Vulnerability to neuroleptic side effects in frontotemporal lobar degeneration

• Published in: International journal of geriatric psychiatry Vol. 18; no. 1; pp. 67 - 72
• Main Authors: Pijnenburg, Y. A. L., Sampson, E. L., Harvey, R. J., Fox, N. C., Rossor, M. N.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01.01.2003; Wiley
• Subjects: Adult; Aged; Aged, 80 and over; Antipsychotic Agents - adverse effects; Atrophy; Basal Ganglia Diseases - chemically induced; Biological and medical sciences; dementia; Dementia - drug therapy; Dementia - psychology; Drug toxicity and drugs side effects treatment; extra-pyramidal side effects; Female; Frontal Lobe - pathology; frontotemporal lobar degeneration; Humans; Male; Medical sciences; Middle Aged; Nervous system involvement in other diseases. Miscellaneous; neuroleptics; Neurology; Pharmacology. Drug treatments; Pick's disease; Retrospective Studies; Social Behavior Disorders - drug therapy; Social Behavior Disorders - etiology; Temporal Lobe - pathology; Toxicity: nervous system and muscle; Human; Disinhibition; Temporal lobe; Nervous system diseases; Frontal lobe; Neuroleptic; Toxicity; Pick disease; Cerebral disorder; Behavioral disorder; Case study; Symptomatology; Chemotherapy; Treatment; Central nervous system disease; Secondary effect; Adult; Degenerative disease; Degeneration; Aggressiveness; Extrapyramidal syndrome
• ISSN: 0885-6230; 1099-1166
• DOI: 10.1002/gps.774

Background Frontotemporal lobar degeneration (FTLD) is commonly associated with behavioural disturbances such as disinhibition and aggression; these often result in the use of neuroleptic medication. Methods All available case notes of patients attending a specialist cognitive disorders clinic with a diagnosis of FTLD were selected. This gave 100 subjects (62 male, 38 female). Results In 61 patients significant behavioural disturbances were present. Of these patients, 24 had been prescribed neuroleptics. Significant extrapyramidal side effects were reported in eight patients (33%); in five patients these were severe enough to cause severe mobility problems and in one patient resulted in impaired consciousness. In some instances the extrapyramidal side effects took weeks to wear off. Conclusion These results suggest that patients with FTLD may, as in Lewy body dementia, be particularly sensitive to the extrapyramidal side effects of neuroleptics. We suggest that neuroleptics should be used cautiously in FTLD and treatment should be started at low doses avoiding depot preparations until further prospective studies have been performed. Copyright © 2002 John Wiley & Sons, Ltd.