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Shin C, Kim R, Yoo D, Oh E, Moon J, Kim M, Lee JY, Kim JM, Koh SB, Kim M, Jeon B. A Practical Guide for Clinical Approach to Patients With Huntington's Disease in Korea. J Mov Disord 2024; 17:138-149. [PMID: 38467449 PMCID: PMC11082599 DOI: 10.14802/jmd.24040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/08/2024] [Accepted: 03/12/2024] [Indexed: 03/13/2024] Open
Affiliation(s)
- Chaewon Shin
- Department of Neurology, Chungnam National University Sejong Hospital, Sejong, Korea
- Department of Neurology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Ryul Kim
- Department of Neurology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Dallah Yoo
- Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
| | - Eungseok Oh
- Department of Neurology, Chungnam National University College of Medicine, Daejeon, Korea
- Department of Neurology, Chungnam National University Hospital, Daejeon, Korea
| | - Jangsup Moon
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Department of Genomic Medicine, Seoul National University Hospital, Seoul, Korea
| | - Minkyeong Kim
- Department of Neurology, Gyeongsang National University Hospital, Jinju, Korea
| | - Jee-Young Lee
- Department of Neurology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jong-Min Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seong-Beom Koh
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Manho Kim
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Beomseok Jeon
- Department of Neurology, BJ Center for Comprehensive Parkinson Care and Rare Movement Disorders, Chung-Ang University Health Care System, Hyundae Hospital, Namyangju, Korea
| | - on behalf of the Korean Huntington’s Disease Society
- Department of Neurology, Chungnam National University Sejong Hospital, Sejong, Korea
- Department of Neurology, Chungnam National University College of Medicine, Daejeon, Korea
- Department of Neurology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
- Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
- Department of Neurology, Chungnam National University Hospital, Daejeon, Korea
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Department of Genomic Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Neurology, Gyeongsang National University Hospital, Jinju, Korea
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
- Department of Neurology, BJ Center for Comprehensive Parkinson Care and Rare Movement Disorders, Chung-Ang University Health Care System, Hyundae Hospital, Namyangju, Korea
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2
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Prange S, Laurencin C, Roche P, Quadrio I, Thobois S. PSP-Richardson's Syndrome as a Rare Phenotypic Expression of Very Late-Onset Huntington's Disease: A Case Report. Mov Disord Clin Pract 2024; 11:303-305. [PMID: 38173343 PMCID: PMC10928328 DOI: 10.1002/mdc3.13943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 10/09/2023] [Accepted: 11/10/2023] [Indexed: 01/05/2024] Open
Affiliation(s)
- Stephane Prange
- Hospices Civils de Lyon, Department of Neurology C, Expert Parkinson Center NS‐PARK/FCRINPierre Wertheimer Neurological HospitalBronFrance
- Univ Lyon, Marc Jeannerod Cognitive Neuroscience Institute, CNRS, UMR 5229BronFrance
- Univ Lyon, Faculté de Médecine et de Maïeutique Lyon Sud Charles MérieuxUniversité Claude Bernard Lyon 1OullinsFrance
| | - Chloé Laurencin
- Hospices Civils de Lyon, Department of Neurology C, Expert Parkinson Center NS‐PARK/FCRINPierre Wertheimer Neurological HospitalBronFrance
| | - Pauline Roche
- Hospices Civils de Lyon, Department of Neurology C, Expert Parkinson Center NS‐PARK/FCRINPierre Wertheimer Neurological HospitalBronFrance
| | - Isabelle Quadrio
- Hospices Civils de Lyon, Neurobiology and NeurogeneticsDepartment of Biochemistry and Molecular BiologyLyonFrance
| | - Stéphane Thobois
- Hospices Civils de Lyon, Department of Neurology C, Expert Parkinson Center NS‐PARK/FCRINPierre Wertheimer Neurological HospitalBronFrance
- Univ Lyon, Marc Jeannerod Cognitive Neuroscience Institute, CNRS, UMR 5229BronFrance
- Univ Lyon, Faculté de Médecine et de Maïeutique Lyon Sud Charles MérieuxUniversité Claude Bernard Lyon 1OullinsFrance
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3
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Sturchio A, Duker AP, Muñoz-Sanjuan I, Espay AJ. Subtyping monogenic disorders: Huntington disease. HANDBOOK OF CLINICAL NEUROLOGY 2023; 193:171-184. [PMID: 36803810 DOI: 10.1016/b978-0-323-85555-6.00003-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Huntington disease is a highly disabling neurodegenerative disease characterized by psychiatric, cognitive, and motor deficits. The causal genetic mutation in huntingtin (Htt, also known as IT15), located on chromosome 4p16.3, leads to an expansion of a triplet coding for polyglutamine. The expansion is invariably associated with the disease when >39 repeats. Htt encodes for the protein huntingtin (HTT), which carries out many essential biological functions in the cell, in particular in the nervous system. The precise mechanism of toxicity is not known. Based on a one-gene-one-disease framework, the prevailing hypothesis ascribes toxicity to the universal aggregation of HTT. However, the aggregation process into mutant huntingtin (mHTT) is associated with a reduction of the levels of wild-type HTT. A loss of wild-type HTT may plausibly be pathogenic, contributing to the disease onset and progressive neurodegeneration. Moreover, many other biological pathways are altered in Huntington disease, such as in the autophagic system, mitochondria, and essential proteins beyond HTT, potentially explaining biological and clinical differences among affected individuals. As one gene does not mean one disease, future efforts at identifying specific Huntington subtypes are important to design biologically tailored therapeutic approaches that correct the corresponding biological pathways-rather than continuing to exclusively target the common denominator of HTT aggregation for elimination.
