Table 2.
Previously published case reports detailing subject’s age and gender, offending agent, neuroleptic malignant syndrome presentation and treatment, and patient outcome.
| Source | Subject | Offending agent | Presentation | Treatment | Outcome |
|---|---|---|---|---|---|
| Al Danaf et al. 20151 | 60M | Risperidone | Shortness of breath, confusion, symmetrical rigidity in extremities, 37.1°C, BP 83/60 mmHg, HR 106 bpm, CPK 8450–12000 | Dantrolene (initial dose 120 mg IV, 100 mg per NG tube every eight hours), Bromocriptine (5 mg per NG tube every eight hours, 10 mg per NG tube every eight hours). For fever reduction, cooling methods and low-dose lorazepam as needed. | Discharged day 17 |
| Drews et al. 201711 | 54M | Quetiapine and haloperidol | GCS 13 declining, diffuse lead-pipe rigidity, 102.2°F–104.7°F, CK 247 IU/L | Cooling measures, offending agents were discontinued, IV dantrolene 2.5 mg/kg tapering dose, bromocriptine 2.5 to 5 mg every eight hours. | Discharged day 29. |
| Saha et al. 201712 | 19M | Olanzapine | Mutism, rigidity in extremities, high-grade fever, CPK 2467 IU/L | Fluids, offending agent was stopped, bromocriptine 5 mg/day to 15 mg/day, lorazepram 4 mg/day. | Discharged day 23 with quetiapine at low dose and gradually increased to 200 mg/day. |
| Ahmad et al. 201313 | 22M | Flupentixol decanoate and Clozapine | GCS 6, increased muscular tone and joint rigidity, fever, BP 70/40, HR 168 bpm, CK 31010 units | Supportive therapy including ventilation, paralysis, intravenous fluids, antipyretics, passive cooling and sedation. | Patient developed compartment syndrome of the right forearm. Fasciotomy with debridement along with a skin harvest and was finally discharged to the psychiatric unit. Brachial plexus injury was also identified and gradually resolved in six months. |
| Leenhardt et al. 20177 | 49M | Clozapine and loxapine | Confusion, muscle rigidity, 39.5–40.8°C, BP 163/90 mmHg, HR 139 bpm | Withdrawal of offending agent. | Discharged day 11. |
| Leenhardt et al. 20177 | 71M | Loxapine | Recent muscle rigidity, 41.2°C/ 106.2°F, CK 562–6760 UI/L | Transferred to the intensive care unit, no NMS treatment started. | Developed multiple organ failure with secondary acute renal insufficiency requiring dialysis, metabolic acidosis, rhabdomyolysis, nosocomial pneumonia, and cardiopulmonary arrest with severe hypoxia. Died 22 days after onset. |
| Kuchibatla et al. 200914 | 32M | Haloperidol depot and zuclopenthixol decanoate depot, and clozapine | Dizziness upon standing, 37.9°C to 38.5°C, BP 69/59 mmHg and 144/93 mmHg, HR 120 bpm, CK 216–521 IU/L | Offending agent stopped, vital signs normalized over four days, CK down to 152 IU/L by day 10. | Restarted on zuclopenthixol depot after an initial test dose of 100 mg intramuscularly, discharged to day hospital for monitoring, reviewed in outpatient clinic with zuclopenthixol decanoate depot, 200 mg intramuscularly weekly. |
| Rajamani et al. 201615 | 43M | Risperidone | Altered sensorium, muscle rigidity, high-grade fever, CPK 1543 IU/L | Offending agent was stopped immediately, and he was treated with lorazepam, trihexyphenidyl, paracetamol, and intravenous fluids. | Discharged day 3 with monitoring of glycemic control and no antipsychotics. |
| Chandran et al. 200316 | 81M | Loxapine and methotrimeprazine | Some cognitive impairment, tremor, rigidity and unsteady gait, 38.3–39.3°C, BP 124/84 mmHg, HR 128 bpm, CK 1145–2574 U/L | Offending agent was stopped, dantrolene (70 mg intravenously), after 24 hours changed to bromocriptine (2.5 mg three times daily). | Discharged five weeks, on olanzapine (2.5 mg once daily) and sertraline (25 mg once daily). |
| Sagud et al. 201617 | 30F | Risperidone and haloperidol | Altered consciousness, muscular rigidity and tremor, 38.6°C, HR 123 bpm, CK 3486 U/L | Offending agents were discontinued, and she was transferred to the ICU, where she stayed for two weeks. Despite normal temp and CK, patient developed catatonia, presenting with negativism, mutism, and occasional episodes of uncontrolled motor restlessness. Electroconvulsive therapy, where she received 12 applications and her condition improved. | The patient was discharged and restarted on clozapine. |
M, male; BP, blood pressure; mmHg, millimeters of mercury; HR, heart rate; bpm, beats per minute; CPK, creatine phosphokinase; IV, intravenous; NG, nasogastric; GCS, Glasgow Coma Scale; IU, international units; L, liter; hrs, hours; U/ L, units per liter; CK, creatine kinase; NMS, neuroleptic malignant syndrome; ICU, intensive care unit.
M, male; F, female; CPK, creatine phosphokinase; CK, creatine kinase; HR, heart rate; BP, blood pressure; IU/L, international units/liter; U/L, units per liter; bpm, beats per minute; ICU, intensive care unit.