A review of neuroleptic malignant syndrome reports suggests possible symptom improvement with lorazepam while leaving major efficacy uncertainty.
The authors found improvement in five of six atypical and seven of nine typical NMS cases. Some atypical presentations improved within 72 hours. At least one case ultimately required electroconvulsive therapy for catatonia. The evidence came from published clinical reports rather than randomized treatment assignment.
Publication and selection bias can overrepresent successful cases. Other interventions and withdrawal of the suspected causative drug complicate attribution. The small denominators cannot establish response rates applicable to all patients or provide diagnostic specificity.
For retrospective review, document the full clinical syndrome, antipsychotic timeline, supportive care, competing diagnoses, and sequence of interventions. Response after lorazepam may help clinical reasoning but does not independently prove NMS or establish that lorazepam alone produced recovery.
Source reviewed: Lorazepam in Managing Atypical Neuroleptic Malignant Syndrome A Systematic Review of Case Reports (PMC12591652). This article summarizes the supplied paper; forensic applications above are interpretive analysis.
Related reading: Phenobarbital Versus Lorazepam: All-Cause Readmission Was Different From Alcohol-Related Readmission; Pediatric Sedation Z-Scores Were Relative Burden Measures Rather Than Dose Equivalents.