NMS or seizure?
Question:
no google/yahoo/wikipedia answers...i've read them all.
Answers:
Anyone can cut and paste answers..... but here is a real one: Wow, go to your neurologist and explain what happened. BUT DO NOT DRIVE! Any time you experience loss of time, you need to tell you doc about it. Not to scare you, but seizures are nothing to be flippant about. Go consult with your doc. Sounds to me like you had an episode.
Other Answers:
Neuroleptic malignant syndrome (NMS) is a life-threatening, neurological disorder most often caused by an adverse reaction to neuroleptic or antipsychotic drugs.
Contents [hide]
1 Causes
2 Signs and Symptoms
2.1 Mnemonic
3 Prognosis
4 Treatment
5 Differential diagnosis
6 NMS and serotonergic syndrome
7 History
8 References
9 External links
[edit]
Causes
NMS is caused almost exclusively by antipsychotics, which includes all types of neuroleptic medicines along with newer antipsychotic drugs. The higher the dosage, the more common the occurrence. Rapid and large increases in dosage can also be attributed with the development of NMS. Other drugs, environmental or psychological factors, hereditary conditions, and specific demographics may be at greater risk, but to date no conclusive evidence has been found to support this. The disorder typically develops within two weeks of the initial treatment with the drug, but may develop at any time that the drug is being taken. NMS may also occur in people taking a class of drugs known as dopaminergics.
[edit]
Signs and Symptoms
The first symptom to develop is usually muscular rigidity, followed by high fever and changes in cognitive functions. Other symptoms can vary, but may be unstable blood pressure, confusion, coma, delirium, muscle tremors, etc. Once symptoms do appear, they rapidly progress and can reach peak intensity in no more than three days. These symptoms can last as little as eight hours or as long as forty days.
A raised creatine phosphokinase (CK) plasma concentration will be reported due to increased muscular activity. The patient may be hypertensive and suffering from a metabolic acidosis. A non-generalised slowing on an EEG is reported in around 50% of cases.
[edit]
Mnemonic
A mnemonic used to remember the features of NMS is: FEVER.[1]
F - Fever
E - Encephalopathy
V - Vitals unstable
E - Elevated enzymes (elevated CK)
R - Rigidity of muscles
[edit]
Prognosis
As with most illnesses, the prognosis is best when identified early and treated aggressively. In these cases NMS is usually not fatal, although there is currently no agreement on the exact mortality rate for the disorder. Studies have given the disorder a mortality rate as low as 5% and as high as 76%, although most studies agree that the correct percentage is in the lower spectrum, perhaps between 10% - 15%. Re-introduction to the drug that originally caused NMS to develop may also trigger a recurrence, although in most cases it does not.
[edit]
Treatment
Although treatment is not always necessary, it will help to cure the disease and prevent fatal developments from occurring. The first step in treatment is generally to remove the patient from any neuroleptic or antipsychotic drugs being taken and to treat fever aggressively. Many cases require intensive care, or some kind of supportive care at the minimum. Depending on the severity of the case, patients may require other treatments to contend with specific effects of the disorder. These include circulator and ventilatory support, the drugs dantrolene sodium, bromocriptine, apomorphine and electroconvulsive therapy (ECT) if medication fails.
[edit]
Differential diagnosis
Infection (sepsis, SIRS)
Serotonergic syndrome
Delirium tremens
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NMS and serotonergic syndrome
The clinical features of NMS and serotonergic syndrome are very similar. This can make differentiating them very difficult.[2]
Features, classically present in NMS, that are useful for differentiating the two syndromes are:[3]
Fever
Muscle rigidity
[edit]
History
NLM was known about as early as 1956, shortly after the introduction of the first phenothiazines, and is derived from the French syndrome malin des neuroleptiques.[4]
[edit]
References
^ Identify neuroleptic malignant syndrome. schizophrenia.com URL: http://www.schizophrenia.com/sznews/archives/002054.html. Accessed: July 2, 2006.
^ Christensen V, Glenthøj B (2001). "[Malignant neuroleptic syndrome or serotonergic syndrome]". Ugeskr Laeger 163 (3): 301-2. PMID 11219110.
