COMMON MEDICATIONS AND TREATMENTS

OVERVIEW

Currently there are no curative treatments available for Frontotemporal degeneration (FTD). The current goal of therapy in treatment of FTD is symptomatic relief. While the medicines listed below may be useful in some individuals, other individuals may worsen with a medication. The medicine may also have an adverse effect if administered at an inappropriate dosage or if it interacts with another medication that is already being taken. The utility of a medication for an individual patient should be reviewed with a physician who knows the individual well. All medications have side effects and possible allergic responses that should be discussed with the prescribing physician. These medications represent only a sampling of available medication regimens, and the inclusion of a medication on this list does not represent an endorsement of its use.

ANTIDEPRESSANTS:

There are many medications on the market used to treat depression. Depression, anxiety, and obsessive behavior are common in FTD. These symptoms can be treated in some individuals with a specific class of antidepressants called Selective Serotonin Reuptake Inhibitors (SSRI). These drugs work to increase the amount of serotonin in the brain. Low levels of serotonin are thought to contribute to anxiety and depression. Another antidepressant, trazadone, is one of the few medications shown to be beneficial in a small, double blinded, placebo controlled trial in FTD.

NEUROLEPTICS:

Also known as antipsychotics, these medications can be effective in treating some symptoms of FTD. Agitation and psychosis are symptoms most often treated with neuroleptic drugs. Newer generation antipsychotic drugs, such as quetiapine (Seroquel) and olanzapine (Zyprexa) are typically well tolerated. Some older antipsychotic agents, while effective, can have significant side effects for motor functioning.

ANTICONVULSANTS:

Anticonvulsant medications can serve as "mood stabilizers." Some of these medications may be used alone or in conjunction with an antipsychotic medication to help manage agitation. Divalproex sodium (Depakote) and carbamazepine (Tegretol) may be helpful in managing some of the extreme behavior symptoms when a neuroleptic medication alone is not effective.

MEDROXYPROGESTRONE:

Sexual disinhibition can be a symptom that is particularly distressing. Medroxyprogestrone is a derivative of the hormone progesterone. This may be useful for calming sexual urges that can be seen in some individuals with FTD.

DOPAMINERGIC AGENTS:

Some reports describe improved speech fluency and improved initiation with the use of medications that supplement the dopamine brain neurotransmitter system. These medications are borrowed from Parkinson's disease. These medications, in small doses, also may help reduce some of the involuntary movements seen in some individuals with FTD. There are well-known side effects associated with these medications that can limit their usefulness.

CHOLINESTERASE INHIBITORS:

These drugs have been approved by the FDA to treat mild to moderate Alzheimer’s Disease. Cholinesterase Inhibitors are designed to increase the level of acetylcholine in the brain. Acetylcholine is a neurotransmitter that helps to carry messages between brain cells. It is important for memory, judgment, and attention. This class of medications may help with naming in primary progressive aphasia, but can worsen the social disorder of patients with FTD.

OTHER:

Namenda (Memantine) is approved for use with vascular forms of dementia and moderate to severe Alzheimer's disease. While clinical reports suggest that this medication may be helpful in some FTD patients, a recent double-blind placebo-controlled trial failed to demonstrate any efficacy for this medication.