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Affiliation(s)
- Andrea Sturchio
- James J. and Joan A. Gardner Family Center for Parkinson's disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, United States; Department of Clinical Neuroscience, Neuro Svenningsson, Karolinska Institutet, Stockholm, Sweden.
| | - Andrew P Duker
- James J. and Joan A. Gardner Family Center for Parkinson's disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, United States
| | | | - Alberto J Espay
- James J. and Joan A. Gardner Family Center for Parkinson's disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, United States.
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4
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Liu Y, Oubre B, Duval C, Lee SI, Daneault JF. A Kinematic Data-Driven Approach to Differentiate Involuntary Choreic Movements in Individuals With Neurological Conditions. IEEE Trans Biomed Eng 2022; 69:3784-3791. [PMID: 35604991 PMCID: PMC9756312 DOI: 10.1109/tbme.2022.3177396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The ability to differentiate similar choreic involuntary movements could lay the groundwork for the development of a minimally-invasive screening tool for their etiology and provide in-depth understandings of pathophysiology. As a first step, we investigate kinematic differences between Huntington's disease (HD) chorea and Parkinson's disease (PD) choreic levodopa-induced dyskinesia (LID), which have distinct pathological causes yet share a great kinematic resemblance. METHODS Twenty subjects with HD and ten subjects with PD stood with both upper limbs in front of them for approximately 60 seconds. The three-dimensional velocity time-series of involuntary movements of both hands were segmented into one-dimensional sub-movements abutted by velocity zero-crossings. A combination of unsupervised and supervised machine learning algorithms was employed to automatically select data features extracted from sub-movements and distinguish the two types of involuntary choreic movements. RESULTS The trained model was able to accurately classify chorea vs. LID with an Area Under the Receiver Operating Characteristic Curve of 99.5%. A set of important features contributing to the construction of the classification model were identified and investigated. CONCLUSION The trained model may serve as a tool for the automatic identification of different types of involuntary choreic movements, enabling continuous monitoring and personalized treatment for patients in various clinical settings. SIGNIFICANCE The results provide insights into kinematic characteristics of HD chorea and PD LID, which is the first step towards an improved general understanding of involuntary choreic movements.
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Affiliation(s)
- Yunda Liu
- College of Information and Computer Sciences, University of Massachusetts, Amherst, MA, USA
| | - Brandon Oubre
- College of Information and Computer Sciences, University of Massachusetts, Amherst, MA, USA
| | - Christian Duval
- Département des Sciences de l’Activité Physique, Université du Québec à Montréal, Montréal, QC, Canada
| | - Sunghoon Ivan Lee
- College of Information and Computer Sciences, University of Massachusetts, Amherst, MA, USA
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5
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Salari M, Beladi Moghadam N, Soleimani S, Etemadifar M. Atypical parkinsonism can be a presenting feature of late‐onset Huntington's disease. Clin Case Rep 2022; 10:e6014. [PMID: 35846909 PMCID: PMC9272221 DOI: 10.1002/ccr3.6014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 06/05/2022] [Accepted: 06/19/2022] [Indexed: 11/30/2022] Open
Abstract
Huntington's disease is a progressive neurodegenerative disease that typically manifests with Choreic movements, psychological disorders, and cognitive decline. Some patients can initially present atypical movements other than the usual symptoms, such as parkinsonism, ataxia, and dystonia. In this report, we present an HD patient who presented with atypical parkinsonism.
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Affiliation(s)
- Mehri Salari
- Department of Neurology Shohada Tajrish Hospital Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Nahid Beladi Moghadam
- Department of Neurology, Imam Hossein Hospital Shahid Beheshti University of Medical Science Tehran Iran
| | - Sevim Soleimani
- Student research Committee, faculty of Medicine Shahid Beheshti University of Medical Science Shahid Beheshti Medical University Tehran Iran
| | - Masoud Etemadifar
- Department of Neurosurgery, School of Medicine Isfahan University of Medical Science Isfahan Iran
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6
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Kwak IH, Kim NH, Ma HI, Kim YE. Huntington's Disease Presenting as Adult-Onset Parkinsonism. J Clin Neurol 2022; 18:87-89. [PMID: 35021281 PMCID: PMC8762510 DOI: 10.3988/jcn.2022.18.1.87] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/02/2021] [Accepted: 11/02/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- In Hee Kwak
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Na Hee Kim
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Hyeo-Il Ma
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Young Eun Kim
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.
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7
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Franco G, Lazzeri G, Di Fonzo A. Parkinsonism and ataxia. J Neurol Sci 2021; 433:120020. [PMID: 34711421 DOI: 10.1016/j.jns.2021.120020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/09/2021] [Accepted: 09/29/2021] [Indexed: 11/17/2022]
Abstract
Ataxia is not a common feature in Parkinson's disease. Nevertheless, some rare forms of parkinsonism have ataxia as one of the main features in their clinical picture, especially those with juvenile or early-onset. On the other side, in cerebellar degenerative diseases, parkinsonism might accompany the typical symptoms and even become predominant in some cases. Many disorders involving different neurological systems present with a movement phenomenology reflecting the underlying pattern of pathological involvement, such as neurodegeneration with brain iron accumulation, neurodegeneration associated with calcium deposition, and metabolic and mitochondrial disorders. The prototype of sporadic disorders that present with a constellation of symptoms due to the involvement of multiple Central Nervous System regions is multiple system atrophy, whose motor symptoms at onset can be cerebellar ataxia or parkinsonism. Clinical syndromes encompassing both parkinsonian and cerebellar features might represent a diagnostic challenge for neurologists. Recognizing acquired and potentially treatable causes responsible for complex movement disorders is of paramount importance, since an early diagnosis is essential to prevent permanent consequences. The present review aims to provide a pragmatic overview of the most common diseases characterized by the coexistence of cerebellar and parkinsonism features and suggests a possible diagnostic approach for both inherited and sporadic disorders. This article is part of the Special Issue "Parkinsonism across the spectrum of movement disorders and beyond" edited by Joseph Jankovic, Daniel D. Truong and Matteo Bologna.
