Which of the following statements regarding the clinical manifestations of NMS is correct?

A. Parkinson’s disease-like symptoms are not usually associated with NMS.
B. Muscle rigidity contributes to dyspnea, dysphagia, and rhabdomyolysis.
C. Normal reflexes are expected in persons with NMS.
D. Seizures are not associated with NMS.
E. NMS is rarely mistaken for other disease states.
 
 

• Answer B is correct.

• Measures to control rigidity will reduce the complications of NMS including dyspnea, dysphagia, and rhabdomyolysis.

• A broad range of movement disorders, predominantly parkinsonism, may occur in persons with NMS:

 
• Rigidity
• Akinesia
• Dyskinesia
• Tremors
• Masklike facies

• Abnormal reflexes (hyperreflexia and clonus) are common in persons with NMS.

• Seizures can occur with NMS.

• Many disease and toxic reactions mimic the cardinal features of NMS:

• Malignant hyperthermia
• Lethal catatonia
• Heat stroke
• Central anticholinergic toxicity
• Central nervous system infection
• Severe dystonic reaction
• Drug- and food-related allergic reactions
• Electrolyte imbalance
• Thyrotoxicosis
• Strychnine poisoning
• Rabies
• Tetanus
• Polymyositis
• Rhabdomyolysis
• Stiff-person syndrome

References:  3, 4, and 5

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