TY - JOUR
T1 - Pharmacotherapy for behavioural manifestations in frontotemporal dementia
T2 - An expert consensus from the European Reference Network for Rare Neurological Diseases (ERN-RND)
AU - Wittebrood, Casper
AU - Boban, Marina
AU - Cagnin, Annchiara
AU - Capellari, Sabina
AU - De Winter, François-Laurent
AU - Djamshidian, Atbin
AU - González, Manuel Menéndez
AU - Hjermind, Lena E
AU - Krajcovicova, Lenka
AU - Krüger, Johanna
AU - Levin, Johannes
AU - Reetz, Kathrin
AU - Rodriguez, Eloy Rodriguez
AU - Rohrer, Jonathan
AU - Van Langenhove, Tim
AU - Reinhard, Carola
AU - Graessner, Holm
AU - Rusina, Robert
AU - Saracino, Dario
AU - Houot, Marion
AU - Seelar, Harro
AU - Vandenberghe, Rik
N1 - © 2024 The Author(s). European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.
PY - 2024
Y1 - 2024
N2 - 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.
AB - 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.
KW - Aggression/drug effects
KW - Antipsychotic Agents/therapeutic use
KW - Consensus
KW - Europe
KW - Frontotemporal Dementia/drug therapy
KW - Humans
KW - Impulsive Behavior/drug effects
KW - Rare Diseases/drug therapy
KW - Selective Serotonin Reuptake Inhibitors/therapeutic use
UR - http://www.scopus.com/inward/record.url?scp=85207517737&partnerID=8YFLogxK
U2 - 10.1111/ene.16446
DO - 10.1111/ene.16446
M3 - Journal article
C2 - 39447217
SN - 1351-5101
VL - 31
SP - e16446
JO - European Journal of Neurology
JF - European Journal of Neurology
IS - 12
M1 - e16446
ER -