Neuroleptic Malignant Syndrome Unmasked by Absence Seizures: A Case Report

Introduction: Neuroleptic malignant syndrome (NMS) is a rare but potentially life-threatening complication of antipsychotic treatment, characterized by hyperthermia, muscle rigidity, and altered mental status. This report presents a case of NMS revealed by a seizure in a patient treated with risperidone. Case Presentation: A 25-year-old male with schizoaffective disorder, managed with risperidone (8 mg/day), experienced a tonic-clonic seizure with tongue biting and urinary incontinence. Postictal examination revealed muscle rigidity. Laboratory tests showed elevated creatine phosphokinase (6000 U/L) and leukocytosis. EEG and brain MRI were conducted for further evaluation. Discussion: NMS is typically triggered by neuroleptics, usually within the first two weeks of treatment, though delayed cases can occur. Seizures as an initial presentation of NMS are rare, complicating the diagnosis. The pathophysiology involves central dopaminergic dysregulation. This case highlights the importance of recognizing NMS signs early and discontinuing the causative agent promptly. Treatment includes supportive care, rehydration, and medications such as dantrolene and bromocriptine. Conclusion: This case emphasizes the need for clinicians to be vigilant for NMS signs, even in atypical presentations such as seizures, and to act quickly to prevent severe complications.