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KMID : 0605720070130010104
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Journal of the Korean Society of Biological Therapies in Psychiatry
2007 Volume.13 No. 1 p.104 ~ p.108
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A Case of Atypical Neuroleptic Malignant Syndrome Which Occurred during Switching from Risperidone to Clozapine
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Choi Jin-Hwan
Park Young-Min
Lee Duk-Gi
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Abstract
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Neuroleptic malignant syndrome(NMS) is rare but a potentially fatal side effect of antipsychotics. It is characterized by muscular rigidity, fever, autonomic instability, and altered consciousness. Because it may be a possible result of a precipitous reduction in dopamine receptor activation, the introduction of the atypical antipsychotics raised expectations that these drugs would not cause NMS. But many NMS cases associated with atypical antipsychotics, including clozapine, have been reported so far. We experienced a case of NMS which is thought to be caused by the use of clozapine. The patient was a 30 year-old man, and he has suffered for 13 years from disorganized schizophrenia with bizarre delusion, auditory hallucination and disorganized behavior. He was treated with various antipsychotics but none of them were effective enough to control the symptoms, so the drug was switched from risperidone to clozapine. We titrated clozapine up to 225㎎/d and tapered off risperidone to 1㎎/d, and physical and neurological condition were normal. On 27th days of clozapine treatment, the patient suddenly developed clouding of consciousness, tremor, severe muscular rigidity and enuresis, so all the medications were stopped. On the 29th days of clozapine treatment, the laboratory test showed abnormal results：creatine phosphokinase(CPK) 128IU/I, lactate dehydrogenase( LDH) 508 IU/I, aspartate aminotransferase(AST) 110IU/I, alanine aminotransferase(ALT) 116IU/I, and white blood cell(WBC) 13.7×10³/μL. The patient was treated with benztropine 3㎎/d and diazepam 10㎎/d, and his condition improved to show no sign of muscular rigidity and disorientation within a week, and the laboratory tests were normal including WBC, CPK and LDK. Five days later, the patient had sudden seizure attacks but there were nothing abnormal on magnetic resonance imaging scan, electrolytes and neurological tests. He started taking valproate, and afterward he had nothing abnormal on blood tests and neurological examinations with no seizure attacks.
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KEYWORD
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Clozapine, Atypical neuroleptic malignant syndrome, Seizure
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