Dementia with Lewy bodies neuroleptics

Dementia with Lewy bodies, Parkinson s disease and neuroleptic sensitivity... 

Research indicates that typical and atypical neuroleptic drugs increase the vulnerability of neurons to cell death and even kill brain cells and that the risk increases in patients already suffering from brain disorders such as Alzheimer s (chapter 5). Consistent with this, Sechi et al. (2000) reported on a case of NMS following exposure of a patient with familial dementia with Lewy bodies to low doses of risperidone. 

Sechi, G., Agnetti, V., Masuri, R., Deiana, G., Pugliatti, M., Paulus, K., et al. (2000). Risperidone, neuroleptic malignant syndrome and probable dementia with Lewy bodies. Progress in Neuro-psychopharmacology and Biological Psychiatry, 24, 1043-1051. 

Court JA, Piggott MA, Lloyd S, Cookson N, Ballard CG, et al. 2000. Nicotine binding in human striatum Elevation in schizophrenia and reductions in dementia with Lewy bodies, Parkinson s disease and Alzheimer s disease and in relation to neuroleptic medication. Neuroscience 98 79-87. 

Ballard C, Grace J, McKeith I, Holmes C. Neuroleptic sensitivity in dementia with Lewy bodies and Alzheimer s disease. Lancet 1998 351(9108) 1032-3. 

Burke WJ, Pfeiffer RF, McComb RD. Neuroleptic sensitivity to clozapine in dementia with Lewy bodies. J Neuropsychiatry Clin Neurosci 1998 10(2) 227-9. 

Sechi G, Agnetti V, Masuri R, Deiana GA, Pughatti M, Paulus KS, Rosati G. Risperidone, neuroleptic mahgnant syndrome and probable dementia with Lewy bodies. Prog Neuropsychopharmacol Biol Psychiatry 2000 24(6) 1043-51. 

EPSEs/neuroleptic sensitivity reactions (especially in Dementia with Lewy Bodies or Parkinson s Disease). 

Atypical neuroleptics have a better side-effect profile, and several studies have confirmed their efficacy. Risperidone has been found effective in the treatment of dementia in patients with agitation (N. Hermann et al. 1998 Jeanblanc and Davis 1995 Jeste et al. 1996 I. R. Katz et al. 1999 Lavretsky and Sultzer 1998), in patients with Lewy body disease (Geizer and Ancill 1998), or in patients with L-dopa-induced hallucinations (Meco et al. 1994). Risperidone has better tolerability than classic neuroleptics such as thioridazine and haloperidol (Frenchman and Prince 1997). No studies of the efficacy of olanzapine in the treatment of agitation in patients with dementia have been done, but its use is widely advocated. 

McKeith, I., Fairbairn, A., Perry, R., Thompson, P., Perry, E. (1992). Neuroleptic sensitivity in patients with senile dementia of Lewy body type. British Medical Journal, 305, 673-678. 

Patients with Lewy body dementia may be more intolerant of neuroleptic drugs, including atypical drugs, than other patients with neurodegenerative dementia. However, because hallucinations are common in this form of dementia, it is likely that people with Lewy body dementia will be exposed to neuroleptic drugs. Two patients with Lewy body dementia taking clozapine developed confusion and behavioral symptoms (227). 

Delayed risperidone-induced neuroleptic malignant syndrome has been reported in a 27-year-old man after 21 months (108), and in a 17-year-old girl who took risperidone 0.5 mg bd (109). Risperidone-induced neuroleptic malignant syndrome has also been reported in a 63-year-old woman with probable Lewy body dementia, who had previously had an episode of neuroleptic malignant syndrome with trifluoperazine (110). 

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