Summary: The authors report two patients with a history of neuroleptic malignant syndrome (NMS) who were treated with ECT using succinylcholine as muscle relaxant, without ensuing complications. Most, though not all, of the evidence suggests that NMS is primarily central in origin in contrast to malignant hyperthermia, which is due to a genetic defect in skeletal muscle. Regardless of the theoretical debate over the origin of the high temperatures noted in NMS, reports to date suggest that modified ECT using succinylcholine can be safely used after remission of an episode of NMS.