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Neuroleptic malignant syndrome in patients with cancer: a systematic review

Izumi Sato1,2, Hideki Onishi3, Chiaki Kawanishi4

  • 1Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.

BMJ Supportive & Palliative Care
|May 17, 2020
PubMed
Abstract

Insights

Neuroleptic malignant syndrome (NMS) is a rare but serious antipsychotic side effect. In cancer patients, NMS is uncommon but treatable, with most survivors benefiting from early detection and prompt intervention.

Area of Science:

  • Oncology
  • Pharmacology
  • Neurology

Background:

  • Neuroleptic malignant syndrome (NMS) is a rare, high-mortality antipsychotic side effect.
  • Limited research exists on NMS in cancer patients.

Purpose of the Study:

  • To investigate the characteristics of antipsychotic-induced NMS in cancer patients.
  • To identify common causative agents and patient demographics.

Main Methods:

  • Systematic review of published case reports and articles on NMS in cancer patients.
  • Searched PubMed, Web of Science, and Cochrane Library up to December 2019.
  • Included human studies in English.

Main Results:

  • Eleven cancer patients with NMS were identified from ten case reports (1988-2013).
  • Mean age was 52.5 years; NMS often occurred postoperatively.
  • Haloperidol and D2 antagonists were common causes; ten patients survived with treatment.

Conclusions:

  • NMS has low incidence but high mortality; few cancer cases reported.
  • Early detection and treatment, including drug withdrawal and dantrolene, improved survival.
  • Clinicians must consider NMS in cancer patients on antipsychotics for timely management.

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