Neuroleptic Malignant Syndrome in a Child Treated with an Atypical Antipsychotic

Abstract

Neuroleptic malignant syndrome (NMS) is an uncommon potentially fatal side effect of neuroleptic drugs, characterized by movement disorder, altered mental status and autonomic instability. A single dose of clotiapine was administered to an 11-year old male with acute psychosis. The previously healthy child had signs consistent with NMS including hyperthermia, hypertension, motor and mental changes. Repeat examination performed two weeks later, demonstrated that while his hyperthermia subsided, his mental status deteriorated. Olanzapine was administered, after which the child had hyperthermia, dystonia and more pronounced restlessness, once again consistent with NMS. He developed respiratory failure and was intubated and mechanically ventilated. Lorazepam, dantrolene and bromocriptine were administered as treatment of possible NMS. His mental condition, movement disorder and autonomic dysfunction improved significantly. Two weeks later, the patient was discharged in good general condition without the need for any ongoing medical treatment. There are only few case reports of NMS in children treated with olanzapine, an atypical antipsychotic. In children, caution must be exercised when prescribing antipsychotics, particularly atypical antipsychotics as these drugs may cause NMS. Because of the low incidence of NMS, a high index of suspicion is needed to identify cases so prompt treatment can be undertaken.

Adverse Events Associated with Sedatives, Analgesics, and Other Drugs That Provide Patient Comfort in the Intensive Care Unit

“…Neuroleptic malignant syndrome has been associated with olanzapine therapy in nonintensive care patients. [94][95][96] In some studies, pancreatitis was reported after months of outpatient therapy but developed in one patient after only 6 days. 97,98 A review of the FDA MedWatch system reported 188 cases of newonset diabetes mellitus within 6 months after the start of olanzapine therapy, including 80 with acidosis or ketosis and 15 deaths.…”

Neuroleptic Malignant Syndrome Due to Risperidone Overdose in a Child: A Case Report

“…The rare occurrence of NMS cases in childhood could be due to the less frequent neuroleptic drug use in this age group (12). However, case reports of NMS development in children and adolescents following the use of drugs such as olanzapine, quetiapine, ziprasidone, risperidone, and alimemazine have increased in recent years (4,(13)(14)(15)(16)(17). We present a 2.5-year-old case who developed NMS following a single dose of risperidone as it is the youngest reported case to the best of our knowledge.…”

Olanzapine approved for the acute treatment of schizophrenia or manic/mixed episodes associated with bipolar I disorder in adolescent patients

“…Cognitive symptoms including agitation and delirium may be more prominent. However, there have been two case reports of classic NMS occurring during olanzapine monotherapy,127,128 one with olanzapine overdose,129 and several in the context of polypharmacy with other psychotropics (as described in two recent reviews) 126,130…”