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jections that induce NMDA receptor–mediated burst firing of ventral tegmental area dopaminergic cells that project to the nucleus accumbens. It is possible in frontal lobe damage that this circuit has diminished influence, lowering the occupancy threshold of the D2 receptors for EPS. Even though the mechanisms responsible for EPS remain controversial, patients with frontal lobe damage may be at a higher risk for complete occupancy of D2 receptors, which in turn would negate the 5-HT2-mediated protection against extrapyramidal symptoms. Clinicians are advised to be cautious in the use of risperidone, as well as other antipsychotics, in those patients who have neurofibromatosis.

Severe Extrapyramidal Reaction Due to Risperidone in a Case of Neurofibromatosis