Table 9.

Treatment of Manifestations in Individuals with FXTAS

Manifestation/
Concern		TreatmentConsiderations/Other
Tremor Primidone, β-blockers, or levotriacetam
Deep brain stimulation may be considered for those w/debilitating tremor w/little ataxia or white matter disease.Has been shown to improve tremor but worsen ataxia & speech
Ataxia / Cerebellar dysfunction Medications incl amantadine, buspirone, varenicline, riluzole, or ampyra can be considered.No evidence for efficacy in FXTAS
Neuropathic pain Gabapentin, pregabalin, duloxetine, or topical lidocaine patchesAvoid opioids.
Cognitive decline Supportive treatment onlyEvaluate & treat for clinical conditions assoc w/cognitive decline that may compound the cognitive decline in FXTAS: vitamin deficiencies (e.g., vitamin D, folate, B12 deficiencies), thyroid deficiency, hypertension, sleep apnea, & psychiatric problems.
Depression/
Anxiety 		Psychiatric referral
SSRIs or selective serotonin-noradrenaline reuptake inhibitorsMonitor for balance issues.

From: FMR1 Disorders

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