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Journal of Pediatric Neurology 2021; 19(06): 425-427
DOI: 10.1055/s-0040-1721380
Case Report

Dexmedetomidine Infusion as a Novel Supportive Therapy for Fluphenazine-Induced Neuroleptic Malignant Syndrome in a 10-Year-Old Boy: A Case Report and Review of Literature

Caroline Yu
1   Department of Pediatrics, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, United States
,
Rajat Kaul
2   Department of Pediatrics, Division of Pediatric Hospitalist Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, United States
,
Waseem Ostwani
3   Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, United States
› Author Affiliations Funding None.
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Abstract

A 10-year-old male child patient developed symptoms of neuroleptic malignant syndrome (NMS) 1 month following initiation of fluphenazine for behavioral therapeutic management. Dexmedetomidine infusion was able to adequately control the symptoms of NMS with resolution of encephalopathy. This was the first report of novel dexmedetomidine utilization for the treatment of NMS. We suggest using dexmedetomidine as an adjunctive agent to control NMS symptomatology without attendant risk of respiratory depression.

Keywords

neuroleptic malignant syndrome - fluphenazine - dexmedetomidine


Publication History

Received: 03 October 2020

Accepted: 21 October 2020

Article published online:
18 December 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
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  • References

  • 1 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Washington, DC: American Psychiatric Association; 2013
    CrossrefGoogle Scholar
  • 2 Numa A. Neuroleptic malignant syndrome in children. Med J Aust 1991; 155 (06) 417-419
    CrossrefPubMedGoogle Scholar
  • 3 Stimmel GL, Gutierrez MA, Lee V. Ziprasidone: an atypical antipsychotic drug for the treatment of schizophrenia. Clin Ther 2002; 24 (01) 21-37
    CrossrefPubMedGoogle Scholar
  • 4 Belvederi Murri M, Guaglianone A, Bugliani M. et al. Second-generation antipsychotics and neuroleptic malignant syndrome: systematic review and case report analysis. Drugs R D 2015; 15 (01) 45-62
    CrossrefPubMedGoogle Scholar
  • 5 Sharma R, Trappler B, Ng YK, Leeman CP. Risperidone-induced neuroleptic malignant syndrome. Ann Pharmacother 1996; 30 (7-8): 775-778
    CrossrefPubMedGoogle Scholar
  • 6 Zalsman G, Lewis R, Konas S. et al. Atypical neuroleptic malignant syndrome associated with risperidone treatment in two adolescents. Int J Adolesc Med Health 2004; 16 (02) 179-182
    CrossrefPubMedGoogle Scholar
  • 7 Mané A, Baeza I, Morer A, Lázaro ML, Bernardo M. Neuroleptic malignant syndrome associated with risperidone in a male with early-onset schizophrenia. J Child Adolesc Psychopharmacol 2005; 15 (06) 844-845
    CrossrefPubMedGoogle Scholar
  • 8 Aruna AS, Murungi JH. Fluphenazine-induced neuroleptic malignant syndrome in a schizophrenic patient. Ann Pharmacother 2005; 39 (06) 1131-1135
    CrossrefPubMedGoogle Scholar
  • 9 Aboraya A, Schumacher J, Abdalla E. et al. Neuroleptic malignant syndrome associated with risperidone and olanzapine in first-episode schizophrenia. W V Med J 2002; 98 (02) 63-65
    PubMedGoogle Scholar
  • 10 Chungh DS, Kim BN, Cho SC. Neuroleptic malignant syndrome due to three atypical antipsychotics in a child. J Psychopharmacol 2005; 19 (04) 422-425
    CrossrefPubMedGoogle Scholar
  • 11 Levenson JL. Neuroleptic malignant syndrome. Am J Psychiatry 1985; 142 (10) 1137-1145
    CrossrefPubMedGoogle Scholar
  • 12 Leibold J, Patel V, Hasan RA. Neuroleptic malignant syndrome associated with ziprasidone in an adolescent. Clin Ther 2004; 26 (07) 1105-1108
    CrossrefPubMedGoogle Scholar
  • 13 Bhanushali MJ, Tuite PJ. The evaluation and management of patients with neuroleptic malignant syndrome. Neurol Clin 2004; 22 (02) 389-411
    CrossrefPubMedGoogle Scholar
  • 14 Strawn JR, Keck Jr PE, Caroff SN. Neuroleptic malignant syndrome. Am J Psychiatry 2007; 164 (06) 870-876
    CrossrefPubMedGoogle Scholar
  • 15 Gratz SS, Levinson DF, Simpson GM. The treatment and management of neuroleptic malignant syndrome. Prog Neuropsychopharmacol Biol Psychiatry 1992; 16 (04) 425-443
    CrossrefPubMedGoogle Scholar
  • 16 Balzan MV. The neuroleptic malignant syndrome: a logical approach to the patient with temperature and rigidity. Postgrad Med J 1998; 74 (868) 72-76
    CrossrefPubMedGoogle Scholar
  • 17 Ty EB, Rothner AD. Neuroleptic malignant syndrome in children and adolescents. J Child Neurol 2001; 16 (03) 157-163
    PubMedGoogle Scholar
  • 18 Croarkin PE, Emslie GJ, Mayes TL. Neuroleptic malignant syndrome associated with atypical antipsychotics in pediatric patients: a review of published cases. J Clin Psychiatr 2008; 69 (07) 1157-1165
    CrossrefPubMedGoogle Scholar
  • 19 Rosebush P, Stewart T. A prospective analysis of 24 episodes of neuroleptic malignant syndrome. Am J Psychiatr 1989; 146 (06) 717-725
    CrossrefPubMedGoogle Scholar
  • 20 Rosebush PI, Stewart T, Mazurek MF. The treatment of neuroleptic malignant syndrome. Are dantrolene and bromocriptine useful adjuncts to supportive care?. Br J Psychiatr 1991; 159: 709-712
    CrossrefPubMedGoogle Scholar
  • 21 Hammerman S, Lam C, Caroff SN. Neuroleptic malignant syndrome and aripiprazole. J Am Acad Child Adolesc Psychiatry 2006; 45 (06) 639-641
    CrossrefPubMedGoogle Scholar
  • 22 Walker A, Delle Donne A, Douglas E, Spicer K, Pluim T. Novel use of dexmedetomidine for the treatment of anticholinergic toxidrome. J Med Toxicol 2014; 10 (04) 406-410
    CrossrefPubMedGoogle Scholar
  • 23 Keating GM. Dexmedetomidine: a review of its use for sedation in the intensive care setting. Drugs 2015; 75 (10) 1119-1130
    CrossrefPubMedGoogle Scholar
  • 24 Okabe T, Takeda S, Akada S, Hongo T, Sakamoto A. Postoperative intensive care unit drug fever caused by dexmedetomidine. Anesth Analg 2009; 108 (05) 1589-1591
    CrossrefPubMedGoogle Scholar