Extrapyramidal symptoms also known as extrapyramidal side effects (EPSE) are symptoms that are as a result of taking any antipsychotic drugs. They can also be caused by antidepressants and other medications. Neuroleptic Malignant syndrome on the other hand, is a severe disorder that is as a result of idiosyncratic reaction to drugs with dopamine receptor-antagonist properties or rapid withdrawal of dopaminergic medications.
Extrapyramidal function refers to the motor system network that causes involuntary actions including the ability to make movements that we do not want to make. Extrapyramidal symptoms are grave and consequential. They include, Akathisia; which is the feeling of restlessness that hinders one’s ability to hold-still or even sit down, Parkinsonism; which infers to having same medication-induced symptoms with someone with Parkinson’s disease, Tardive dyskinesia; a condition in which you have unintentional facial movements such as lip smacking or sticking your tongue out and dystonia; which is when one’s muscles contract without the ability to control the contraction which leads to painful positions or movements.
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Neuroleptic Malignant Syndrome’s patients develop the syndrome hours or days after exposure to the causative medication. It is rare, and the causative drugs are mostly used to treat schizophrenia, bipolar disorder among other mental conditions. The syndrome symptoms, for majority of those diagnosed, start 2 weeks after ingestion of the medicine or after change of dosage. The symptoms have linger-on for a short duration that is majorly 7 to 10 days. The symptoms may include, severe fever, stiffness on the muscles, more sweating than usual, anxiety, abnormal heartbeat, quick breathing and production of more saliva than usual.
The similarities between Extrapyramidal symptoms and Neuroleptic syndrome is that they are as a result of typical antipsychotic drugs that antagonize dopamine D2 receptors. Moreover, in both cases, they can be life-threatening if not treated early or dosage reduced or medications changed. They both also have an effect on the muscles as well as on the mental well-being of the individual. Lastly, their symptoms in one way or another mimic Parkinson’s disease symptoms.
There are few differences between the two cases, basically, the two are almost essentially compatible and similar. However, NMS is a rare occurrence while extrapyramidal symptoms are likely to occur when one takes typical antipsychotic over and above the dosage prescribed by the physician. When NMS occurs, it lasts for a shorter period as compared to extrapyramidal symptoms and the period is typically a week or two and this is without prior treatment.
The best teaching mechanism for these diseases is basically to examine as many study cases as possible on both NMS and extrapyramidal symptoms. The reason I think is the best teaching mechanism is because of the glaring similarities of both cases. Therefore, reading on different cases will help in finding unique characteristics and make them easily identifiable. Moreover, they both need to be diagnosed early due to the life-threatening nature of both of them. Early recognition together with correct treatment will ensure effective treatment of both diseases as well as better management of the patient.
Reference
Levenson, J. L. (1985). Neuroleptic malignant syndrome. The American journal of psychiatry .
Pierre, J. M. (2005). Extrapyramidal symptoms with atypical antipsychotics. Drug safety , 28 (3), 191-208.