^ Birmes P, Coppin D, Schmitt L, Lauque D (2003). "Serotonin syndrome: a brief review.". CMAJ 168 (11): 1439-42. PMID 12771076. Full Free Text.
^ Friedberg JM. Neuroleptic malignant syndrome. URL: http://www.idiom.com/~drjohn/biblio.html. Accessed: July 3, 2006.
[edit]
External links
Neuroleptic Malignant Syndrome - emedicine.com
Canadian Movement Disorder Group - cmdg.org.
NMS - counsellingresource.com.
NINDS Neuroleptic Malignant Syndrome Information Page - NIH.
[http://www.currentpsychiatry.com/article_pages.asp?AID=704&UID=187 Neuroleptic malignant syndrome:
Still a risk, but which patients may be in danger?] - currentpsychiatry.com.
Retrieved from "http://en.wikipedia.org/wiki/Neuroleptic_malignant_syndrome"
Seizure
From Wikipedia, the free encyclopedia
Jump to: navigation, search
Name of Symptom/Sign:
Convulsions ICD-10 R56
ICD-9 780.3
This article is about the medical term, epileptic seizure, as distinct from psychogenic non-epileptic seizure. In law, seizure can also refer to taking possession of an item: see search and seizure.
Seizures (or convulsions) are temporary abnormal electrophysiologic phenomena of the brain, resulting in abnormal synchronization of electrical neuronal activity. They can manifest as an alteration in mental state, tonic or clonic movements and various other symptoms. They are due to temporary abnormal electrical activity of a group of brain cells. The medical syndrome of recurrent, unprovoked seizures is termed epilepsy, but some seizures may occur in people who do not have epilepsy.
The treatment of epilepsy is a subspecialty of neurology; the study of seizures is part of neuroscience.
Contents [hide]
1 Signs and symptoms
2 Types
3 Diagnosis
4 Management
4.1 Safety
5 Seizures without epilepsy
6 External links
[edit]
Signs and symptoms
Seizures can cause involuntary changes in body movement or function, sensation, awareness, or behavior. A seizure can last from a few seconds to status epilepticus, a continuous seizure that will not stop without intervention. Seizure is often associated with a sudden and involuntary contraction of a group of muscles. However, a seizure can also be as subtle as marching numbness of a part of body, a brief loss of memory, sparkling of flashes, sensing an unpleasant odor, a strange epigastric sensation or a sensation of fear. Therefore seizures are typically classified as motor, sensory, autonomic, emotional or cognitive.
Symptoms experienced by a person during a seizure depend on where in the brain the disturbance in electrical activity occurs. A person having a tonic-clonic seizure (also known as a grand mal seizure) may cry out, lose consciousness and fall to the ground, and convulse, often violently. A person having a complex partial seizure may appear confused or dazed and will not be able to respond to questions or direction. Some people have seizures that are not noticeable to others. Sometimes, the only clue that a person is having an absence (petit mal) seizure is rapid blinking or a few seconds of staring into space.
[edit]
Types
Main article: Seizure types
Seizure types are organised firstly according to whether the source of the seizure within the brain is localised (partial or focal onset seizures) or distributed (generalised seizures). Partial seizures are further divided on the extent to which consciousness is affected. If it is unaffected, then it is a simple partial seizure; otherwise it is a complex partial seizure. A partial seizure may spread within the brain - a process known as secondary generalisation. Generalised seizures are divided according to the effect on the body but all involve loss of consciousness. These include absence (peitit mal), myoclonic, clonic, tonic, tonic-clonic (grand mal) and atonic seizures.
[edit]
Diagnosis
An isolated abnormal electrical activity recorded by an electroencephalography examination without a clinical presentation is not called a seizure. Nevertheless, they may identify background epileptogenic activity, as well as help identify particular causes of seizures.
Additional diagnostic methods include CT Scanning and MRI imaging or angiography. These may show structural lesions within the brain, but the majority of epileptics show nothing unusual.
As seizures have a differential diagnosis, it is common for patients to be simultaneously investigated for cardiac and endocrine causes. Checking glucose levels, for example, is a mandatory action in the management of seizures as hypoglycemia may cause seizures, and failure to administer glucose would be harmful to the patient. Other causes typically considered are syncope and cardiac arrhythmias, and occasionally panic attacks and cataplexy. For more information, see non-epileptic seizures.
