Case ReportsSuccessful Emergency Treatment of Refractory Neuroleptic Malignant Syndrome With Electroconvulsive Therapy and a Novel Use of Dexmedetomidine A Case Report From California in the Era of COVID-19Rajan, Rajani MA, MD∗; Sage, Mary MD†Author Information From the ∗Department of Psychiatry, Kaiser Permanente, Santa Clara †Department of Psychiatry, Kaiser Permanente, Walnut Creek, CA. Received for publication July 2, 2020; accepted August 17, 2020. Reprints: Rajani Rajan, MA, MD, Department of Psychiatry, Kaiser Permanente, 710 Lawrence Expressway, Santa Clara, CA 95051 (e-mail: [email protected]). The authors have no conflicts of interest or financial disclosures to report. The Journal of ECT: March 2021 - Volume 37 - Issue 1 - p 71-73 doi: 10.1097/YCT.0000000000000725 Buy Metrics Abstract We describe the case of a patient, hospitalized in a California community medical ICU for over a month, with severe neuroleptic malignant syndrome (NMS), unresponsive to medical management, but responsive to electroconvulsive therapy (ECT). We discuss the medical, logistical, and legal challenges in providing ECT in this setting. We also describe a previously unpublished use of dexmedetomidine, which aided in the safe and rapid reduction of benzodiazepines and permitted a successful ECT course. The rapid delivery and efficacy of ECT were essential because of the burgeoning coronavirus pandemic. The patient's treatment required exemplary efforts by providers across multiple disciplines, ongoing medicolegal consultation with the county mental health medical director, as well as consultation with expert members of the International Society for ECT and Neurostimulation. We conclude with a discussion of the unique challenges of providing emergency ECT to patients in California, including during a serious pandemic, when courts are closed. This case illustrates the importance of cultivating and maintaining high-quality ECT expertise in community hospitals and keeping ECT services available even during pandemics. Also, this case demonstrates that ECT is not “merely an elective procedure” but a vital, life-saving treatment, even during the era of COVID-19. To our knowledge, this is the first such published case of emergency ECT performed in California. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.