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Affiliation(s)
- Giulia Franco
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy
| | - Giulia Lazzeri
- Dino Ferrari Center, Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Alessio Di Fonzo
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy.
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8
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Stoker TB, Mason SL, Greenland JC, Holden ST, Santini H, Barker RA. Huntington's disease: diagnosis and management. Pract Neurol 2021; 22:32-41. [PMID: 34413240 DOI: 10.1136/practneurol-2021-003074] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2021] [Indexed: 11/03/2022]
Abstract
Huntington's disease (HD) is an inherited neurodegenerative disease characterised by neuropsychiatric symptoms, a movement disorder (most commonly choreiform) and progressive cognitive impairment. The diagnosis is usually confirmed through identification of an increased CAG repeat length in the huntingtin gene in a patient with clinical features of the condition. Though diagnosis is usually straightforward, unusual presentations can occur, and it can be difficult to know when someone has transitioned from being an asymptomatic carrier into the disease state. This has become increasingly important recently, with several putative disease-modifying therapies entering trials. A growing number of conditions can mimic HD, including rare genetic causes, which must be considered in the event of a negative HD genetic test. Patients are best managed in specialist multidisciplinary clinics, including when considering genetic testing. Current treatments are symptomatic, and largely directed at the chorea and neurobehavioural problems, although supporting trial evidence for these is often limited.
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Affiliation(s)
- Thomas B Stoker
- John van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Sarah L Mason
- John van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Julia C Greenland
- John van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Simon T Holden
- Department of Clinical Genetics, Addenbrooke's Hospital, Cambridge, UK
| | | | - Roger A Barker
- John van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,Wellcome Trust Medical Research Council - Cambridge Stem Cell Institute, Cambridge, UK
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9
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Huntington's disease: lessons from prion disorders. J Neurol 2021; 268:3493-3504. [PMID: 33625583 DOI: 10.1007/s00415-021-10418-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 02/06/2023]
Abstract
Decades of research on the prion protein and its associated diseases have caused a paradigm shift in our understanding of infectious agents. More recent years have been marked by a surge of studies supporting the application of these findings to a broad array of neurodegenerative disorders such as Alzheimer's and Parkinson's diseases. Here, we present evidence to suggest that Huntington's disease, a monogenic disorder of the central nervous system, shares features with prion disorders and that, it too, may be governed by similar mechanisms. We further posit that these similarities could suggest that, like other common neurodegenerative disorders, sporadic forms of Huntington's disease may exist.
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10
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Ranganathan M, Kostyk SK, Allain DC, Race JA, Daley AM. Age of onset and behavioral manifestations in Huntington's disease: An Enroll-HD cohort analysis. Clin Genet 2020; 99:133-142. [PMID: 33020896 DOI: 10.1111/cge.13857] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/01/2020] [Accepted: 10/03/2020] [Indexed: 11/28/2022]
Abstract
Huntington's disease is associated with motor, cognitive and behavioral dysfunction. Behavioral symptoms may present before, after, or simultaneously with clinical disease manifestation. The relationship between age of onset and behavioral symptom presentation and severity was explored using the Enroll-HD database. Manifest individuals (n = 4469) were initially divided into three groups for preliminary analysis: early onset (<30 years; n = 479); mid-adult onset (30-59 years; n = 3478); and late onset (>59 years; n = 512). Incidence of behavioral symptoms reported at onset was highest in those with early onset symptoms at 26% (n = 126), compared with 19% (n = 678) for mid-adult onset and 11% (n = 56) for late onset (P < 0.0001). Refined analysis, looking across the continuum of ages rather than between categorical subgroups found that a one-year increase in age of onset was associated with a 5.6% decrease in the odds of behavioral symptoms being retrospectively reported as the presenting symptom (P < 0.0001). By the time of study enrollment, the odds of reporting severe behavioral symptoms decreased by 5.5% for each one-year increase in reported age of onset. Exploring environmental, genetic and epigenetic factors that affect age of onset and further characterizing types and severity of behavioral symptoms may improve treatment and understanding of Huntington's disease's impact on affected individuals.
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Affiliation(s)
- Megha Ranganathan
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA.,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Sandra K Kostyk
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Dawn C Allain
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Jonathan A Race
- Division of Biostatistics, The Ohio State University, Columbus, Ohio, USA.,Eli Lilly and Company, Design Hub-Immunology Division, Indianapolis, Indiana, USA
| | - Allison M Daley
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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11
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Rojas NG, Ziliani JE, Cesarini ME, Etcheverry JL, Da Prat GA, McCusker E, Gatto EM. Late Onset Huntington Disease: Phenotypic and Genotypic Characteristics of 10 Cases in Argentina. J Huntingtons Dis 2020; 8:195-198. [PMID: 31045517 DOI: 10.3233/jhd-180330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Huntington's disease (HD) is a neurodegenerative disorder that includes motor, psychiatric and cognitive manifestations with typical onset of symptoms is in the forties. A percentage of patients (4.4% - 11.5%) may be exceptions to this and manifest symptoms later (>60 years old). Diagnosis of Late onset HD (LoHD) can be a challenge, due to the low suspicion of the disease at this age. OBJECTIVE To review the genotype and phenotype of LoHD in an Argentinian cohort. METHODS We reviewed the medical records and genetic testing of a total of 95 individuals with clinical and molecular diagnosis of Huntington's disease, based on 2 institution's registry. RESULTS Among our HD cohort, 10 patients (10.52%) had LoHD, with variable results regarding family history. The average of repetitions of the expanded allele was 40 (range 38-44). All cases had mild motor symptoms at onset. CONCLUSIONS Late onset HD can be a diagnostic challenge, due to its slow progression, unawareness of manifestations among patients and in many cases, mild symptomatology that does not warrant medical attention.
