Pharmacotherapy for behavioural manifestations in frontotemporal dementia: An expert consensus from the European Reference Network for Rare Neurological Diseases (ERN-RND)
Language English Country England, Great Britain Media print-electronic
Document type Journal Article
PubMed
39447217
PubMed Central
PMC11555005
DOI
10.1111/ene.16446
Knihovny.cz E-resources
- Keywords
- drug therapy, expert testimony, frontotemporal dementia, neurobehavioural manifestations, neurodegenerative diseases,
- MeSH
- Aggression drug effects MeSH
- Antipsychotic Agents therapeutic use MeSH
- Frontotemporal Dementia * drug therapy MeSH
- Impulsive Behavior drug effects MeSH
- Consensus MeSH
- Humans MeSH
- Selective Serotonin Reuptake Inhibitors therapeutic use MeSH
- Rare Diseases drug therapy MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Europe MeSH
- Names of Substances
- Antipsychotic Agents MeSH
- Selective Serotonin Reuptake Inhibitors MeSH
BACKGROUND AND PURPOSE: Frontotemporal dementia (FTD) is a neurodegenerative disorder characterized by pervasive personality and behavioural disturbances with severe impact on patients and caregivers. In current clinical practice, treatment is based on nonpharmacological and pharmacological approaches. Unfortunately, trial-based evidence supporting symptomatic pharmacological treatment for the behavioural disturbances in FTD is scarce despite the significant burden this poses on the patients and caregivers. METHOD: The study examined drug management decisions for several behavioural disturbances in patients with FTD by 21 experts across European expert centres affiliated with the European Reference Network for Rare Neurological Diseases (ERN-RND). RESULTS: The study revealed the highest consensus on drug treatments for physical and verbal aggression, impulsivity and obsessive delusions. Antipsychotics (primarily quetiapine) were recommended for behaviours posing safety risks to both patients and caregivers (aggression, self-injury and self-harm) and nightly unrest. Selective serotonin reuptake inhibitors were recommended for perseverative somatic complaints, rigidity of thought, hyperphagia, loss of empathy and for impulsivity. Trazodone was specifically recommended for motor unrest, mirtazapine for nightly unrest, and bupropion and methylphenidate for apathy. Additionally, bupropion was strongly advised against in 10 out of the 14 behavioural symptoms, emphasizing a clear recommendation against its use in the majority of cases. CONCLUSIONS: The survey data can provide expert guidance that is helpful for healthcare professionals involved in the treatment of behavioural symptoms. Additionally, they offer insights that may inform prioritization and design of therapeutic studies, particularly for existing drugs targeting behavioural disturbances in FTD.
Centre for Rare Diseases University Hospital Tübingen Tübingen Germany
Centre of Excellence of Neurodegenerative Disease AP HP Pitié Salpêtrière Hospital Paris France
Department of Biomedical and Neuromotor Science University of Bologna Bologna Italy
Department of Medicine Universidad de Oviedo Oviedo Spain
Department of Neurology Cognitive Centre Ghent University Hospital Ghent Belgium
Department of Neurology Hospital Universitario Central de Asturias Oviedo Spain
Department of Neurology LMU University Hospital LMU Munich Munich Germany
Department of Neurology Medical University Innsbruck Innsbruck Tyrol Austria
Department of Neurology Neurocentre Oulu University Hospital Oulu Finland
Department of Neurology RWTH Aachen University Aachen Germany
Department of Neurology University Hospital Leuven Leuven Belgium
Department of Neuroscience and Padua Neuroscience Centre University of Padua Padua Italy
German Centre for Neurodegenerative Diseases Munich Germany
Institute for Medical Genetics and Applied Genomics University of Tübingen Tübingen Germany
Instituto de Investigación Sanitaria del Principado de Asturias Oviedo Spain
IRCCS Istituto delle Scienze Neurologiche di Bologna Bologna Italy
Medicine and Psychiatry Department University of Cantabria Santander Spain
MRC Oulu University Hospital Oulu Finland
Munich Cluster for Systems Neurology Munich Germany
Research Unit of Clinical Medicine University of Oulu Oulu Finland
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