[Protracted recurrent neuroleptic malignant syndrome]

Area of Science:

• Neuroscience
• Pharmacology
• Clinical Medicine

Background:

• Neuroleptic Malignant Syndrome (NMS) is a rare but serious adverse reaction to antipsychotic medications.
• The typical duration of untreated NMS is generally limited to three weeks.
• Pharmacological interventions like dantrolene and bromocriptine are known to shorten NMS duration.

Observation:

• This report describes an unusual case of NMS that persisted for three months.
• The NMS episode occurred following an injection of haloperidol decanoate, a long-acting antipsychotic formulation.
• The patient's NMS symptoms fluctuated over the extended period.

Findings:

• The prolonged NMS duration in this patient deviated significantly from the typical clinical course.
• Potential contributing factors identified include the concurrent administration of oral neuroleptics and potentially insufficient doses of dantrolene.
• This case highlights the complexity of managing NMS, especially with long-acting injectable antipsychotics.

Implications:

• This case suggests that continued exposure to oral neuroleptics may prolong NMS, even with long-acting injectable administration.
• The findings underscore the importance of optimizing dantrolene dosage and duration in managing prolonged NMS cases.
• Further research is warranted to understand the factors contributing to atypical NMS chronicity and to refine treatment guidelines.