Neuroleptic malignant syndrome induced by donepezil

Neuroleptic malignant syndrome (NMS), a potentially lethal adverse reaction to neuroleptics, is characterized by hyperthermia, extrapyramidal symptoms, altered consciousness, and autonomic dysfunction including fluctuation of blood pressure, arrhythmia, dyspnoea, diaphoresis, and incontinence (Kawanishi, 2003 for review). In this report, we first describe a patient with dementia with Lewy bodies (DLB) who developed NMS following donepezil monotherapy. Donepezil, a selective and reversible acetylcholine esterase inhibitor, is an anti-dementia drug widely used for cognitive and behavioural disturbances in Alzheimer's type dementia (ATD), and the therapeutic effect of donepezil on DLB has also been reported (Lanctôt and Herrmann, 2000; Shea et al., 1998).