Neuroleptic malignant syndrome from clozapine

The presentation of neuroleptic malignant syndrome with clozapine can be different from that associated with traditional neuroleptic drugs (SEDA-28, 66), and the authors of a recent report have pointed out the differential diagnosis with heat stroke, a medical emergency with the two cardinal features of raised core body temperature (40° C) and central nervous system dysfunction, which is fatal in up to 50% of cases (205). 

Neuroleptic malignant syndrome has been associated with clozapine (SEDA-22, 58) (98), although some doubts were expressed about the features of earlier cases. The presentation can be different from that associated with traditional antipsychotic drugs for example, the patient may not develop rigidity or a rise in creatine kinase activity (SEDA-25, 62). In the light of two cases, a 35-year-old man and a 62-year-old woman, the literature was comprehensively reviewed and the characteristics of neuroleptic malignant syndrome due to clozapine and typical neuroleptic drugs were compared (99). Causation with clozapine... 

A 22-year-old male on amisulpride and recently withdrawn from clozapine developed neuroleptic malignant syndrome 10 days after the addition of oral paliperidone. 

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