Prognosis

Some cases of NMS are milder than those in published reports, which may reflect a greater awareness of the risk for this syndrome and more prompt intervention. However, it is possible that NMS manifests in a spectrum of clinical severity.

Mortality associated with NMS appears to vary.[3][5][6][14][19][20][21] Two large studies reported a rate between 8% and 9%.[16][22] A subsequent systematic review found that respiratory difficulties, hyperthermia severity, and older age were associated with increased mortality.[23]

Recurrence of NMS has been estimated to be as high as 30%, but there are no reliable data regarding recurrence.[3] It is usually recommended that rechallenge be postponed until at least 2 weeks after complete resolution of the syndrome.[52] Rechallenge should proceed slowly and under close monitoring, including appropriate laboratories.[1]

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