Pharmacologically Addressing Chorea in Huntington Disease

New evidence-based guidelines need to be considered in context.

To assess the efficacy of current pharmacologic treatments for chorea in patients with Huntington disease (HD), the Guideline Development Subcommittee of the American Academy of Neurology examined 33 relevant studies identified in the literature. The main conclusions were as follows:

Tetrabenazine (up to 100 mg/day), amantadine (300–400 mg/day), and riluzole (200 mg/day) are recommended, with “varying degrees of expected benefit” (Level B). The authors highlight the importance of clinicians' monitoring for depressive symptoms, suicidality, and parkinsonism in patients who receive these medications.
Nabilone, a class II narcotic, has a modest effect on chorea (Level C) but might have abuse potential.
Limited data suggest a lack of substantial b…

Reviewing Author

Michael S. Okun, MD

Disclosures

Consultant/Advisory BoardParkinson’s Foundation; Tourette Association of America

Speaker’s BureauMedscape/WebMD CME, Movement Disorders Society CME, American Academy of Neurology CME

RoyaltiesBooks4Patients; Demos; Cambridge; Taylor and Francis; Robert Rose; Public Affairs

Grant/Research SupportNational Institutes of Health; Parkinson’s Foundation; Tourette Association of America; University of Florida Foundation

Editorial BoardsTremor and Other Hyperkinetic Movements; JAMA Neurology

Leadership Positions in Professional SocietiesParkinson’s Foundation (Medical Advisor)