(A) Decreased CPK# Neuroleptic malignant syndrome (NMS) is a life-threatening neurological disorder most often caused by an adverse reaction to neuroleptic or antipsychotic drugs. It generally presents with muscle rigidity, fever, autonomic instability and cognitive changes such as delirium, and is proven on a raised creatine phosphokinase (CPK).> Causes NMS is caused almost exclusively by the blocking of dopamine receptors with antipsychotic medications, including all types of neuroleptics (typical and atypical antipsychotic drugs).> Pathophysiology: The mechanism is thought to depend on decreased levels of dopamine due to: Dopamine receptor blockade Genetically reduced function of dopamine receptor D2.> Signs and symptoms: The first symptom to develop is usually muscular rigidity, followed by high fever, symptoms of instability of the autonomic nervous system such as unstable blood pressure, and changes in cognition, including agitation, delirium and coma. Other symptoms may include muscle tremors and pharyngitis. Once symptoms do appear, they rapidly progress and can reach peak intensity in as little as three days. These symptoms can last anywhere from eight hours to forty days. A raised creatine phosphokinase (CPK) plasma concentration will be reported due to increased muscular activity. The patent may be hypertensive and suffering from a metabolic acidosis. A non-generalised slowing on an EEG is reported in around 50% of cases.> Synopsis of Symptoms Increased Body Temp >100.4 degrees Confused or Altered Consciousness Diaphoresis "sweat shock" Rigid Muscles Autonomic Imbalance Mnemonic F - Fever E - Encephalopathy V - Vitals unstable E - Elevated enzymes (elevated CPK) R - Rigidity of muscles> Treatment: 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. These include circulatory and ventilatory support, the drugs dantrolene sodium, bromocriptine, apomorphine and electroconvulsive therapy (ECT) if medication fails. Benzodiazepines may also be of great benefit.