Neuroleptic malignant syndrome associated with atypical antipsychotics in pediatric patients: a review of published cases.
OBJECTIVE
To retrospectively examine published cases of neuroleptic malignant syndrome (NMS) in patients aged 18 and below who had been treated with atypical antipsychotics (clozapine, risperidone, olanzapine, quetiapine, ziprasidone, and aripiprazole).


METHODS
Information was collected via MEDLINE searches in February 2006 and May 2007. The term neuroleptic malignant syndrome was used and cross-referenced with individual atypical antipsychotics. The authors also contacted (by telephone and in writing) pharmaceutical companies that produce and market atypical antipsychotics for any data on NMS.


METHODS
Twenty case reports (written in English only and published from 1991-2007) were identified and reviewed. These publications all described symptoms of NMS in patients aged 18 or younger who had been treated with atypical antipsychotics.


METHODS
Data were reviewed and compared with 3 diagnostic criteria (DSM-IV-TR, Levenson's, and Caroff and Mann's) for NMS. Interventions and outcomes were also reviewed.


RESULTS
Twenty case reports were identified and presented with a descriptive approach. Sixteen cases met criteria for NMS, with at least 1 of the diagnostic sets utilized. The majority of cases involved male subjects. All patients recovered.


CONCLUSIONS
Young patients can develop NMS during treatment with atypical antipsychotics. Symptoms of this disorder are consistent with those described in adults. Although NMS is rare in this population, clinicians should maintain a high index of suspicion. Appropriate caution in treating children and adolescents with any antipsychotic is warranted.
Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA. Paul.Croarkin@childrens.com
Paul E
PE
Croarkin
Graham J
GJ
Emslie
Taryn L
TL
Mayes
D000293:Adolescent; D014150:Antipsychotic Agents / Q000009:adverse effects*; D000068180:Aripiprazole; D001569:Benzodiazepines / Q000009:adverse effects; D001714:Bipolar Disorder / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D003024:Clozapine / Q000009:adverse effects; D003987:Dibenzothiazepines / Q000009:adverse effects; D006801:Humans; D009459:Neuroleptic Malignant Syndrome / Q000175:diagnosis / Q000209:etiology*; D000077152:Olanzapine; D010879:Piperazines / Q000009:adverse effects; D000069348:Quetiapine Fumarate; D015363:Quinolones / Q000009:adverse effects; D012189:Retrospective Studies; D018967:Risperidone / Q000009:adverse effects; D013844:Thiazoles / Q000009:adverse effects
D014150:Antipsychotic Agents; D003987:Dibenzothiazepines; D010879:Piperazines; D015363:Quinolones; D013844:Thiazoles; D001569:Benzodiazepines; D000069348:Quetiapine Fumarate; C092292:ziprasidone; D000068180:Aripiprazole; D003024:Clozapine; D018967:Risperidone; D000077152:Olanzapine