On the early recognition of neuroleptic malignant syndrome

Neuroleptic Malignant Syndrome, a serious and sometimes fatal complication, has been reported to occur in some patients with the administration of neuroleptic medications. Clinically it is manifested by four groups of symptoms which include muscular hypertonicity, autonomic instability, altered consciousness, and hyperthermia. Laboratory findings such as elevated creatinine phosphokinase and leukocytosis are also seen. While it is true that the incidence of the full blown clinical picture of this syndrome is rare, the authors report that only muscular hypertonicity and autonomic instability have occurred frequently in their setting leading to discontinuation of neuroleptics. Such abortive cases may go undetected. If properly diagnosed, the occurrence of this syndrome is not as rare as the published reports indicate. Second, it is reported that rechallenge with neuroleptics may not induce Neuroleptic Malignant Syndrome again. The authors noted recurrence of fever after rechallenge with a different neuroleptic drug. This article describes the method of early recognition and prevention of morbidity as well as mortality.