In a review of 734 published cases of neuroleptic malignant syndrome (NMS), we found 665 with sufficient data to allow statistical analyses. Forty-eight received ECT either during or shortly after an episode of NMS and were compared to control cases who received no specific treatment for their episode. We also compared the mortality rates in these two groups to data previously analyzed for specific drug treatments (i.e., amantadine, bromocriptine, L-dopa, and dantrolene). We find a substantially better outcome in the specific drug-treated (mortality rate of 9.7%) or ECT-treated (mortality rate of 10.3%) groups compared to the group receiving no specific treatment (mortality rate of 21%). We conclude that ECT is safe to use shortly after an episode of acute NMS has resolved and, furthermore, that ECT is probably safe in the actual treatment of NMS provided concomitant neuroleptics are discontinued.