We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Correspondence |

Hyperthermia and Jaw Opening in Drug-Induced Movement Disorders

Fereydoon Fred Roohi, MD
Arch Neurol. 2012;69(2):279. doi:10.1001/archneurol.2011.1107.
Text Size: A A A
Published online


The main focus of Robottom et al1 in their recent review article was drug-induced movement disorders. However, I would like to comment on 2 issues related to their article that were of concern to me. The first concern is the statement in their review that neuroleptic malignant syndrome is associated with “fever.” Fever is an elevation of normal body temperature as a result of an increase in the hypothalamic thermoregulatory set point. The genesis of fever starts with the production of endogenous cytokines, which interact with the preoptic/anterior hypothalamic area, inducing prostaglandin E2, which stimulates thermogenesis to keep up with the higher shift of the thermoregulatory set point in the hypothalamus.2 The patients with neuroleptic malignant syndrome are hyperthermic but not febrile. Pathogenesis of hyperthermia is distinct from fever. The hypothalamic set point is unchanged in drug-induced hyperthermia, which develops with the use of antipsychotics and serotoninergic antidepressants. The elevation of body temperature results from an imbalance between heat generation and heat dissipation and occurs when heat-generating processes exceed normal heat-losing processes.25 Misdiagnosing hyperthermia as fever is risky since drug-induced hyperthermia can be life threatening if not recognized and treated properly.4 Antipyretic medications, by interfering with prostaglandin production, successfully lower the hypothalamic set point in the case of fever and allow body temperature to return to normal. In hyperthermia, antipyretic medications are completely ineffective and lowering the hypothalamic set point makes no difference because what is causing the elevated temperature is not a higher shift of the thermoregulatory hypothalamic set point. The effective treatment of hyperthermia linked to neuroleptic malignant syndrome depends on early clinical recognition, prompt withdrawal of the neuroleptic agents, supportive measures, temperature reduction by cooling the patient, and pharmacology therapies including dantrolene sodium and/or bromocriptine mesylate.5 Accurate recognition of hyperthermia can also avoid the unnecessary use of antipyretic medications and antibiotics and prevent neurological injuries that may not necessarily be transient and can lead to death.5

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Original Article: Does This Patient Have Ventilator-Associated Pneumonia?