Neuroleptic malignant syndrome in children and adolescents

J Am Acad Child Adolesc Psychiatry. 1999 Feb;38(2):187-94. doi: 10.1097/00004583-199902000-00018.


Objective: Neuroleptic malignant syndrome (NMS) is a serious iatrogenic condition. This report reviews the world literature to characterize the syndrome and evaluate factors that promote early detection and effective intervention.

Method: The review identified 77 NMS cases (49 males, 27 females, 1 gender unknown); ages ranged from 0.9 to 18 years (mean 14.8 +/- 3.96). Univariate and multiple regression analyses were applied to 38 variables to identify early signs of the disorder, to identify correlates of outcome, and to evaluate treatments.

Results: The duration of NMS spanned from 1 to 119 days. Nine percent of patients died and 20% resolved with serious sequelae. Patients receiving low-potency neuroleptics had a poorer outcome (p = .01). Fever was related to longer duration of illness (p = .03). Anticholinergics and bromocriptine were effective and without fatalities, but dantrolene was not useful in this sample of children and adolescents.

Conclusions: Early detection and appropriate interventions appear important in moderating the course and outcome of NMS.

Publication types

  • Review

MeSH terms

  • Adolescent
  • Antipsychotic Agents / therapeutic use
  • Child
  • Child, Preschool
  • Cholinergic Antagonists / therapeutic use
  • Disease Progression
  • Dose-Response Relationship, Drug
  • Electroconvulsive Therapy
  • Electroencephalography
  • Female
  • Fever / etiology
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Muscle Rigidity / etiology
  • Neuroleptic Malignant Syndrome / complications
  • Neuroleptic Malignant Syndrome / diagnosis*
  • Neuroleptic Malignant Syndrome / therapy*
  • Regression Analysis
  • Severity of Illness Index
  • Tachycardia / etiology
  • Treatment Outcome


  • Antipsychotic Agents
  • Cholinergic Antagonists