Lewy Body Dementia, Pharmacotherapeutic Security and Differential Indication of Antipsychotics According to Adverse Effects – A Case Report

Introduction: Lewy Body Dementia is well known as a type of dementia including optical hallucinations, fluctuating cognitive impairment and hypersensitivity to antipsychotics. According to the latest literature, clozapine and quetiapine (1^st choice) are recommended as antipsychotics for the treatment of productive symptoms.

Case report: A 77-year-old man was hospitalized „suffering from affective lability, hallucinations, delusions, changing cognitive deficits and desynchronisation of sleeping“, whereas clinical impression and neuropsychiatric examinations showed symptoms of a Lewy Body dementia. A week after starting a psychopharmacotherapy with quetiapine in combination with oxcarbacepine the patient developed massive EPS (dramatic worsening of Webster scale), nearly an inability of walking, which was interpreted as severe adverse pharmacological effects and they were reversible after their withdrawal.

Conclusion and discussion: Although Quetiapine is mentioned as one of the best-tolerated antipsychotics in treating productive symptoms of a Lewy-Body dementia, the example shows hazardous side effects. The speed of increasing dose of the antipsychotic drug – less than the low dose treatment itself – might be a possible influencing factor as well as a (pharmacokinetic) interaction of quetiapine and oxcarbacepine is to be discussed.