Objective: Neuroleptic malignant syndrome (NMS) is a neurological emergency that is often induced by antipsychotic drugs. NMS may be mortal if left untreated.

Background: In this paper, two-month treatment course of a patient diagnosed with paliperidone induced NMS is presented.

Method: A 34-years-old female patient, who was followed up with the diagnosis of bipolar affective disorder, applied to the emergency service. In the patient’s history, it was learned that he had been treated with 100 mg/month paliperidone and 3 mg/day biperiden for 2 years. Paliperidone injection was given to the patient 12 days after the last injection due to the increase in his psychiatric complaints. Three days later, the patient applied to the emergency department with fever, sweating, stifness and changes in consciousness. The patient’s fewer was 38.1 degress and his consciousness was lethargic. Examination revealed diffuse parkinsonism findings. Laboratory findings revealed creatine kinase: 1098 u/L and wbc: 12.000.

Results: The patient was admitted to the intensive care unit with the diagnosis of NMS. The patient’s management was given lorazepam, bromocriptine and amantadine treatment together with general supportive treatment. The patient, whose general condition improved and was admitted to the ward, was given continuous apomorphine treatment. In addition, three sessions of electroconvulsive therapy were applied to the patient whose parkinsonism findings partially improved. At the end of the second month, the patient’s symptoms improved completely, and apomorphine treatment was terminated.

Conclusion: ECT is a good treatment option in cases of NMS accompanied by psychiatric symptoms. Morbidity and mortality can be prevented by early diagnosis and treatment of patients with NMS.

References: 1- Kane JM, Correll CU, Delva N et al. Low Incidence of Neuroleptic Malignant Syndrome Associated With Paliperidone Palmitate Long-Acting Injectable: A Database Report and Case Study. J Clin Psychopharmacol. 2019 Mar/Apr;39(2):180-182.
2- Kuhlwilm L, Schönfeldt-Lecuona C, Gahr M et al. The neuroleptic malignant syndrome-a systematic case series analysis focusing on therapy regimes and outcome. Acta Psychiatr Scand. 2020 Sep;142(3):233-241.
3- Ware MR, Feller DB, Hall KL. Neuroleptic Malignant Syndrome: Diagnosis and Management. Prim Care Companion CNS Disord. 2018 Jan 4;20(1):17r02185.

« Back to 2022 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/paliperidone-induced-neuroleptic-malignant-syndrome-treated-with-electroconvulsive-therapy-and-continuous-apomorphine-a-case-report/