Withdrawal From Controlled Carbamazepine Therapy Followed by Further Carbamazepine Treatment in Patients With Dementia

GABAergic Function in Alzheimer's Disease: Evidence for Dysfunction and Potential as a Therapeutic Target for the Treatment of Behavioural and Psychological Symptoms of Dementia

“…Both Lemke and colleagues (118) and Gleason and colleagues (119) reported a significant decrease in BPSD (approximately 24%) between 4 weeks and 7 weeks posttreatment. Tariot and colleagues reported on the carbamazepine open-label extension (modal dosage 300 mg daily, serum concentration 4.7 µg/mL to 5.0 µg/mL) from an RCT of 51 AD patients (120). Over a 12-week period, the authors reported continued improvement in BPSD and aggression.…”

Recognition and Management of Behavioral Disturbances in Dementia

“…An early pilot study 134 displayed the potential for 300 mg of carbamazepine to decrease impulsive or aggressive behaviors; when the medication was withdrawn, the behavioral disturbances relapsed. A recent study 135 did not find divalproex sodium to improve signs and symptoms of mania associated with dementia in a sample of nursing home residents, but divalproex did improve symptoms of agitation.…”

Strategies for Optimizing Antiepileptic Drug Therapy in Elderly People

“…137,138 Short-term studies and several case reports suggest that carbamazepine, alone and in combination with other psychotropic agents, may be effective in decreasing agitation in elderly patients with dementia as first-line therapy or in those refractory to neuroleptic agents. [120][121][122][123][124][125][126][127][128][129][130] The pooled results of these studies indicate that carbamazepine decreases agitated behavior in approximately 31% more patients than placebo, similar to antipsychotic agents. 137,138 Decreased agitation generally is achieved with mean carbamazepine SDCs of 5-8 µg/ml, albeit some patients required SDCs up to 12 µg/ml.…”

“…The dosage associated with good control approximates 300-600 mg/day but up to 1000 mg/day (divided doses) may be necessary. [120][121][122][123][124][125][126][127][128][129][130] Valproate appears to be effective in decreasing agitation associated with dementia in elderly people when given alone and in combination with antipsychotic agents. [108][109][110][111][112][113][114][115][116][117][118][119] Like carbamazepine, the optimal dosage and concentration of valproate for alleviating agitation and aggression are not established.…”