Talk:Neuroleptic malignant syndrome

From the public domain resource at http://www.ninds.nih.gov/health_and_medical/disorders/neuroleptic_syndrome.htm

NMS and Sinemet withdrawal?

I think NMS can also be caused by withdrawal from Sinemet, but I don't know enough about it to make the edit. Can a physician or other expert comment?

Sarah Waggoner 21:21, 26 September 2007 (UTC)

http://www.rxlist.com/cgi/generic/sinemet_wcp.htm It seems so - this source IS reliable, but I'm sure there are high quality ones.

It is also worth noting that the condition can occur on *withdrawing* from Neuroleptics (antipsychotics) too. Although some might say that it is 'Malignant Catatonia' in this case. And there may well be a crossover between NMS and Malignant Catatonia too! I might find sources later and add this to the article if not already there. Buckethed (talk) 01:04, 14 December 2007 (UTC)

Dubious

I question the validity of the statement "NMS should be ruled out in the case of acute behaviour change of any person on antipsychotic medication". Isn't the intended effect of antipsychotic medication to produce behavioural change, so a change in the behaviour of people starting treatment (the people most likely to be afflicted with NMS) shouldn't rule out anything — it should be expected. Neitherday (talk) 04:03, 17 December 2007 (UTC)

I just read it again and what I meant was:

Acute and significant behaviour change/deterioration (eg: over a day or less) in someone who has otherwise been stable for a period of time on antipsychotics. (i.e. the dose hasn't been changed and the person hasn't deteriorated because of drug-taking or noncompliance)

I'll get a ref and figure out the best way to word it exactly. Is that clearer? cheers, Casliber (talk · contribs) 04:38, 17 December 2007 (UTC)

I get it now, thank you. :) Neitherday (talk) 06:34, 17 December 2007 (UTC)

Fever vs Hyperthermia

The rise in core temperature is really hyperthermia due mostly to excessive muscle activity and not fever, although these two are frequently mixed up (even the mesh definition for Neuroleptic malignant syndrome says 'fever'). Maybe this should be changed, although the useful mnemonic would also need to be altered. —Preceding unsigned comment added by T vanhove (talk • contribs) 09:39, 30 December 2007 (UTC)

"Supportive?"

The article states, "Treatment is generally supportive." I have no idea what this means. Perhaps it is medical jargon. Perhaps it is a mistake. Either way, I think it could use some clarification. David (talk) 14:10, 24 March 2009 (UTC)

It means that treatment targets whatever symptoms the patient is having, instead of targeting the cause. Giving IV fluids, pain management, etc. Peetiemd (talk) 03:05, 13 May 2009 (UTC)

I'm glad someone corrected that mistake. Thanks! David spector (talk) 00:42, 30 November 2009 (UTC)

Potential Revisions

Make sure to use proper sentence structure. For example, the phrase “Occurs in 0.1-0.2% of patients receiving conventional anti-psychotics (e.g., butyrophenones [especially haloperidol], phenothiazines, thioxanthenes)” under the “Epidemiology” section is not a complete sentence. Also, consider expanding this section. Including other factors, such as age and gender distributions, would help your article (being young and male may be risk factors for the development of NMS—you can find this information at the url: http://cat.inist.fr/?aModele=afficheN&cpsidt=2894011). Also, how do dantrolene sodium, bromocriptine, and apomorphine function to treat NMS? It is good that you have linked them to other Wikipedia articles, but a short description specifying their use is perhaps needed. Bergaa7 (talk) 02:14, 24 November 2009 (UTC)

I found different data on the occurrence of NMS from what you provide in the "Epidemiology" section. Instead of .1-.2% of patients receiving neuroleptics, I found data suggesting .2-3.23% of these patients experience NMS. The paper that had this data has other epidemiological data that could be helpful in expanding your "Epidemiology" section, along with the suggestions by Bergaa7. The paper can be found at: [[1]].

