Citation

Armstrong MJ, Miyasaki JM. Neurology 2012; 79(6): 597-603.

Copyright

(Copyright © 2012, Lippincott Williams and Wilkins)

DOI

10.1212/WNL.0b013e318263c443

PMID

unavailable

Abstract

OBJECTIVE: To develop an evidence-based guideline assessing pharmacologic options for treating Huntington disease (HD) chorea.

METHODS: We evaluated available evidence from a structured literature review performed through February 2011.

RESULTS and recommendations: If HD chorea requires treatment, clinicians should prescribe tetrabenazine (up to 100 mg/day), amantadine (300-400 mg/day), or riluzole (200 mg/day) (Level B) for varying degrees of expected benefit. Occurrence of adverse events should be discussed and monitored, particularly depression/suicidality and parkinsonism with tetrabenazine and elevated liver enzymes with riluzole. Clinicians may also prescribe nabilone for modest decreases (1- to <2-point changes on the Unified Huntington's Disease Rating Scale [UHDRS] chorea score) in HD chorea (Level C), but information is insufficient to recommend long-term use, particularly given abuse potential concerns (Level U). Clinicians should not prescribe riluzole 100 mg/day for moderate (2- to < 3-point UHDRS chorea change) short-term benefits (Level B) or for any long-term (3-year) HD antichoreic goals (Level B). Clinicians may choose not to prescribe ethyl-EPA (Level B), minocycline (Level B), or creatine (Level C) for very important improvements (>3-point UHDRS chorea change) in HD chorea. Clinicians may choose not to prescribe coenzyme Q10 (Level B) for moderate improvements in HD chorea. Data are insufficient to make recommendations regarding the use of neuroleptics or donepezil for HD chorea treatment (Level U). Copyright © 2012 by AAN Enterprises, Inc.

Language: en

Keywords

human; systematic review; insomnia; suicidal ideation; depression; anxiety; suicide attempt; clozapine; article; physician; prescription; sedation; unclassified drug; neutropenia; priority journal; hallucination; somnolence; practice guideline; falling; confusion; drug safety; placebo; drug efficacy; diarrhea; drug tolerability; nausea; agranulocytosis; drug withdrawal; restlessness; heart arrest; lung edema; side effect; cardiovascular effect; evidence based medicine; agitation; hepatitis; parkinsonism; QT prolongation; drug response; drug indication; amantadine; drug hypersensitivity; minocycline; neuroleptic malignant syndrome; creatine; Huntington chorea; drug dose increase; drug dose titration; jaundice; tetrabenazine; riluzole; acute respiratory failure; donepezil; ubidecarenone; remacemide; allergic pneumonitis; interstitial lung disease; randomized controlled trial (topic); ethyl eicosapentaenoic acid; nabilone