Neuroleptic malignant syndrome in children and adolescents: two case reports and a warning

Area of Science:

• Pediatric Neurology
• Psychopharmacology
• Neuroscience

Background:

• Neuroleptic malignant syndrome (NMS) is a rare but life-threatening condition linked to antipsychotic medication use.
• Previous research on NMS has primarily focused on adult populations, with limited data on pediatric cases.

Purpose of the Study:

• To investigate the characteristics, risk factors, and outcomes of NMS in children and adolescents.
• To highlight early warning signs and effective treatment strategies for juvenile NMS.
• To compare mortality rates between pediatric and adult NMS cases.

Main Methods:

• Review of two personally treated cases of juvenile NMS to identify early indicators and management approaches.
• Systematic review of 49 previously reported cases of NMS in pediatric patients (children and adolescents).
• Analysis of diagnostic data, neuroleptic potency, and patient demographics to assess risk factors and outcomes.

Main Results:

• Schizophrenia was the most common preceding diagnosis (35%), followed by bipolar disorder (12%).
• High-potency neuroleptics were associated with over half of the reported juvenile NMS cases (57%).
• The mortality rate for NMS in patients 18 years or younger was 16%, significantly higher than the estimated 4% in adults. Mortality was higher in younger children (27% in those ≤12 years) compared to adolescents (13%).

Conclusions:

• Juvenile NMS may be underdiagnosed, contributing to its elevated mortality rate in pediatric populations.
• Prompt recognition of early warning signs and appropriate management are critical for improving outcomes in children and adolescents with NMS.
• Further research is needed to understand and mitigate the risks of NMS in pediatric patients treated with neuroleptics.