The term “drug-induced neurologic disorders” (DIND) refers to unintended or undesirable effects on the nervous system caused by drugs or associated with drug use. Adverse drug reactions (ADRs) may be due to drugs for neurologic or other diseases. The exact incidence of DIND is unknown. Reported adverse effects of drugs on the nervous system form only a small proportion of all neurological disorders but they are under-recognized and under-reported. Our special issue will focus on three of the most dangerous and feared DIND: neuroleptic malignant syndrome, malignant hyperthermia, serotonin syndrome.

Neuroleptic malignant syndrome is a clinical condition characterized by mental status changes, generalized rigidity, fever, and dysautonomia and it almost always occurs after “inappropriated response” to administering neuroleptic medication. Prevalence estimates range from 0.167 cases per thousand people to 32.6 cases per thousand people. A meta-analysis that analyzed the epidemiological data available in the literature yielded an overall estimate of 0.991 cases per thousand people. The pathogenesis and cause of neuroleptic malignant syndrome remain unclear. Malignant hyperthermia (MH) is an acute life-threatening hypermetabolic syndrome that occurs in susceptible individuals during exposure to inhalational anesthetic gases or the depolarizing neuromuscular blocker succinylcholine. The signs of MH can be variable and include respiratory acidosis, metabolic acidosis, generalized rigidity, rhabdomyolysis, and hyperthermia. The incidence of MH reactions ranges from 1:10,000 to 1: 250,000 anesthetics. However, the prevalence of the genetic abnormalities may be as great as one in 400 individuals. In fact, it occurs predominantly among people who have inherited a mutation of the skeletal muscle ryanodine receptor. Serotonin syndrome (SS), also referred to as serotonin toxicity, is a potentially life-threatening drug-induced toxidrome associated with increased serotonergic activity in both the peripheral (PNS) and central nervous systems (CNS). It is precipitated by the use of serotonergic drugs and overactivation of both the peripheral and central postsynaptic 5HT-1A and, most notably, 5HT-2A receptors. It includes neuromuscular abnormalities, autonomic hyperactivity, and mental state changes. Severe SS is only usually precipitated by the simultaneous initiation of 2 or more serotonergic drugs, but the syndrome can also occur after the initiation of a single serotonergic drug in a susceptible individual, the addition of a second or third agent to long-standing doses of a maintenance serotonergic drug, or after an overdose.

This special issue aims to help physicians working at emergency medicine departments to early suspect, recognize, diagnose and treat these potentially lethal syndromes, considering that the diagnosis is predominantly clinical. It will be focused on diagnosis (after exclusion of similar disorders) and treatment at the department of emergency. Case reports, case series, guidelines proposal will be accepted.