The true incidence of NMS is not known because the available evidence is inconclusive.[14] Estimates range from 0.02% to 3%.[15] An important limitation when considering published estimates is that they are almost exclusively incidence proportions (number of new cases over a period of time divided by number of persons at risk at the beginning of the time period) rather than true incidence rates (number of new cases over a period of time divided by the person-time at risk).[14] Reported incidence has declined over the last 20 years, which may reflect greater awareness with heightened vigilance and more prompt clinical intervention. Other possible factors may include systematic reporting bias,[14] an evolving practice trend toward the use of second-generation antipsychotic medications (SGAs), and caution in using high initial doses of antipsychotics.

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