Recovery and rechallenge after the neuroleptic malignant synorome

The Neuroleptic Malignant Syndrome (NMS) can have a complicated recovery and rechallenging these patients is fraught with risks of recurrence. We examined our data from a sequential case series of NMS over a four-year period for details about treatment, complications and rechallenge. Duration of NMS when treated with one versus two dopamine agonists, and neuroleptic loading rates before NMS and on rechallenge were compared using the chi-square test with correction. Duration of NMS was found to be longer when treated with more than one agonist. The mean loading rate on rechallenge. attempted in six patients, was not found tc be statistically different from that resulting in NMS However, two patients (33%) re-challenged with high-potency neuroleptics at high loading rates experienced partial recurrence. Our findings show no advantage for treating NMS with multiple agents and emphasize the need for a cautious dosing strategy while re-challenging patients with typical neuroleptics.