Forgotten Frontal Lobe Syndrome or "Executive Dysfunction Syndrome"

Indications:1 patient with frontal lobe syndrome or `executive dysfunction syndrome`. Coexisting disease: Huntingtons chorea and depression.

TypeofStudy:The effect of Symmetrel treatment in a patient with Huntington's disease and frontal lobe syndrome or "executive dysfunction syndrome" was described. A case report.

Patients:1 patient, a 52 year old man (treated as inpatient and outpatient). Follow up: 6 and 12 months.

DosageDuration:Dosage: initially 50 mg bid (=100 mg daily); increased to 100 mg bid (=200 mg daily) within a week. Duration not stated.

FreeText:The patient had no psychiatric history and the medical history, other than for Huntingtons disease, was negative. He was admitted in the hospitals inpatient neuropsychiatry service for increasingly undirected motor activity, agitation and disinhibited behavior. Concomitant drug: fluoxamine (50 mg bid=100 mg daily). Tests done: clinical observation, mini mental state examination (MMSE).

Results:Symmetrel treatment was started (50 mg bid =100 mg daily; increased to 100 mg bid =200 mg daily within a week), and within a few days, there was a rapid, almost total resolution of the behavior disorders. The patient was no longer "getting stuck" on ideas or behaving in an internally driven, "sticky," and intrusive fashion. He was cooperative and pleasant. He continued being apathetic and withdrawn most of the time, with little spontaneous interest in activties or people around him. However, he could be engaged in activities, including basic self-care, if they were offered to him as part of his daily structure. Given that his apathy might have reflected a mild degree of depression, fluvoxamine was added to his drug regimen and increased to 50 mg bid (=100 mg daily), resulting in some increase in his level of interest. There were no further problematic behaviors over the ensuing week, and his family stated that he had returned to the behavioral baseline he had exhibited several months ago. He was able to go home on a pass, and that visit went very well. He was then discharged, with a score on the MMSE of 23 of 30. He was noted as doing well at his outpatient follow-up visits 6 and 12 months later, despite mild progression of the motor symptoms of Huntington's disease. He was able to return to his former job in the fast-food industry.

AdverseEffects:No adverse events were mentioned.

AuthorsConclusions:From the clinical point of view, this patients behaviors caused problems for him, his family, and other persons in his care environment. The management of his condition was challenging. He worsened when he was treated with an atypical neuroleptic (a dopamine receptor blocker), but he appeared to improve substantially when he was treated with amantadine (a dopamine augmenter) and possibly after the addition of a selective serotonin reuptake inhibitor (SSRI).