Brain with blossoming flowers, representing renewed mental clarity

When ECT Isn't Enough: How Acamprosate Can Help in Catatonic Dementia Treatment

Lena Voss in Health & Wellness November 2025 • 3 min read.

"A new approach to managing catatonia in frontotemporal dementia, offering hope when traditional treatments fall short."

Frontotemporal dementia (FTD), representing 10-15% of all dementia cases, poses significant challenges, particularly when complicated by catatonia. This combination, marked by motor and behavioral disturbances, often resists standard treatments, creating a desperate need for innovative solutions.

Catatonia, historically described by Kahlbaum, manifests in various motor phenomena like rigidity, stupor, and automatic obedience, frequently complicating conditions such as schizophrenia, autism, and dementia. The overlap of catatonia and dementia can obscure diagnosis, pushing clinicians towards therapeutic trials with medications like lorazepam or electroconvulsive therapy (ECT) for diagnostic clarity.

While ECT and benzodiazepines traditionally serve as the primary treatments for catatonia, their effectiveness can wane over time or prove unsuitable due to side effects, especially in elderly patients with dementia. This limitation calls for alternative strategies that can enhance and prolong the therapeutic benefits, improving patient outcomes.

Acamprosate: A Novel Adjunct Therapy

Brain with blossoming flowers, representing renewed mental clarity

Recognizing the neurobiological underpinnings of catatonia—specifically cortical GABA deficiency and glutamate excitotoxicity—researchers have explored alternative treatments like acamprosate. Acamprosate, known for its role in alcoholism treatment through NMDA-glutamate antagonism and GABAa enhancement, presents a compelling therapeutic option.

A recent case study highlights acamprosate’s potential in managing catatonic FTD. A 59-year-old male, diagnosed with FTD and experiencing progressive psychomotor slowing and catatonic symptoms, initially responded to ECT. However, the benefits were short-lived, prompting the exploration of acamprosate as an adjunct therapy.

Initial Presentation: The patient exhibited symptoms including mutism, resistance, negativism, and occasional stereotypies.
Treatment Course: Following a positive response to a lorazepam challenge, ECT was administered, showing initial promise.
Acamprosate Intervention: When ECT benefits diminished, acamprosate was introduced at 333 mg three times daily.
Outcomes: Marked reduction in catatonic symptoms was observed, with sustained improvement and high tolerability.
Monitoring: The Buch-Francis Catatonia Rating Scale was used to objectively track progress, showing a significant decrease in catatonia severity.

Upon acamprosate's introduction, the patient showed remarkable improvement, maintaining stability over several months. An attempt to withdraw acamprosate led to a relapse, quickly resolved by reinstating the original dosage, confirming its ongoing therapeutic value. This outcome suggests acamprosate can offer a stable, well-tolerated option for managing catatonia in FTD when first-line treatments falter.

The Future of Catatonia Treatment in Dementia

This case opens new avenues for treating catatonia, particularly when conventional treatments are ineffective or poorly tolerated. While further research through well-designed clinical trials is necessary, acamprosate holds promise for improving the quality of life for geriatric patients with catatonia and compromised cognition.

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Everything You Need To Know

Why is catatonia in frontotemporal dementia (FTD) so challenging to treat?

Catatonia in frontotemporal dementia (FTD) is particularly challenging because it often resists standard treatments like lorazepam or electroconvulsive therapy (ECT). The combination of motor and behavioral disturbances characteristic of catatonia, alongside the cognitive decline of FTD, complicates diagnosis and management, necessitating innovative therapeutic approaches to improve patient outcomes. The overlap between catatonia and dementia makes it hard to pinpoint the right approach, often leading to clinicians trying different treatments to see what works.

How does acamprosate work to potentially alleviate catatonic symptoms in patients with frontotemporal dementia (FTD)?

Acamprosate addresses the neurobiological aspects of catatonia, particularly the cortical GABA deficiency and glutamate excitotoxicity. Known for its role in treating alcoholism, acamprosate acts as an NMDA-glutamate antagonist and enhances GABAa activity. This dual action helps restore the balance of neurotransmitters in the brain, potentially reducing the severity of catatonic symptoms in patients with frontotemporal dementia (FTD). By modulating these key neurotransmitter systems, acamprosate offers a targeted approach to managing catatonia's underlying causes.

When electroconvulsive therapy (ECT) benefits diminish, what alternative treatment has shown promise for catatonic frontotemporal dementia (FTD)?

When the benefits of electroconvulsive therapy (ECT) diminish in treating catatonic frontotemporal dementia (FTD), acamprosate has emerged as a promising alternative. In a case study, a patient with FTD and catatonia experienced a relapse after initial ECT success. The introduction of acamprosate at 333 mg three times daily led to a marked reduction in catatonic symptoms, with sustained improvement and high tolerability, suggesting it can provide a stable option when first-line treatments falter. Relapse upon withdrawal and recovery after readministration indicates the ongoing therapeutic value of Acamprosate.

What are the primary motor symptoms observed in catatonia, and how do they complicate conditions like frontotemporal dementia (FTD)?

The primary motor symptoms observed in catatonia include rigidity, stupor, and automatic obedience. These symptoms complicate conditions like frontotemporal dementia (FTD) by obscuring diagnosis and making it challenging to distinguish between the motor and cognitive aspects of the disorders. This overlap pushes clinicians towards therapeutic trials with medications like lorazepam or electroconvulsive therapy (ECT) to gain diagnostic clarity and manage the patient's condition more effectively. The diagnostic difficulties arise from the fact that catatonia can mimic or exacerbate the symptoms of dementia, leading to a more complex clinical picture.

What does the Buch-Francis Catatonia Rating Scale reveal about the effectiveness of acamprosate in treating catatonia?

The Buch-Francis Catatonia Rating Scale is used to objectively track the progress of catatonia treatment. In the case study involving acamprosate, the scale showed a significant decrease in catatonia severity after the introduction of acamprosate. This objective measurement supports the conclusion that acamprosate can effectively reduce catatonic symptoms, providing clinicians with a reliable tool to monitor and assess treatment outcomes. The Buch-Francis Catatonia Rating Scale is a critical tool in measuring the efficacy of interventions like acamprosate, ensuring that improvements are not just perceived but also quantitatively validated.