Topiramate may modulate alcohol abuse but not other compulsive behaviors in frontotemporal dementia: case report.
Frontotemporal dementia (FTD) is an insidious presenile neurodegenerative disorder presenting with personality changes, compulsive behaviors, psychosis, apathetic, aberrant, and elated mood and behavior. No psychopharmacologic strategy has proven to be efficacious in the treatment of FTD yet. This is a case report of FTD in a 53-year-old male engineer whose alcohol abuse, but not other compulsive behaviors, responded to topiramate. Alcohol exerts reinforcing effects on cortico-mesolimbic dopamine pathways through the disinhibition of the inhibitory effects of gamma-amino-butyric acid-A neurons in the ventral tegmental area. Topiramate is a sulfamate-substituted fructopyranose derivative that may antagonize the reinforcing effects associated with the abuse liability of alcohol by modulation of cortico-mesolimbic dopamine function. On the basis of the mechanism of action of topiramate, we discuss the possible specificity of action of topiramate to control abusive drinking, but not to treat other clinical symptoms of FTD.
Drug Abuse Research and Assistance Program, Institute of Psychiatry, Federal University of Rio de Janeiro, RJ, Brazil. marceloscruz@terra.com.br
Marcelo
M
Cruz
Valeska
V
Marinho
Leonardo F
LF
Fontenelle
Eliasz
E
Engelhardt
Jerson
J
Laks
D000437:Alcoholism / Q000188:drug therapy* / Q000523:psychology; D000927:Anticonvulsants / Q000627:therapeutic use*; D002540:Cerebral Cortex / Q000187:drug effects / Q000473:pathology; D003192:Compulsive Behavior / Q000188:drug therapy* / Q000523:psychology; D003704:Dementia / Q000188:drug therapy* / Q000523:psychology; D003952:Diagnostic Imaging; D004298:Dopamine / Q000378:metabolism; D004305:Dose-Response Relationship, Drug; D005500:Follow-Up Studies; D005632:Fructose / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D008032:Limbic System / Q000187:drug effects / Q000473:pathology; D008297:Male; D008609:Mental Status Schedule; D008875:Middle Aged; D009434:Neural Pathways / Q000187:drug effects / Q000473:pathology; D000077236:Topiramate
D000927:Anticonvulsants; D000077236:Topiramate; D005632:Fructose; D004298:Dopamine