pooja Jasrotia

Abstract


Neuroleptic malignant syndrome (NMS) and Serotonin Syndrome are uncommon but potentially life-threatening
adverse reactions associated with Psychotropic medications. Polypharmacy and the similar presentation of SS and NMS
make diagnosis of the 2 syndromes problematic.
A MEDLINE search was performed for the period 1970 to 2018 for case reports, review articles, and studies pertaining to
SS and NMS.
SS presents as mental status changes, autonomic nervous system disturbances, neurologic manifestations, and
hyperthermia. Similarly, NMS presents as muscle rigidity, hyperpyrexia, mental status changes, and autonomic
instability. However, the clinical laboratory profile of elevations in creatine kinase, liver function tests (lactate
dehydrogenase, aspartate transaminase), and white blood cell count, coupled with a low serum iron level, distinguishes
NMS from SS among patients taking neuroleptic and serotonin agonist medications simultaneously. For both SS and NMS,
immediate discontinuation of the causative agent is the primary treatment, along with supportive care. For NMS,
dantrolene is the most effective evidence-based drug treatment whereas there are no evidence-based drug treatments
for SS.


Keywords


differential diagnosis, neuroleptic malignant syndrome, serotonin syndrome

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