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Affiliation(s)
| | | | | | | | - Gustavo Andrés Da Prat
- Instituto Neurociencias Buenos Aires (INEBA), Buenos Aires, Argentina.,Sanatorio de La Trinidad Mitre, Buenos Aires, Argentina
| | - Elizabeth McCusker
- The University of Sydney, School of Medicine Westmead and Neurology Department, Westmead Hospital, Sydney, NSW, Australia
| | - Emilia Mabel Gatto
- Instituto Neurociencias Buenos Aires (INEBA), Buenos Aires, Argentina.,Sanatorio de La Trinidad Mitre, Buenos Aires, Argentina
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12
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How to approach a patient with parkinsonism - red flags for atypical parkinsonism. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2019; 149:1-34. [PMID: 31779810 DOI: 10.1016/bs.irn.2019.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Parkinsonism is a clinical syndrome defined by bradykinesia plus rigidity or tremor. Though most commonly encountered in the setting of idiopathic Parkinson's disease, a number of neurodegenerative, structural, metabolic and toxic neurological disorders can result in parkinsonism. Accurately diagnosing the underlying cause of parkinsonism is of both therapeutic and prognostic relevance, especially as we enter the era of disease-modifying treatment trials for neurodegenerative disorders. Being aware of the wide array of potential causes of parkinsonism is of paramount importance for clinicians. In this chapter, we present a pragmatic clinical approach to patients with parkinsonism, specifically focusing on 'red flags', which should alert one to consider diagnoses other than idiopathic Parkinson's disease.
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13
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Parkinsonism with a Hint of Huntington's from 29 CAG Repeats in HTT. Brain Sci 2019; 9:brainsci9100245. [PMID: 31546689 PMCID: PMC6826852 DOI: 10.3390/brainsci9100245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 09/20/2019] [Accepted: 09/20/2019] [Indexed: 01/09/2023] Open
Abstract
Huntington's disease is caused by at least 36 cytosine-adenine-guanine (CAG) repeats in an HTT gene allele, but repeat tracts in the intermediate range (27-35 repeats) also display a subtle phenotype. This patient had a slightly elongated CAG repeat tract (29 repeats), a prominent family history of Parkinson's disease (PD), and a clinical phenotype mostly consistent with PD, but early dystonia and poor levodopa response. Neurophysiological test results were more consistent with Huntington's disease (HD) than PD. It is suggested that the intermediate allele modulated the clinical phenotype of PD in this patient.
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14
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Manalo RVM. Cytosolic non-vesicular dopamine accumulation as the predominant mechanism for developing non-DOPA responsive parkinsonism in late-stage Huntington disease. Med Hypotheses 2019; 132:109377. [PMID: 31466019 DOI: 10.1016/j.mehy.2019.109377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 08/09/2019] [Accepted: 08/20/2019] [Indexed: 12/30/2022]
Abstract
Disturbances in motor movement can have similar clinical presentations, albeit having different pathways and temporal onset. Hypokinetic movements present with rigidity, resting tremors, postural instability and bradykinesia, as seen in parkinsonism, while hyperkinetic movements typically present with chorea, ballismus, tic, athetosis and dystonia. Nonetheless, movement disorders are thought to be a continuum. Long-term therapy of parkinsonism with L-DOPA or dopamine (DA) agonists leads to late-onset dyskinesia - a hyperkinetic movement disorder, while patients with late-stage Huntington disease (HD) often develop non-DOPA responsive parkinsonism. In this paper, it is proposed that late-onset parkinsonism is driven by the overactivity of the nigrostriatal dopaminergic pathway. The excessive synthesis, storage, release, reuptake and degradation of dopamine in the presynaptic terminal and synaptic clefts lead to cellular stress and damage, resulting to progressive neuroapoptosis aggravated by pro-parkinsonism drugs used to treat hyperkinesia. Glutamate excitotoxicity may provide initial stress to neurons during early HD - but as the disease advances, lower glutamate levels are observed, making it less likely to cause the hypokinetic shift on its own. Over time, dopaminergic neurons are depleted and cholinergic influence to striatal GABA release is unopposed, leading to late-onset parkinsonism that is unresponsive to DOPA challenge, due to drastic DA neuron loss previously masked by the dominating choreic presentation. This paper thus provides a mechanism of action to a common clinical sequela and complication of long-term choreic diseases, whose pathophysiologic mechanism is presently lacking.
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Affiliation(s)
- Rafael Vincent M Manalo
- College of Medicine, University of the Philippines Manila, Ermita, Manila 1000, Philippines.
