Neuroleptic malignant syndrome in adolescents: four probable cases in the Western Cape.

BACKGROUND: Neuroleptic malignant syndrome (NMS) is a rare side-effect of neuroleptic medication. Most NMS reports have been on adults, and the incidence in children and adolescents is unknown.

OBJECTIVE: This report reviews cases of NMS to highlight possible risk factors for the development of NMS in adolescents.

METHOD: Four cases of probable NMS in adolescents diagnosed in the Western Cape between February 2009 and March 2010 are presented.

RESULTS: Risk factors in the development of the syndrome in adolescents in the Western Cape may be male gender, polypharmacy, the use of zuclopenthixol acetate (clopixol acuphase), a previous history of extra-pyramidal side-effects or NMS, and a history of substance misuse - in particular methamphetamine.

CONCLUSION: Caution must be applied in the apparent overuse of intramuscular antipsychotics, and especially zuclopenthixol acetate (clopixol acuphase), in neuroleptic-naïve and agitated psychotic adolescents where the short-term use of benzodiazepines is more appropriate.