Ziprasidone‐related neuroleptic malignant syndrome in a patient with Parkinson's disease: a diagnostic challenge

Abstract

A case of neuroleptic malignant syndrome (NMS) in a patient with Parkinson's disease (PD) is presented. The syndrome was precipitated by the atypical antipsychotic, ziprasidone. The challenge of recognizing NMS in a patient with underlying parkinsonian symptoms, where prominent symptom overlap can occur, is discussed.

Parenteral ziprasidone: a new atypical neuroleptic for emergency treatment of psychosis in Parkinson's disease?

“…A patient with resistant psychosis responded to the treatment with a maximum dose of 80 mg/d of ziprasidone without worsening of motor function (Connemann and Schondeldt-Lecuona, 2004). Another PD patient was treated with 40 mg of ziprasidone and developed elevation of creatinine kinase and body temperature so that neuroleptic malignant syndrome was discussed in this patient and ziprasidone was stopped (Gray, 2004). More data concerning the treatment of psychosis in PD with ziprasidone are lacking.…”

Use of Ziprasidone in Parkinsonian Patients With Psychosis

“…22 There was also a case report of a patient with PD treated with ziprasidone who developed a neuroleptic malignant syndrome. 23 In our series, patients improved significantly using scales that evaluate mental condition (UPDRS I) and the complications caused by dopaminergic drugs (UPDRS IV). The effect of ziprasidone on psychotic symptoms explains the improvement in mental condition, as seen with item 2 of UPDRS I.…”

Psychiatric Care in Parkinson’s Disease

“…135 One case report also described a patient with PD who developed neuroleptic malignant syndrome when treated with ziprasidone. 136 Based on a case series, Oechsner and Korchounov suggested that an intramuscular injection of ziprasidone (10-20 mg) may successfully treat acute agitation in patients with psychosis in PD, without deterioration of motor function or other clinically relevant side effects. 137 Aripiprazole.…”