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Joe, Unless there are the symptoms are there you can't make the diagnosis. I think that the only symptom may have been confusion and that likely occurred prior to the lowering of meds. If he developed a high fever, severe muscular rigididy (beyond the dystonia found in PD). The masnagement was far from ideal but I doubt that it was NMS. If someone can show me an elevated CPK (the normal I believe is in the range of the double digits and NMS patients can run 50,000-100,000. I am nitpicking but at the same time while I can't rule it out entirely you can't make a diagnosis based on the fact that it sometimes happens when PD drugs are withdrawn. You have to have posititive symptoms. No one is suggesting ignoring the risk of NMS. That does not mitigate the tragedy of his death one bit or excuse the MD's for their poor management of Joe. Charlie "J. R. Bruman" wrote: > To those who dispute or object to my comments about Joe's death, I'm > standing pat. Given the rather vague definition of neuroleptic > malignant syndrome (NMS), it doesn't matter whether his history is an > exact match. The point is, NMS is a life-threatening condition that > may result from mis-management of drug dosage, and something like that > appears to be what happened to Joe. The PDR, from which I draw that > inference, may not be the most glamorous source but it's very reliable, > as every word must withstand intense scrutiny by the FDA. For those who > insist on not reading it, here's what the PDR says: > > (p.2711): "Withdrawal Emergent Hyperpyrexia and Confusion: Four cases > of a symptom complex resembling the neuroleptic malignant syndrome > (characterized by elevated temperature, muscular rigidity, and altered > consciousness), similar to that reported in association with the rapid > dose reduction or withdrawal of other dopaminergic drugs, have been > reported in association with the abrupt withdrawal or lowering of the > dose of tolcapone. In 3 of these cases, CPK was elevated as well. One > patient died, and the other 3 patients recovered over periods of > approximately 2, 4, and 6 weeks." And, > > (p.987): "SYMMETREL should not be discontinued abruptly in patients with > Parkinson's disease since a few patients have experienced a parkinsonian > crisis, i.e., a sudden marked clinical deterioration, when this > medication was suddenly stopped. The dose of anticholinergic drugs or of > SYMMETREL should be reduced if atropine-like effects appear when these > drugs are used concurrently. > Neuroleptic Malignant Syndrome (NMS): Sporadic cases of possible > Neuroleptic Malignant Syndrome (NMS) have been reported in association > with dose reduction or withdrawal of SYMMETREL therapy. Therefore, > patients should be observed carefully when the dosage of SYMMETREL is > reduced abruptly or discontinued, especially if the patient is > receiving neuroleptics. > NMS is an uncommon but life-threatening syndrome characterized by > fever or hyperthermia; neurologic findings including muscle rigidity, > involuntary movements; mental status changes; other disturbaances > such as autonomic dysfunction, tachycardia, tachypnea, hyper- or > hypotension; laboratory findings such as creatine phosphokinase > elevation, leukocytosis, myoglobinuria, and increased serum > myoglobin." > > Quibble if you like about definition, to me the message seems clear; > Ignore it at your own risk. Cheers, > Joe > -- > J. R. Bruman (818) 789-3694 > 3527 Cody Road > Sherman Oaks, CA 91403-5013 -- ****************************************************************************************** Charles T. Meyer, M.D. Middleton (Madison), Wisconsin [log in to unmask] ******************************************************************************************