To the Editor: We read with great interest the article by Ronald J. Gurrera, M.D. (1), a distinguished researcher, regarding the etiology of neuroleptic malignant syndrome. He correctly stated that the current theories of origin—hypothalamic hypodopaminergia and direct myotoxicity—do not explain the entire pathophysiological changes found in neuroleptic malignant syndrome. He further added that the treatment options based on these mechanisms are not reliable and are reported to be insufficiently effective in overall management of the symptoms of neuroleptic malignant syndrome. Similarly, when we reviewed and updated the relevant literature (2) and presented nine cases (3) of neuroleptic malignant syndrome, one of our main conclusions was that all the manifestations of neuroleptic malignant syndrome are not explained exclusively by dopaminergic antagonism in the central nervous system. Therefore, we recommended that other putative neurotransmitters and also peripheral factors should be explored in studying its pathophysiology.