NEUROLEPTIC MALIGNANT SYNDROME IN CHILDREN

Objectives: Neuroleptic Malignant Syndrome (NMS) is a potentially life threatening condition, uncommon in children, characterized by hyperthermia, muscle rigidity, elevated creatine kinase (CK) levels, and autonomic instability. It is often precipitated by use of high dose neuroleptics. The purpose of this study is to raise awareness of the course and prognosis of NMS in a pediatric population to optimize strategies for early diagnosis and effective interventions.

Methods: A retrospective chart review to identify children diagnosed with NMS over a two-year period was performed.

Results: We present six children (three girls, three boys) with varying admitting neurological diagnoses, exhibiting changes in mental status, agitation, and seizures, with elevated CK levels and defining symptoms of NMS. Four of the children had treatment with neuroleptics (haloperidol, molindone, methotrimeprazine), while two were given metoclopramide. All six had muscle rigidity and autonomic instability while three also had hyperthermia. Five were treated with bromocriptine and two of the five required further management with dantrolene. The remaining child was treated with dantrolene, steroids, and IVIG. There was full recovery in all children but one, who died from multiple medical complications.

Conclusion: We wish to alert pediatric neurologists, emergency room physicians, and intensivists of the signs and symptoms of NMS when administering not only neuroleptics, but metoclopramide and other medications. Early recognition, supportive care, discontinuing the inciting agent, and NMS specific treatment can help reduce morbidity and mortality of this severe neurological condition.