Neuroleptic malignant syndrome: review of experience with children and adolescents

Area of Science:

• Child and Adolescent Psychiatry
• Neuropharmacology
• Pediatric Neurology

Background:

• Neuroleptic Malignant Syndrome (NMS) is a rare but serious adverse reaction to neuroleptic medications.
• While well-documented in adults, NMS in pediatric populations requires specific consideration due to developmental differences.

Purpose of the Study:

• To report a case of NMS in an adolescent with bipolar disorder.
• To review and compare pediatric NMS cases with adult data.
• To identify key clinical features, diagnoses, and treatment outcomes in children and adolescents.

Main Methods:

• Case report of an adolescent patient diagnosed with NMS.
• Literature review of 35 pediatric cases of NMS (onset before age 19).
• Comparison of pediatric NMS characteristics with existing adult literature.

Main Results:

• Fever, rigidity, altered mental status, and tachycardia were present in over 70% of pediatric cases.
• Symptoms typically emerged shortly after exposure to neuroleptic medications, often high-potency agents or polypharmacy.
• Schizophrenia and bipolar disorder were the most frequent underlying diagnoses.
• Eighty-one percent of pediatric patients recovered with supportive care, medication discontinuation, and adjunctive therapies; electroconvulsive treatment (ECT) was successful in 3 cases.

Conclusions:

• NMS should be suspected in pediatric patients presenting with unexplained fever, rigidity, autonomic dysfunction, and altered mental status following neuroleptic exposure.
• Early recognition and intervention are crucial for favorable outcomes.
• Discontinuation of offending neuroleptics and supportive care are primary treatment modalities.