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Electroconvulsive Therapy for Neuroleptic Malignant Syndrome

A Case Series

Morcos, Nicholas MD; Rosinski, Amy MD; Maixner, Daniel F. MD

doi: 10.1097/YCT.0000000000000600
Original Studies

Objectives Neuroleptic malignant syndrome (NMS) is an uncommon condition associated with significant morbidity and mortality. Data on treatment interventions are limited. In this case series, we sought to describe all NMS cases requiring ECT from a large academic institution over a nearly 2-decade period.

Methods We retrospectively identified all patients with NMS who were treated with ECT over a 17-year period. Patients were included in the study based on chart review using the International Consensus Diagnostic Criteria for NMS. Data were collected related to clinical findings, treatment course, and response to ECT.

Results We identified 15 patients meeting the inclusion criteria. Most patients had neurocognitive or schizophrenia spectrum disorders and developed NMS after exposure to multiple antipsychotic drugs. All patients received bitemporal ECT after failed pharmacotherapy for NMS. Electroconvulsive therapy was well tolerated and resulted in a remission rate of 73.3% (n = 11). Patients showed early initial response to ECT (mean of 4.2 treatments), but an average of 17.7 treatments was necessary to minimize recurrence of catatonic signs. One patient died after interruption of the index course of ECT because of severe infection, and another was discharged to hospice care after limited response. These cases highlight the lethality of NMS and its complications despite aggressive treatment measures.

Conclusions Bitemporal ECT was well tolerated and effective in treating NMS refractory to pharmacotherapy. We suggest that ECT be considered early in cases of NMS that are refractory to pharmacological interventions, especially if the underlying condition is also responsive to ECT.

From the Michigan Medicine Department of Psychiatry, The University of Michigan, Ann Arbor, MI.

Received for publication December 19, 2018; accepted March 15, 2019.

Reprints: Nicholas Morcos, MD, 4250 Plymouth Rd, Ann Arbor, MI 48109 (e-mail:

The authors have no conflicts of interest or financial disclosures to report. The authors note that use of electroconvulsive therapy (ECT) for treatment of neuroleptic malignant syndrome is not Food and Drug Administration approved and is an off-label/investigational treatment.

Online date: April 23, 2019

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