American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the primary approach to treating neuroleptic malignant syndrome (NMS)?

1. Increase the dosage of the neuroleptic medication

2. Administer anticonvulsants

3. Remove the causative agent and provide supportive care

4. Start a high-dose glucocorticoid therapy

The correct answer is: Remove the causative agent and provide supportive care

The primary approach to treating neuroleptic malignant syndrome (NMS) centers on the immediate removal of the causative agent, typically the neuroleptic medication responsible for the condition, followed by supportive care. NMS is a potentially life-threatening reaction characterized by severe muscle rigidity, hyperthermia, autonomic dysfunction, and altered mental status, which arises from the blockade of dopamine receptors. By discontinuing the neuroleptic medication, the precipitating factor is eliminated, allowing the body's systems to gradually return to their normal state. Supportive care includes monitoring vital signs, providing hydration, and managing complications such as hyperthermia or electrolyte imbalances, all of which are crucial in stabilizing the patient. The other approaches, such as increasing the dosage of the neuroleptic, administering anticonvulsants, or initiating glucocorticoid therapy, do not address the underlying issue of dopamine receptor blockade and can potentially worsen the patient's condition. Instead, focusing on withdrawal of the offending agent and supportive management is essential for recovery from NMS.