--Philades (talk) 23:16, 28 November 2009 (UTC)

you mention many signs and symptoms but you don't really go into how NMS actually causes those symptoms. further elaboration on that can help readers understand more about the pathology and what the disease is connected with physically. perhaps you can throw that into the "pathophysiology" section. the mnemonic device was pretty nifty though. it seems that those are the most COMMON symptoms though, so you should mention that they aren't just limited to those. Also, you say they are "features" which kind of puts a positive connotation. perhaps another synonym would be more appropriate? Under "causes", it is unclear whether this adverse reaction is random, genetic, or allergenic. is there any research that sheds light on this subject? "differential diagnosis" also seems to be out of place under the "causes" section. it would probably be better in the "signs and symptoms" section. "prognosis" and "epidemiology" seem so short that they can be integrated into other sections of the article. Perhaps elaborating on them or finding another place to put them could help. Good work so far!

Justindchien (talk) 01:45, 29 November 2009 (UTC)

Under the signs and symptoms section, you may want to cite more of your information. For example, what did you use to determine that symptoms can last from eight hours to forty days? This would make your article more verifiable. Also, I found an article called "Symptoms of neuroleptic malignant syndrome in 82 consecutive inpatients" by G Addonizio, VL Susman and SD Roth which mentions that there are milder variants of NMS. You might want to look through the article and include information about the milder forms of the disease. The paper can be found at [[2]]. Overall, this is a great article. Farnhach (talk) 03:48, 29 November 2009 (UTC) You have compiled great information on Neuroleptic malignant syndrome. In revising the article, you may want to expand on the Research section. You discuss past research and obstacles, but it would be beneficial to discuss current reasearch, clinical trials and/or future research. Additionally, it is helpful to understand the condition better if you include graphics. marissa.hone 29 November 2009 12:29, 29 November 2009 (UTC)

---

The second paragraph in the “Signs and Symptoms” section is confusing to me. It seems slightly to jump from one point to another. If at all possible, maybe explain why these events occur. For example, why does increased muscular activity and rhabdomyolysis lead to an increase in WBC count and creatine phosphokinases? Even a sentence or two could help to explain the cause and effect relationship between the two and clarify your point. Also, why is there a slowing on the EEG? Even if research is still unclear, what are some possible explanations for it? And then the way you end this paragraph “White blood cells go up in the blood” does not really make sense or smoothly end the paragraph.

Still in the “Signs and Symptoms” section, a simple bold title (like the one for Mnemonic) above the list of symptoms could be a nice way just to organize it a little bit better.

The first sentence in Pathophysiology is very long and confusing to read. Maybe breaking it up into a few sentences could help you get your point across better. For example, right after this long first sentence you talk about the release of calcium in a short sentence and then explain the significance in the next sentence (again, which is not long, but straightforward and to the point). This format was very easy to read and understand. Even though I did a little research on your topic and understand what you are trying to say in the first few sentences, I still found it confusing to read, so someone who does not have any knowledge of the subject could be easily confused.

Other than that, there were a few grammatical mistakes and some inconsistencies (eg versus e.g.) so just keep an eye out for that when doing your final revisions. I really liked the external links since they offer a good jumping off point for others who want to do more research. I also thought your first introduction paragraph was a good overall description of the subject matter (since this is the most important part that most people look to when using Wikipedia). I tried to find some more resources for you guys to possibly use, but you already have all the resources I was finding so good job on the research of your subject. Overall, really good job.

MichelleMaglio (talk) 18:35, 29 November 2009 (UTC)

I think your article would greatly benefit from a little background information on how neuroleptic and antipsychotic drugs function and if so, how they lead to dopamine receptor blockade or decreased D2 function. I realize this may be found on their own respective wikipages, but it would certainly make your pathophysiology section much more clearer. Also, you may want to talk about some case studies that have played a pivotal role in understanding NMS under your history section. This would probably give the reader a better understanding of the syndrome as a whole. An article called "Neuroleptic Malignant Syndrome" by James L. Levenson discusses some of these case studies. Gandhi7 (talk) 19:00, 29 November 2009 (UTC)

I agree with what was stated before that some of the sentances were hard to understand and sometimes breaking them up into short strong statements is best. I was wondering if some citations are missing becuause i felt some facts were listed, especially in symptoms sections without any citation. I also would like to see some expansion on what exactly the drugs do to cause NMS and maybe look at some studies to support that. I was somewhat confused on the example about the twins and mother having NMS I think you are trying to say it can be linked to genetics but maybe rework that section to make it more clear. Finally I was wondering if the order of your subsections is the most effective. I felt there was some repition and maybe should start out with basics of what is happening and then expand with experiments and other data. I just felt that I went and read later sections to fully understand what was stated prior. EPalmquist (talk) 00:33, 30 November 2009 (UTC)