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15
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Bachoud-Lévi AC, Ferreira J, Massart R, Youssov K, Rosser A, Busse M, Craufurd D, Reilmann R, De Michele G, Rae D, Squitieri F, Seppi K, Perrine C, Scherer-Gagou C, Audrey O, Verny C, Burgunder JM. International Guidelines for the Treatment of Huntington's Disease. Front Neurol 2019; 10:710. [PMID: 31333565 PMCID: PMC6618900 DOI: 10.3389/fneur.2019.00710] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 06/17/2019] [Indexed: 12/11/2022] Open
Abstract
The European Huntington's Disease Network (EHDN) commissioned an international task force to provide global evidence-based recommendations for everyday clinical practice for treatment of Huntington's disease (HD). The objectives of such guidelines are to standardize pharmacological, surgical and non-pharmacological treatment regimen and improve care and quality of life of patients. A formalized consensus method, adapted from the French Health Authority recommendations was used. First, national committees (French and English Experts) reviewed all studies published between 1965 and 2015 included dealing with HD symptoms classified in motor, cognitive, psychiatric, and somatic categories. Quality grades were attributed to these studies based on levels of scientific evidence. Provisional recommendations were formulated based on the strength and the accumulation of scientific evidence available. When evidence was not available, recommendations were framed based on professional agreement. A European Steering committee supervised the writing of the final recommendations through a consensus process involving two rounds of online questionnaire completion with international multidisciplinary HD health professionals. Patients' associations were invited to review the guidelines including the HD symptoms. Two hundred and nineteen statements were retained in the final guidelines. We suggest to use this adapted method associating evidence base-medicine and expert consensus to other rare diseases.
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Affiliation(s)
- Anne-Catherine Bachoud-Lévi
- National Centre of Reference for Huntington's Disease, Henri Mondor Hospital, AP-HP, Creteil & NeurATRIS, Créteil, France
| | - Joaquim Ferreira
- Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal
| | - Renaud Massart
- National Centre of Reference for Huntington's Disease, Henri Mondor Hospital, AP-HP, Creteil & NeurATRIS, Créteil, France
| | - Katia Youssov
- National Centre of Reference for Huntington's Disease, Henri Mondor Hospital, AP-HP, Creteil & NeurATRIS, Créteil, France
| | - Anne Rosser
- IPMCN, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Monica Busse
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - David Craufurd
- Division of Evolution and Genomic Sciences, Faculty of Biology, Medicine and Health, Manchester Centre for Genomic Medicine, School of Biological Sciences, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Ralf Reilmann
- Department of Radiology, George-Huntington-Institute, Universitaetsklinikum Muenster, Münster, Germany
- Department of Neurodegenerative Diseases and Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | | | - Daniela Rae
- Department of Clinical Genetics, NHS Grampian, Aberdeen, United Kingdom
| | - Ferdinando Squitieri
- Huntington and Rare Diseases Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Klaus Seppi
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Charles Perrine
- Genetic Department, National Center of reference for Huntington's Disease, Salpêtrière Hospital, Paris, France
| | | | - Olivier Audrey
- Neurology Department, Angers University Hospital, Angers, France
| | - Christophe Verny
- Neurology Department and UMR CNRS 6214 INSERM U1083, National Centre of Reference for Neurodegenerative Diseases, Angers University Hospital, Angers, France
| | - Jean-Marc Burgunder
- NeuroZentrumSiloah and Department of Neurology, Swiss HD Center, University of Bern, Bern, Switzerland
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16
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Youssov K, Bachoud-Lévi AC. Malattia di Huntington: aspetti diagnostici attuali e applicazioni pratiche. Neurologia 2018. [DOI: 10.1016/s1634-7072(18)89403-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Abstract
Background: Although the typical age of onset for Huntington’s disease (HD) is in the fourth decade, between 4.4–11.5% of individuals with HD have a late onset (over 60 years of age). Diagnosis of Late onset HD (LoHD) can be missed, due to the perceived low likelihood of HD in the over 60-year-olds. Objective: To review the epidemiology, genotype and phenotype of LoHD. Methods: We systematically searched MEDLINE, EMBASE and Web of Science (inception-November 2016). Web of Science was then used to search for papers citing identified studies. Content experts were consulted for any additional studies. We included all studies reporting the clinical phenotype of LoHD for more than one participant. Results: 20 studies were identified from a potential list of 1243. Among Caucasian HD cohorts, 4.4–11.5% of individuals have LoHD, and this proportion may be increasing. Proportion of LoHD without a positive family history ranges from 3–68%. 94.4% of reported cases of LoHD had CAG repeat lengths of ≤44. Motor manifestations are the commonest initial presentation, although 29.2% presented with non-motor manifestations as the first clinical feature in one case series. Individuals with LoHD may have slower progression of illness. Cognitive impairment rather than chorea may be the major source of disability in this group. Conclusions: LoHD represents a substantial proportion of new diagnoses of HD and has some unique features. Further characterization of this population will aid clinicians in diagnosis.
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Affiliation(s)
- Sai S Chaganti
- Huntington Disease Service, Westmead Hospital, Sydney, Australia.,Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Elizabeth A McCusker
- Huntington Disease Service, Westmead Hospital, Sydney, Australia.,Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Clement T Loy
- Huntington Disease Service, Westmead Hospital, Sydney, Australia.,School of Public Health, The University of Sydney, Sydney, Australia.,The Garvan Institute of Medical Research, Sydney, Australia
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Rangel-Barajas C, Rebec GV. Dysregulation of Corticostriatal Connectivity in Huntington's Disease: A Role for Dopamine Modulation. J Huntingtons Dis 2017; 5:303-331. [PMID: 27983564 PMCID: PMC5181679 DOI: 10.3233/jhd-160221] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Aberrant communication between striatum, the main information processing unit of the basal ganglia, and cerebral cortex plays a critical role in the emergence of Huntington’s disease (HD), a fatal monogenetic condition that typically strikes in the prime of life. Although both striatum and cortex undergo substantial cell loss over the course of HD, corticostriatal circuits become dysfunctional long before neurons die. Understanding the dysfunction is key to developing effective strategies for treating a progressively worsening triad of motor, cognitive, and psychiatric symptoms. Cortical output neurons drive striatal activity through the release of glutamate, an excitatory amino acid. Striatal outputs, in turn, release γ-amino butyric acid (GABA) and exert inhibitory control over downstream basal ganglia targets. Ample evidence from transgenic rodent models points to dysregulation of corticostriatal glutamate transmission along with corresponding changes in striatal GABA release as underlying factors in the HD behavioral phenotype. Another contributor is dysregulation of dopamine (DA), a modulator of both glutamate and GABA transmission. In fact, pharmacological manipulation of DA is the only currently available treatment for HD symptoms. Here, we review data from animal models and human patients to evaluate the role of DA in HD, including DA interactions with glutamate and GABA within the context of dysfunctional corticostriatal circuitry.
