J Neurol Neurosurg Psychiatry 83:349-350 doi:10.1136/jnnp.2010.238899
  • PostScript
  • Letter

Reversal of abnormal eating and drinking behaviour in a frontotemporal lobar degeneration patient using low-dose topiramate

  1. Peter J Nestor
  1. Correspondence to Dr Peter J Nestor, Department of Clinical Neuroscience, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Robinson Way, Cambridge CB2 0SZ, UK; pjn23{at}
  • Received 17 December 2010
  • Revised 28 February 2011
  • Accepted 17 March 2011
  • Published Online First 19 April 2011

Abnormal eating behaviour is a highly specific symptom in frontotemporal lobar degeneration (FTLD) and can increase the burden on the care-giver.1 This case report suggests that topiramate may be a potential treatment for this problem.

Case report

The patient was 58 years old when first seen. He reported minor, longstanding memory symptoms. His wife's account was dramatically different, stating that it was like ‘having a child in the house.’ About 2 years before presentation, problems had arisen at work where he was noted to have difficulty following conversations, asking questions repeatedly, lacking initiative and making inappropriate jokes. In public, he would approach strangers, again, making inappropriate jokes and could appear intimidating. He had no idea as to how this could cause unease. Formerly a very competent handyman, his work had become slow, of poor quality and incomplete. His desire for sweet foods had increased considerably, and he hoarded biscuits and apple pies in his wardrobe.

On examination, his behaviour was overfamiliar and rather childish. He was markedly anomic with superordinate errors, for instance describing pictures of a camel and a kangaroo as ‘large animals.’ Real object knowledge and use were also impaired. General neurological examination was unremarkable. Baseline neuropsychology and neuropsychiatric inventory2 data are summarised in table …

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