Neuroleptic malignant syndrome is a rare but potentially fatal complication of treatment with antipsychotic medications. Prior to 1994, there was no accepted set of diagnostic criteria. This article presents four adolescents admitted at Cleveland Clinic Foundation from 1985 to 1998, illustrating the broad spectrum of neuroleptic malignant syndrome. A review of the pediatric literature is discussed as to the current risk factors, pathogenesis, management, and outcome. Early recognition and supportive and specific treatment of neuroleptic malignant syndrome reduced the morbidity and mortality. (J Child Neurol 2001;16:157-163).
Pope HG, Keck PE, McElroy SL: Frequency and presentation of neuroleptic malignant syndrome in a large psychiatric hospital. Am J Psychiatry1986;143:1227-1233.
3.
American Psychiatric Association: Diagnostic and Statistical Manual for Mental Disorders, 4th ed. Washington, DC, APA, 1994.
4.
Hunter R.: Dangerous drugs. Nurs Times1989;85:42-44.
5.
Susman V., Addonizio G.: Recurrence of neuroleptic malignant syndrome. J Nerv Ment Dis1988;176:234-241.
6.
Bristow MF, Kohen D.: How "malignant" is the neuroleptic malignant syndrome?BMJ1993;307:1223-1224.
7.
Bertorini T. : Myoglobinuria, malignant hyperthermia, neuroleptic malignant syndrome and serotonin syndrome. Neurol Clin1997;15:649-971.
8.
Addonizio G. , Susman V., Roth S.: Neuroleptic malignant syndrome: Review and analysis of 115 cases. Biol Psychiatry1987 ;22:1004-1020.
9.
Moyes DJ: Malignant hyperpyrexia caused by trimeprazine. Br J Anaesth1973;45:1163-1164.
10.
Itoh H., Ohtsuka N., Ogita K.: Neuroleptic malignant syndrome: Its present status in Japan and clinical problems . Folia Psych Neurol (Japonica) 1977 ;31:567-576.
11.
Geller B., Greydanus D.: Haloperidol-induced comatose state with hyperthermia and rigidity in adolescence: 2 case reports with a literature review. J Clin Psychiatry1979;40:102-103.
12.
Grunhaus L. , Sancovici S., Rimon R.: Neuroleptic malignant syndrome due to depot fluphenazine. Clin Psychiatry1979;40:99-100.
13.
Ries RK, Schuckit MA: Catatonia and autonomic hyperactivity. Psychosomatics1980;21:349-350.
14.
Goulan M., de Rohan-Chabot PD, Elkharrat D.: Beneficial effects of dantrolene in the treatment of neuroleptic malignant syndrome: A report of two cases. Neurology1983;33:516-518.
15.
Klein SK, Levinsohn MW, Blumer JL: Accidental chlorpromazine ingestion as a cause of neuroleptic malignant syndrome in children. J Pediatr1985;107:970-973.
16.
Verhoeven WM , Elderson A., Westenberg HG: Neuroleptic malignant syndrome: Successful treatment with bromocriptine. Biol Psychiatry1985;20:680-684.
17.
Tenenbien M. : Neuroleptic malignant syndrome: Occurrence in a 15 year old boy and recovery with bromocriptine therapy. Pediatr Neurosci1985-1986;12:161-164.
18.
Merry SN, Werry JS, Merry AF, Birchall N.: The neuroleptic malignant syndrome in an adolescent. J Am Acad Child Psychiatry1986;25:284-286.
Akari M., Tkagi A., Higuchi I., Sugita H.: Neuroleptic malignant syndrome: Caffeine contracture of single muscle fibers and muscle pathology. Neurology1988 ;38:297-301.
Carden PA, Mitchell SL: Acute psychosis plus neuroleptic malignant syndrome as complications of therapy in an adolescent with acute lymphoblastic leukemia. Aust J Hosp Pharmacol1988;18:205-207.
28.
Guerrero RM , Shifrar KA: Diagnosis and treatment of neuroleptic malignant syndrome. Clin Pharmacol1988;7:697-701.
Kontaxakis V. , Stefanis C., Markidis M., Tserpe V.: Neuroleptic malignant syndrome in a patient with Wilson's disease. J Neurol Neurosurg Psychiatry1988;51:1001-1002.
31.
Padgett R., Lipman E.: Use of neuroleptics after an episode of neuroleptic malignant syndrome . Can JPsychiatry1989;34:323-325.
32.
Rosebush P., Stewart T.: A prospective analysis of 24 episodes of neuroleptic malignant syndrome . Am J Psychiatry1989; 146:717-725.
33.
Brown FE, Nierenberg DW, Nordgren RE: Neuroleptic malignant syndrome: Occurrence in a child after reconstructive surgery. Plast Reconstr Surg1991;87:961-964.
34.
Joshi PT, Capozzoli JA, Coyle JT: Neuroleptic malignant syndrome: Life-threatening complication of neuroleptic treatment in an adolescents with affective disorder. Pediatrics1991;87:235-239.
35.
Numa A.Neuroleptic malignant syndrome in children. Med J Aust1991;155:417-419.
36.
Steingard R. , Khan A., Gonzalez A., Herzog DB: Neuroleptic malignant syndrome: Review of experience with children and adolescents. J Child Adolesc Psychopharmacol1992;2:183-198.
37.
Latz S., McCracken J.: Neuroleptic malignant syndrome in children and adolescents: 2 case reports and a warning. J Child Adolesc Psychopharmacol1992;2:123-129.
38.
Shaw A., Matthews E.: Post-operative neuroleptic malignant syndrome. Anaesthesia1995;50:246-247.
39.
Peterson S. , Myers KM, McClellan J., Crow S.: Neuroleptic malignant syndrome: 3 adolescents with complicated courses. J Child Adolesc Psychopharmacol1995;5:139-149.
40.
Unal F., Hizli S., Ozyurek H.: Fever and altered consciousness are not always equal to central nervous system infection: Neuroleptic malignant syndrome in a 15 year old girl. Turk J Pediatr1996;38:505-510.
41.
Addonizio G. , Susman V., Roth S.: Symptoms of neuroleptic malignant syndrome in consecutive in-patients. Am J Psychiatry1986;143:1587-1590.
42.
Ebadi M., Srinivasan SK: Pathogenesis, prevention and treatment of neuroleptic induced movement disorder . Pharmacol Rev1995;47:575-604.
43.
Fink M.: Toxic serotonin syndrome or neuroleptic malignant syndrome ?Pharmacopsychiatry1996;29:159-161.
44.
Sachdev P., Mason C., Hadzi-Pavlovic D.: Case-control study of neuroleptic malignant syndrome. Am J Psychiatry1997;154:1156-1158.
Ram A., Cao Q., Keck PE Jr, et al: Structural change in dopamine D2 receptor gene in a patient with neuroleptic malignant syndrome. Am J Med Genet1995;60:228-230.
