Neuroleptic malignant syndrome in children and adolescents on atypical antipsychotic medication: a review.
OBJECTIVE
Neuroleptic malignant syndrome (NMS) is a severe iatrogenic complication of treatment with antipsychotic medication. The purpose of this report is to examine the published cases of NMS in children and adolescents receiving atypical antipsychotic medication and review early warning symptoms, risk factors, and treatment in this population.


METHODS
An extensive review of the literature from 1990 to 2008 was conducted via computerized searches (PubMed and Ovid) to identify case reports. Descriptive statistics were employed to describe our findings.


RESULTS
There were 23 episodes in 20 subjects, with ages ranging from 11 to 18 years. Increased creatine phosphokinase (CPK) was the most common finding (100%), followed by fever (78%), tachycardia (74%), rigidity (70%), and altered mental status (61%). The number of NMS symptoms ranged from 1 to 11 (mean 4.7 +/- 2.4) and positive laboratory findings ranged from 1 to 4 (2.2 +/- 1). The duration of NMS (mean 6.1 +/- 6.4 days) was one third of the duration associated with typical antipsychotics. Patients treated with bromocriptine had a shorter duration of illness, whereas the same was not true for those receiving dantrolene. In all cases, the NMS symptoms eventually resolved and there were no reported deaths or permanent sequelae.


CONCLUSIONS
NMS is a serious condition. Symptom presentation related to atypical agents differs from that seen with older antipsychotic medications.
Neuhut
Rachel
R
Department of Psychiatry, New York University School of Medicine , New York, New York 10016, USA. neuhur01@med.nyu.edu
Lindenmayer
Jean-Pierre
JP
Silva
Raul
R
D000293:Adolescent; D000367:Age Factors; D014150:Antipsychotic Agents / Q000009:adverse effects*; D002648:Child; D006801:Humans; D009127:Muscle Rigidity / Q000139:chemically induced / Q000175:diagnosis; D009459:Neuroleptic Malignant Syndrome / Q000175:diagnosis* / Q000453:epidemiology*; D013610:Tachycardia / Q000139:chemically induced / Q000175:diagnosis
D014150:Antipsychotic Agents
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