Neuroleptic malignant syndrome: review of experience with children and adolescents.

ABSTRACT A report of neuroleptic malignant syndrome (NMS) in an adolescent patient with bipolar disorder is presented, and findings from a literature review of 35 child and adolescent cases (presenting before age 19) are compared with the reported experience in adults. Fever, rigidity, altered mental status, and tachycardia were observed in more than 70% of cases, and symptoms closely follow the patient's exposure to neuroleptic medications. A majority of the patients were being treated with a high-potency neuroleptic agent and often with more than a single drug. Schizophrenia and bipolar disorder were the most common diagnoses. Neither gender predominates the sample, and adjunctive lithium therapy does not appear to be a significant factor in the genesis of this syndrome in children. Eighty-one percent of the patients recovered, with the majority of patients treated with supportive measures, discontinuation of medications, and adjunctive pharmacotherapy. Only 9 patients were treated with supportive measures alone, and electroconvulsive treatment (ECT) was successfully used in 3 patients. Six patients were reported to have been successfully rechallenged with neuroleptic medications. NMS should be considered in any child with a combination of unexplained fever, rigidity, signs of autonomic dysfunction, changes in mental status, and a history of neuroleptic exposure.