[edit]
Management
The first-aid for a seizure depends on the type of seizure occurring. Generalized seizures will cause the person to fall, which may result in injury. A tonic-clonic seizure results in violent movements that cannot and should not be suppressed. The person should never be restrained, nor should there be any attempt to put something in the mouth. Potentially sharp or dangerous objects should also be moved from the vicinity, so that the individual does not hurt him or herself. After the seizure, if the person is not fully conscious and alert, they should be placed in the recovery position.
It is not necessary to call an ambulance if the person is known to have epilepsy, if the seizure is shorter than 5 minutes and is typical for them, if it is not immediately followed by another seizure, and if the person is uninjured. Otherwise, or if in any doubt, medical assistance should be sought.
A seizure longer than 5 minutes is a medical emergency. Relatives and other caregivers of those known to have epilepsy often carry medicine such as rectal diazepam or buccal midazolam in order to rapidly end the seizure.
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Safety
A sudden fall can lead to broken bones and other injuries. Children who are affected by frequent drop-seizures may wear helmets to protect the head during a fall.
Unusual behaviour or violent jerks can sometimes be misinterpreted as an aggressive act. This may invoke a hostile response or police involvement, where there was no intention to cause harm or trouble. During a prolonged seizure, the person is defenceless and may become the victim of theft.
A seizure response dog can be trained to summon help or ensure personal safety when a seizure occurs. These are not suitable for everybody. Rarely, a dog may develop the ability to sense a seizure before it occurs.
[edit]
Seizures without epilepsy
Unprovoked seizures are often associated with epilepsy and related seizure disorders.
Causes of provoked seizures include:
head injury
intoxication with drugs
drug toxicity, for example aminophylline or local anaesthetics
infection, such as encephalitis or meningitis
fever leading to febrile convulsions (but see above)
metabolic disturbances, such as hypoglycaemia or hypoxia
withdrawal symptoms (from sedatives such as alcohol, barbiturates and benzodiazepines)
space-occupying lesions in the brain (abscesses, tumors)
seizures during (or shortly after) pregnancy can be a sign of eclampsia.
Some medications produce an increased risk of seizures and electroconvulsive therapy (ECT) deliberately sets out to induce a seizure for the treatment of major depression. Many seizures have unknown causes.
Seizures which are provoked are not associated with epilepsy, and people who experience such seizures are normally not diagnosed with epilepsy. However, the seizures described above resemble those of epilepsy both outwardly, and on EEG testing.
[edit]
External links
MEDLINEplus: Seizures
Epilepsy and seizure information for patients and health professionals : Epilepsy.com
Retrieved from "http://en.wikipedia.org/wiki/Seizure"
DO YOURSELF A FAVOR AND GO FOR A SECOND OPINON, IT NEVER HURTS!!!! BELIEVE ME I LEARNED A VERY HARD WAY!!!:( GOOD LUCK TO YOU & TAKE CARE:)
It sounds like you have a seizure indeed. this is almost definitely not a presentation of NMS and i would not entertain such a diagnosis. NMS can be caused by a lot of psychiatric medications as well.
Why i say you probably had a seizure is because, in NMS, you have very many signs and symptoms: increased heart rate, increased temperature etc.. you can read about that from the cut and pasted post.
However in a seizure, typically you lose conciousness with a degree of amnesia as to the events preceding the seizure. your "hot and thirsty" precedeng event before the seizure suggest some form of "aura", which is typically described in patients who go into an attack and who experience a unique set of symptoms to them just before the attack. A history of epilepsy also suggests that you probably got an attack this time round as well.
The best solution now is for you to go to a general practitioner at least, or better yet, a neurologist. He can fully understand your condition and provide some qualitative and conclusive tests to help you understand ur condition better.
Just curious but what medication are you on that can cause NMS? is it risperidone?
Hope this helps. :D
For someone who has a seizure disorder, GET A SECOND OPINION. I saw 3 different doctors before I found a great doctor and she isnt even on my insurance plan anymore but I still see her since they are highly recommended. Check your local area to see who is the best and go there. If you are in the NY metro area I would recommend The Epilepsy center in NYC, they deal with every aspect of the disorder as well as other neurological disorders. You could probably even call them and get a referrel.
Good Luck :-)
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