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Affiliation(s)
| | - George V. Rebec
- Correspondence to: George V. Rebec, PhD, Department of Psychological and Brain Sciences, Program in
Neuroscience, Indiana University, 1101 E. 10th Street, Bloomington, IN 47405-7007, USA. Tel.: +1 812 855 4832;
Fax: +1 812 855 4520; E-mail:
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19
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Medical management of motor manifestations of Huntington disease. HANDBOOK OF CLINICAL NEUROLOGY 2017. [PMID: 28947112 DOI: 10.1016/b978-0-12-801893-4.00012-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
The motor and movement disorders of Huntington disease (HD) are managed in the context of the other disease features. Chorea and dystonia are the most common HD-associated movement disorders, and they can be assessed on research rating scales. However other motor manifestations have a significant impact. In particular, dysphagia influences choice and tolerance of treatment for the movement disorder, as will comorbidities, patient awareness, and distress related to the motor feature or movement. Treatment for other disease features may aggravate the motor disorder, e.g., increased swallowing difficulty associated with antipsychotic agents. Basic principles in deciding to institute a treatment are outlined as well as treatment of specific motor manifestations and movements. There is a paucity of evidence to support the treatments available for the motor disorder, with only one agent with class 1 evidence, tetrabenazine, for chorea. There are, however, treatments informed by expert opinion which reflect the management of a wider HD phenotype than that represented in clinical trials. Some treatments are based on evidence from use in other conditions. Medical management is usually undertaken later in the disease with concurrent nonmedical interventions after multidisciplinary assessments. Medication review with HD progression is essential.
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Sipilä JOT, Kauko T, Päivärinta M, Majamaa K. Comparison of mid-age-onset and late-onset Huntington’s disease in Finnish patients. J Neurol 2017; 264:2095-2100. [DOI: 10.1007/s00415-017-8600-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 08/16/2017] [Accepted: 08/18/2017] [Indexed: 11/29/2022]
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21
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Abstract
Huntington's disease (HD) is an autosomal dominantly inherited neurodegenerative disease characterized by progressive motor, behavioral, and cognitive decline, ending in death. Despite the discovery of the underlying genetic mutation more than 20 years ago, treatment remains focused on symptomatic management. Chorea, the most recognizable symptom, responds to medication that reduces dopaminergic neurotransmission. Psychiatric symptoms such as depression and anxiety may also respond well to symptomatic therapies. Unfortunately, many other symptoms do not respond to current treatments. Furthermore, high-quality evidence for treatment of HD in general remains limited. To date, there has been minimal success with identifying a disease-modifying therapy based upon molecular models. However, one of the emerging gene silencing techniques may provide a breakthrough in treating this devastating disease.
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Affiliation(s)
- Kara J Wyant
- Department of Neurology, University of Michigan, 1324 Taubman Center, SPC 5322, 1500 E. Medical Center Drive, Ann Arbor, 48109-5322, USA.
| | - Andrew J Ridder
- Department of Neurology, University of Michigan, 1324 Taubman Center, SPC 5322, 1500 E. Medical Center Drive, Ann Arbor, 48109-5322, USA
| | - Praveen Dayalu
- Department of Neurology, University of Michigan, 1324 Taubman Center, SPC 5322, 1500 E. Medical Center Drive, Ann Arbor, 48109-5322, USA
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22
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Erro R, Schneider SA, Stamelou M, Quinn NP, Bhatia KP. What do patients with scans without evidence of dopaminergic deficit (SWEDD) have? New evidence and continuing controversies. J Neurol Neurosurg Psychiatry 2016; 87:319-23. [PMID: 25991401 DOI: 10.1136/jnnp-2014-310256] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Accepted: 05/04/2015] [Indexed: 11/03/2022]
Abstract
The term SWEDD (scans without evidence for dopaminergic deficit) refers to the absence, rather than the presence, of an imaging abnormality in patients clinically presumed to have Parkinson's disease (PD). However, such a term has since been widely used in the medical literature, even as a diagnostic label. While many authors have suggested that different disorders of PD lookalikes may account for a proportion of SWEDD cases, others have claimed that some of them may have a benign subtype of PD. Thus, there has been ensuing controversy and confusion and the use of this term continues without clarity of what it represents. We have systematically reviewed all the studies involving patients with SWEDD with the aim of shedding light on what these patients actually have. It becomes clear from this systematic review that while most 'SWEDD' cases are due to a clinical misdiagnosis of PD, there exists a small proportion of patients with SWEDD who may have PD on the basis of a positive levodopa response, clinical progression, imaging and/or genetic evidence. The latter challenge the seemingly incontrovertible relationship between dopaminergic tracer binding and the diagnosis of nigrostriatal parkinsonism, particularly PD. Patients with SWEDD are unlikely to reflect a single clinical entity and we suggest that the term SWEDD should be abandoned.
