Management of neuroleptic malignant syndrome with anticholinergic medication

Neuroleptic Maglignant Syndrome (NMS) is a life-threatening adverse reactio n arising from the use of neuroleptic medications. While dopaminergic agoni sts, dantrolrene and supportive care are traditionally utilized in the stab ilization and management of NMS, anticholinergic medication may also prove effective therapy. Treatment with anticholinergic medication has been sugge sted in cases of NMS associated with mild hyperthermia. We describe a case of a 17-y-old female, who was brought to the emergency department for a pos sible "acute dystonic reaction". The patient received 50 mg diphenhydramine iv, which resulted in improvement in mental status. The patient was readmi tted to the emergency department 1 d following discharge with symptoms simi lar, but now considering the diagnosis of NMS. Diphenhydramine 50 mg iv was again administered and resulted in significant improvement.