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Antiepileptic Drugs for the Treatment of Agitation and Aggression in Dementia: Do They Have a Place in Therapy?

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Abstract

Antiepileptic drugs (AEDs) are a class of medications that have received considerable attention as possible treatments for agitation and aggression in patients with dementia. This attention has been driven in equal measure by promising findings from limited trial and observational data and the desire to find treatments with improved tolerability. Their use, to date, has been largely confined to circumstances where first-line treatments have proven inadequate or are poorly tolerated. In recent years there has been some growth in the evidence base, and we can now make more informed recommendations regarding a number of older AEDs. Carbamazepine continues to have the best evidence to support its use, although the evidence base remains relatively small and concerns regarding tolerability limit its use. There is now more consistent evidence that valproate preparations should not be used for agitation and aggression in dementia. Despite a lack of high-quality data, some results have been reported for several newer medications, including levetiracetam, oxcarbazepine, gabapentin, topiramate and lamotrigine, and a number of these warrant further investigation. Recent findings and implications for clinical practice are discussed.

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Acknowledgments

No industry funding was received to assist with the preparation of this review. Dr. Gallagher has no conflicts of interest to declare. Dr. Herrmann has received research Grants from Lundbeck, Sanofi-Aventis and Roche, consultant fees from Abbvie and speaker’s honoraria from Pfizer.

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  1. Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada

    Damien Gallagher & Nathan Herrmann

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Correspondence to Damien Gallagher.

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Gallagher, D., Herrmann, N. Antiepileptic Drugs for the Treatment of Agitation and Aggression in Dementia: Do They Have a Place in Therapy?. Drugs 74, 1747–1755 (2014). https://doi.org/10.1007/s40265-014-0293-6

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