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Affiliation(s)
- Roberto Erro
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London (UCL) Institute of Neurology, London, UK Dipartimento di Scienze Neurologiche e del Movimento, Università di Verona, Verona, Italy
| | - Susanne A Schneider
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London (UCL) Institute of Neurology, London, UK Department of Neurology, University Kiel, Kiel, Germany
| | - Maria Stamelou
- Second Department of Neurology, University of Athens, Greece; Movement Disorders Department, Hygeia Hospital, Athens, Greece Department of Neurology, Philipps University Marburg, Germany
| | - Niall P Quinn
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London (UCL) Institute of Neurology, London, UK
| | - Kailash P Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London (UCL) Institute of Neurology, London, UK
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Schwab LC, Garas SN, Garas SN, Drouin-Ouellet J, Mason SL, Stott SR, Barker RA. Dopamine and Huntington's disease. Expert Rev Neurother 2015; 15:445-58. [PMID: 25773746 DOI: 10.1586/14737175.2015.1025383] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Huntington's disease (HD) is an incurable, inherited, progressive neurodegenerative disorder that is defined by a combination of motor, cognitive and psychiatric features. Pre-clinical and clinical studies have demonstrated an important role for the dopamine (DA) system in HD with dopaminergic dysfunction at the level of both DA release and DA receptors. It is, therefore, not surprising that the drug treatments most commonly used in HD are anti-dopaminergic agents. Their use is based primarily on the belief that the characteristic motor impairments are a result of overactivation of the central dopaminergic pathways. While this is a useful starting place, it is clear that the behavior of the central dopaminergic pathways is not fully understood in this condition and may change as a function of disease stage. In addition, how abnormalities in dopaminergic systems may underlie some of the non-motor features of HD has also been poorly investigated and this is especially important given the greater burden these place on the patients' and families' quality of life. In this review, we discuss what is known about central dopaminergic pathways in HD and how this informs us about the mechanisms of action of the dopaminergic therapies used to treat it. By doing so, we will highlight some of the paradoxes that exist and how solving them may reveal new insights for improved treatment of this currently incurable condition, including the possibility that such drugs may even have effects on disease progression and pathogenesis.
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Affiliation(s)
- Laetitia C Schwab
- John van Geest Centre for Brain Repair, University of Cambridge, E.D. Adrian Building, Forvie Site, Robinson Way, Cambridge, CB2 0PY, UK
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Killoran A, Biglan KM. Current therapeutic options for Huntington's disease: good clinical practice versus evidence-based approaches? Mov Disord 2014; 29:1404-13. [PMID: 25164707 DOI: 10.1002/mds.26014] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 07/18/2014] [Accepted: 08/06/2014] [Indexed: 01/17/2023] Open
Abstract
Therapeutic decision-making in Huntington's disease (HD) is often guided by clinical experience, because of the limited empirical evidence available. The only medication for HD that has met the regulatory hurdle for approval is tetrabenazine, indicated for the treatment of chorea. However, its use has limitations, and in the setting of specific contraindications or comorbidities the treatment of choice for chorea is still the multipurpose antipsychotics. For the management of psychiatric disturbances, selective serotonin reuptake inhibitors (SSRIs) and mood stabilizers are often used, although empirical evidence is lacking. Finally, no known effective treatment is available for cognitive dysfunction in HD. We discuss the limited evidence available and current expert opinion on medical treatment of the dominant motor, psychiatric, and cognitive features of HD. This follows a brief introduction on the general principles of HD management and on evidence-based medicine in relation to clinical practice.
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Affiliation(s)
- Annie Killoran
- West Virginia University, Morgantown, West Virginia, USA
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25
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Gonzalez V, Cif L, Biolsi B, Garcia-Ptacek S, Seychelles A, Sanrey E, Descours I, Coubes C, de Moura AMR, Corlobe A, James S, Roujeau T, Coubes P. Deep brain stimulation for Huntington's disease: long-term results of a prospective open-label study. J Neurosurg 2014; 121:114-22. [PMID: 24702329 DOI: 10.3171/2014.2.jns131722] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
UNLABELLED OBJECT.: To date, experience of globus pallidus internus (GPi) deep brain stimulation (DBS) in the treatment of Huntington's disease (HD) has been limited to a small number of case reports. The aim of this study was to analyze long-term motor outcome of a cohort of HD patients treated with GPi DBS. METHODS Seven patients with pharmacologically resistant chorea and functional impairment were included in a prospective open-label study from 2008 to 2011. The main outcome measure was the motor section of the Unified Huntington's Disease Rating Scale. The primary end point was reduction of chorea. RESULTS Patients underwent MRI-guided bilateral GPi implantation. The median duration of follow-up was 3 years. A significant reduction of chorea was observed in all patients, with sustained therapeutic effect; the mean improvement on the chorea subscore was 58.34% at the 12-month follow-up visit (p = 0.018) and 59.8% at the 3-year visit (p = 0.040). Bradykinesia and dystonia showed a nonsignificant trend toward progressive worsening related to disease evolution and partly to DBS. The frequency of stimulation was 130 Hz for all patients. DBS-induced bradykinesia was managed by pulse-width reduction or bipolar settings. Levodopa mildly improved bradykinesia in 4 patients. Regular off-stimulation tests confirmed a persistent therapeutic effect of DBS on chorea. CONCLUSIONS GPi DBS may provide sustained chorea improvement in selected HD patients with pharmacologically resistant chorea, with transient benefit in physical aspects of quality of life before progression of behavioral and cognitive disorders. DBS therapy did not improve dystonia or bradykinesia. Further studies including quality of life measures are needed to evaluate the impact of DBS in the long-term outcome of HD.