Do you have any more information that you can include as to why there are elevated white blood cell counts observed during NMS? Also, what is the time-frame of attack for NMS, does it last a few hours or days, is it acute or chronic, etc? Furthermore, you mention that NMS must be caught in its early onset if fatality is to be avoided; how fast is the onset of the disease, and what is the inital treatment while a diagnosis is being made? Other than that, you might want to try to combine parts of your research section with the pathophysiology section, as you mention in the research section that the pathophysiology remains unclear. This could be said before giving an explanation of the suspected mechanism, and perhaps the pathophysiology section could be reworded so that it is nto so dense, as it seems just a little confusing. Other than that, great job, this is a well written article. Rueltnj (talk) 01:33, 30 November 2009 (UTC)

This topic seems very interesting and the information that you have so far is very good. I think the best thing that you can do to improve your article is to include some studies that would support what you are saying. For example, in the introduction of the causes section I think it would be beneficial to maybe include some studies that have supported some of these facts that you are stating or perhaps at least some statistics which support your information. Additionally, I think you should include some information about how the lowering of D2 actually causes the symptoms that you talk about. What are the biological links? I think it would also be good to look into how NMS is related to other diseases. I found a few articles about how NMS relates to Wilson’s disease and also how NMS affects people with AIDS. Perhaps you will find some useful information in these articles to include in your article.

Article 1: “Neuroleptic malignant syndrome in the acquired immunodeficiency syndrome” http://www.ncbi.nlm.nih.gov:80/pmc/articles/PMC2431511/pdf/postmedj00156-0013.pdf

Article 2: Kontaxakis V., C. Stefanis, M. Markidis, et al. “Neuroleptic malignant syndrome in a patient with Wilson’s disease” Journal of Neurology, Neurosurgery & Psychiatry

I know this was already said in above comments so I will just say that I agree that the changing the formatting of the article will help reader comprehension. I would suggest moving the Pathophysiology section so that it is earlier in the article. I think it would make more sense for the reader to know what mechanism is causing NMS before they know how it is diagnosed. Lastly, I found one more article that I think would be helpful in expanding on the information that you already have in your article. From what I can tell this information has a lot of information on the topics that you touched upon in your article.

Article: http://psychservices.psychiatryonline.org/cgi/content/full/49/9/1163

Overall, I think the information that you have is good but I think it would serve you and the reader best to just reformat the article and perhaps correct sentence structure so that it is clearer to understand. Msprockel (talk) 21:34, 30 November 2009 (UTC)

I think your article is very well written, cohesive and informative. I really like how you included a mnemonic to remember the symptoms of NMS because I think it is important to remember that the purpose of the article is to be informative and a mnemonic strengthens the reader's ability to retain the information given in the article, making it an article with real purpose. I also liked how you summarized the symptoms in bullets, but I would preface it with a sentence or two instead of jumping right into the bullets. I think you need to look most closely at your causes and pathophysiology sections. In the causes section you list several drugs that can cause NMS, but you do not include what those drugs are used for. I think it would benefit your article to include more detail about the diseases those drugs are used to treat. I think the pathophysiology section seems rushed when it should probably be your most in depth section of the article. Much of it was unclear and difficult to follow. Also, it seemed as if you used parentheses to restate or clarify the preceding statement. I suggest you take the parentheses out altogether and try to incorporate clarifications in the body of the text, which would make it easier to understand. I think you should go more in depth in the mechanisms involved in NMS in this section as well. You mentioned the sympathoadrenal hyperactivity hypothesis, but didn't explain what it was very well, how it came to be, arguments for it, or arguments against it. I think including these things would strengthen your article's validity. Be sure to read it over and catch some grammatical errors and awkward wording. There were a couple of sections where you used phrases, but I suggest you make them complete sentences (e.g. epidemiology). Overall, I think it is a good start and could be a very strong article. Brikathleen (talk)