Electroconvulsive Therapy for Neuroleptic Malignant Syndrome

Introduction to Neuroleptic Malignant Syndrome

Neuroleptic malignant syndrome is a potentially lethal condition characterized by a tetrad of symptoms including mental status changes, fever, muscle rigidity/hypertonicity, and autonomic dysfunction 1
The pathophysiology of neuroleptic malignant syndrome involves deficiency of central dopaminergic activity, primarily affecting D2 receptors 1
Neuroleptic malignant syndrome occurs due to dopamine antagonists, dopamine receptor blockade, dysfunction of dopamine receptors, or withdrawal of dopamine agonists 1

The American Academy of Child and Adolescent Psychiatry indicates ECT for NMS when the condition is severe and persistent 3, 4
ECT is considered for patients with neuroleptic malignant syndrome who have concurrent psychiatric conditions that would also benefit from ECT 5
In life-threatening situations, earlier initiation of ECT may be considered, as recommended by the American Academy of Child and Adolescent Psychiatry 4

Close monitoring during and after ECT treatment is essential until the patient is fully recovered, including observation of seizure duration, airway patency, vital signs, and adverse effects 6
Patients should be monitored for at least 24 hours for potential tardive seizures, and a neurology consultation should be obtained if recurrent prolonged seizures or tardive seizures occur 6