Opinion
Video
Resources to Manage HD
Author(s):
An expert neurologist discusses the management of HD, highlighting pharmacologic vs nonpharmacologic treatment.
This is a video synopsis/summary of a discussion involving Daniel Claassen, MD, MS.
Physicians managing Huntington's disease (HD) derive gratification from witnessing the alleviation of symptoms through medications that target motor, cognitive, and emotional aspects concurrently. The diagnostic approach guides the selection between pharmacologic and non-pharmacologic interventions, emphasizing the treatment of prevalent psychiatric symptoms with serotonin reuptake inhibitors or antipsychotics such as olanzapine, risperidone, and aripiprazole.
In the past decade, vesicular monoamine transporter 2 (VMAT2) inhibitors, including tetrabenazine and its derivatives like deutetrabenazine and valbenazine, have gained prominence in HD treatment by modulating presynaptic dopamine release. These inhibitors have proven efficacy in ameliorating chorea, as substantiated by three double-blind placebo-controlled trials. Despite their positive impact, clinicians must judiciously consider their use in light of potential risks, particularly depression and suicidality. Given the heightened risk of suicidal ideation in HD patients, routine discussions on mental health and safety are integral in clinical practice. VMAT2 inhibitors, while not altering disease progression, have become a common therapeutic choice owing to FDA approval for chorea associated with HD. This approach underscores the delicate balance between therapeutic benefits and potential adverse effects, highlighting the nuanced management required in addressing the complex symptoms of Huntington's disease.
Video synopsis in AI-generated and reviewed by NeurologyLive editorial staff.
