Neuroleptic malignant syndrome and methylphenidate.
A 1-year-old female presented with neuroleptic malignant syndrome probably caused by methylphenidate. She had defects in the supratentorial brain including the basal ganglia and the striatum (multicystic encephalomalacia) due to severe perinatal hypoxic-ischemic encephalopathy, which was considered to be a possible predisposing factor causing neuroleptic malignant syndrome. A dopaminergic blockade mechanism generally is accepted as the pathogenesis of this syndrome. However, methylphenidate is a dopamine agonist via the inhibition of uptake of dopamine, and therefore dopaminergic systems in the brainstem (mainly the midbrain) and the spinal cord were unlikely to participate in the onset of this syndrome. A relative gamma-aminobutyric acid-ergic deficiency might occur because diazepam, a gamma-aminobutyric acid-mimetic agent, was strikingly effective. This is the first reported patient with neuroleptic malignant syndrome probably caused by methylphenidate.
Ehara
H
H
Division of Child Neurology, Institute of Neurological Sciences, Tottori University Faculty of Medicine, Yonago, Japan.
Maegaki
Y
Y
Takeshita
K
K
D001921:Brain / Q000000981:diagnostic imaging; D003975:Diazepam / Q000627:therapeutic use; D005260:Female; D018757:GABA Modulators / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008774:Methylphenidate / Q000009:adverse effects*; D009459:Neuroleptic Malignant Syndrome / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology*; D014057:Tomography, X-Ray Computed
D018757:GABA Modulators; D008774:Methylphenidate; D003975:Diazepam