A Severe Neuroleptic Malignant Syndrome Treated with Daily Electroconvulsive Therapy: A Case Report

Neuroleptic malignant syndrome (NMS) is a rare but life-threatening condition caused by dopamine modulating medications, particularly antipsychotics. First-line treatments of neuroleptic malignant syndrome are supportive care, discontinuation of the offending agent and pharmacotherapy. In drug-resistant and severe situations, electroconvulsive therapy (ECT) is recommended as well. In this paper we present a 23-year old male with bipolar disorder who was treated with multiple injections of zuclopenthixol long acting and depot forms for a recent manic episode and developed NMS. The patient was transferred to an intensive care unit, medical management was initiated including benzodiazepines, bromocriptine and dantrolene. Due to the inadequate response after several days, ECT (bitemporal electrode placement, brief-pulse, on a daily basis) was initiated. After 17 sessions, NMS relieved and there was no need for maintenance ECT. The patient is under follow-up care for 3 years with no cognitive and physical sequela.