Neuroleptic Malignant Syndrome in Children with Autism Spectrum Disorder (ASD): A Case Report and Brief Review of Recent Literature

Abstract

Neuroleptic malignant syndrome (NMS) is a rare, life-threatening, idiosyncratic adverse reaction to antipsychotic drugs. Despite the increasing rates in the prescription of antipsychotics in pediatric patients with autism spectrum disorder (ASD), little is known about the occurrence and hallmarks of NMS in this specific population. NMS appears to be part of the larger catatonia domain, based on the frequent relationship between ASD and catatonia, on the shared, when not overlapping, clinical features with malignant catatonia, and on the effectiveness of catatonia treatments on the NMS/MC symptoms. The intrinsic difficulties of exploring NMS in ASD in controlled studies accounts for the subsequent lack of available information. Based on recent reports and on our case report, clinical features of NMS in the pediatric ASD population appear to be the same as the non-ASD population. Further studies are needed to confirm these results.

Neuroleptic Malignant Syndrome in a 15-Month-Old Child

“…[3][4][5][6] Dopamine blockers prescribed in children as antiemetics can be associated with NMS. 7 Neuroleptic malignant syndrome is a disorder recognized as a hypodopaminergic state characterized by muscle rigidity, hyperthermia, altered sensorium, autonomic instability, and elevated serum CPK levels. 8 According to the Diagnostic and Statistical Manual of Mental Disorders, 9 these required symptoms are accompanied by 2 (or more) of the following symptoms: dysphagia, diaphoresis, incontinence, tremor, tachycardia, changes in level of consciousness ranging from confusion to coma, mutism, alterations in blood pressure, leukocytosis, and laboratory evidence of muscle injury (eg, elevated creatine phosphokinase).…”

“…However, increased exposure may occur more often now with their expanded off-label use in children, especially for those with developmental disability, and in adults, leading to accidental poisoning when pills are not secured in the home 3–6 . Dopamine blockers prescribed in children as antiemetics can be associated with NMS 7 …”

Comorbidities in Youth with Bipolar Disorder: Clinical Features and Pharmacological Management

“…Patients with autism and catatonia preferentially show features such as echolalia and echopraxia, stereotypies and mannerisms, mutism, negativism, and repetitive psychomotor behaviors [ 151 ]. A difficult differential diagnosis between catatonia and Neuroleptic Malignant Syndrome (NMS) after antipsychotic treatment may occur in ASD patients, and should be always considered in this specific population, considering the effectiveness of catatonia treatments on the NMS symptoms [ 152 ]. The intrinsic difficulties of exploring NMS in ASD in controlled studies account for the subsequent lack of available information.…”