Electroconvulsive Therapy for Neuroleptic Malignant Syndrome: A Case Series

Area of Science:

• Neuroscience
• Psychiatry
• Pharmacology

Background:

• Neuroleptic malignant syndrome (NMS) is a rare but severe condition with high mortality.
• Limited data exist on effective treatment interventions for NMS.
• NMS often occurs in patients with neurocognitive or schizophrenia spectrum disorders.

Purpose of the Study:

• To describe cases of NMS requiring electroconvulsive therapy (ECT).
• To evaluate the efficacy and safety of ECT in NMS treatment.
• To determine the optimal use of ECT for refractory NMS.

Main Methods:

• Retrospective chart review of 15 patients diagnosed with NMS using International Consensus Diagnostic Criteria.
• Patients received bitemporal ECT after failure of pharmacotherapy.
• Data collected on clinical presentation, treatment course, and response to ECT.

Main Results:

• ECT was well-tolerated in all patients.
• A remission rate of 73.3% was observed.
• While initial response was rapid, an average of 17.7 treatments were needed to minimize catatonic sign recurrence.
• Two patients experienced mortality or required hospice care despite treatment.

Conclusions:

• Bitemporal ECT is a safe and effective treatment for NMS refractory to pharmacotherapy.
• ECT should be considered early for NMS cases unresponsive to medication.
• Consideration of ECT is particularly relevant when the patient's underlying psychiatric condition is also responsive to ECT.