A group of international experts developed consensus criteria for the diagnosis of Neuroleptic Malignant Syndrome (NMS).
Patient selection: suspected neuroleptic malignant syndrome
Parameters:
(1) exposure to dopamine antagonist or dopamine agonist withdrawal within the past 72 hours
(2) hyperthermia on >= 2 occasions (measured orally, > 38.0°C)
(3) rigidity
(4) altered mental status (reduced or fluctuating level of consciousness, LOC)
(5) serum creatinine kinase (CK) activity >= 4 times the upper limit of normal (ULN)
(6) hypermetabolic (heart rate >= 1.25 times baseline AND respiratory rate >= 1.5 times baseline)
(7) sympathetic nervous system lability with >= 2 of the following:
(7a) elevated blood pressure (systolic and/or diastolic >= 1.25 times baseline)
(7b) fluctuation in blood pressure (change in systolic blood pressure >= 25 mm Hg within 24 hours and/or change in diastolic blood pressure >= 20 mm Hg within 24 hours)
(7c) diaphoresis
(7d) urinary incontinence
(8) exclusion of toxic, metabolic, infectious and neurologic causes
|
Parameter
|
Finding
|
Points
|
|
dopamine medication change
|
no
|
0
|
|
|
yes
|
20
|
|
hyperthermia
|
no
|
0
|
|
|
yes
|
18
|
|
rigidity
|
no
|
0
|
|
|
yes
|
17
|
|
altered mental status
|
no
|
0
|
|
|
yes
|
13
|
|
serum CK activity
|
< 4 times ULN
|
0
|
|
|
>- 4 times ULN
|
10
|
|
hypermetabolic
|
no
|
0
|
|
|
yes
|
5
|
|
sympathetic nervous system lability
|
0 or 1
|
0
|
|
|
2 to 4
|
10
|
|
alternative diagnosis
|
no
|
7
|
|
|
yes
|
0
|
total score =
= SUM(points for all 8 parameters)
Interpretation:
• minimum score: 0
• maximum score: 100
• A cutoff of >= 70 or >= 74 can be used.
