Residual catatonic state following neuroleptic malignant syndrome

Neuroleptic malignant syndrome (NMS) is usually a self-limited disorder, wi th most cases resolving within 2 weeks after antipsychotic drug discontinua tion. However, the course of NMS may not always be short-lived. In this rep ort, the authors describe five patients who developed a residual catatonic state that persisted after acute hyperthermic symptoms of NMS had subsided and compare them with 27 similar cases in the literature. Two of our patien ts recovered gradually with supportive treatment. Three patients were treat ed with electroconvulsive therapy (ECT). Of these, two showed a positive re sponse, although one died later of intercurrent pneumonia. A third patient did not respond to ECT, but recovered gradually thereafter. Although dopami ne agonists or benzodiazepines have been advocated for the treatment of res idual symptoms in previous case reports, ECT was the treatment most often a ssociated with a. rapid response and no mortality, even in patients refract ory to pharmacotherapy. In conclusion, catatonic and parkinsonian symptoms of NMS may persist as a residual state lasting for weeks to months after mo re fulminant acute symptoms abate. These residual symptoms may be more Like ly to develop in patients with preexisting structural brain disorders. Alth ough patients may improve gradually with supportive care or pharmacotherapy , ECT can often be highly effective in treating the residual catatonic stat e that follows NMS.