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Quadruple deep brain stimulation in Huntington's disease, targeting pallidum and subthalamic nucleus: case report and review of the literature. J Neural Transm (Vienna) 2014; 121:1303-12. [PMID: 24699718 DOI: 10.1007/s00702-014-1201-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 03/18/2014] [Indexed: 10/25/2022]
Abstract
Deep brain stimulation (DBS) represents an established treatment option in a growing number of movement disorders. Recent case reports suggest beneficial effect of globus pallidus internus (GPi)-DBS in selected patients suffering from Huntington's disease with marked disabling chorea. We present a 41-year-old man with genetically confirmed HD following quadruple GPi- and subthalamic nucleus (STN)-DBS. Motor function was assessed by Abnormal Involuntary Movement Scale (AIMS) and by Unified Huntington Disease Rating Scale (UHDRS) presurgery and postsurgery for up to 4 years. Furthermore, cognitive, neuropsychiatric state and quality of life (QoL) including life satisfaction (QLS) were annually evaluated. Chorea assessed by AIMS and UHDRS subscores improved by 52 and 55 %, 45 and 60 %, 35 and 45 % and 55-66 % at 1-4 years, respectively, compared to presurgical state following GPi-STN-DBS. During these time periods bradykinesia did not increase following separate STN- and combined GPi-STN-DBS compared to presurgical state. Mood, QoL and QLS were ameliorated. However, dysexecutive symptoms increased at 4 years postsurgery. The present case report suggests that bilateral GPi- and STN-DBS may represent a new treatment avenue in selected HD patients. Clinically, GPi-DBS attenuated chorea and was associated with a larger effect-adverse effect window compared to STN-DBS. However, GPi-DBS-induced bradykinesia may emerge as one main limitation of GPi-DBS in HD. Thus, quadruple GPi-STN-DBS may be indicated, if separate GPi-DBS does not result in sufficient control of motor symptoms. Future controlled studies need to confirm if the present anecdotal observation of additive beneficial effects of GPi- and STN-DBS in a HD patient with severe generalized chorea and relatively intact cognitive and affective functions indeed represents a new therapeutic option.
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28
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Nucleic Acid-Based Therapy Approaches for Huntington's Disease. Neurol Res Int 2012; 2012:358370. [PMID: 22288011 PMCID: PMC3263636 DOI: 10.1155/2012/358370] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 09/28/2011] [Accepted: 10/05/2011] [Indexed: 01/30/2023] Open
Abstract
Huntington's disease (HD) is caused by a dominant mutation that results in an unstable expansion of a CAG repeat in the huntingtin gene leading to a toxic gain of function in huntingtin protein which causes massive neurodegeneration mainly in the striatum and clinical symptoms associated with the disease. Since the mutation has multiple effects in the cell and the precise mechanism of the disease remains to be elucidated, gene therapy approaches have been developed that intervene in different aspects of the condition. These approaches include increasing expression of growth factors, decreasing levels of mutant huntingtin, and restoring cell metabolism and transcriptional balance. The aim of this paper is to outline the nucleic acid-based therapeutic strategies that have been tested to date.
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29
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Atypical Parkinsonism Revealing a Late Onset, Rigid and Akinetic Form of Huntington's Disease. Case Rep Neurol Med 2011; 2011:696953. [PMID: 22937345 PMCID: PMC3420516 DOI: 10.1155/2011/696953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Accepted: 07/11/2011] [Indexed: 11/17/2022] Open
Abstract
Huntington's disease (HD) is a rare hereditary neurodegenerative disorder characterized in over 90 percent of cases by chorea as the presenting motor symptom. We report a 54-year-old male who presented with Parkinsonism as the initial symptom of the disease. Genetic analysis revealed expansion of 40 CAG repeats, and brain MRI showed both severe caudate nuclei and cortical atrophy. Single-photon emission computed tomography (SPECT) imaging of the dopamine transporter showed nigrostriatal pathway degeneration. Here, we also describe his 2 years of clinical followup after ensuing dopaminergic stimulation.
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30
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Abstract
Huntington's disease (HD) is an inherited disorder that causes neurological, cognitive, and psychiatric symptoms. Most patients with HD develop symptoms in all three of these domains, often concurrently. Problems in one area can impact and magnify symptoms in another domain. Limited treatment options exist for neurological and cognitive symptoms at this time, and no treatment exists to slow disease progression. In contrast, many behavioral symptoms respond to psychiatric medication. Thorough and aggressive treatment of psychiatric symptoms can positively impact both patient and caregiver quality of life, and may allow patients to remain longer in the home. There are currently numerous treatment trials not only for symptomatic therapy, but also for disease-modifying agents.
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Affiliation(s)
- Karen E Anderson
- Movement Disorders Division, Department of Neurology, School of Medicine, University of Maryland, Baltimore 21201, USA.
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31
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Klein C, Schneider SA, Lang AE. Hereditary parkinsonism: Parkinson disease look-alikes-An algorithm for clinicians to “PARK
” genes and beyond. Mov Disord 2009; 24:2042-58. [DOI: 10.1002/mds.22675] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Abstract
Huntington's disease (HD) is a relentless neurodegenerative disease that results in profound disability through a triad of motor, cognitive and neuropsychiatric symptoms. At present, there are very few therapeutic interventions available with the exception of a limited number of drugs that offer mild symptomatic relief. Although the genetic basis of the disease has been identified, the mechanisms behind the cellular pathogenesis are still not clear and as a result no candidate drugs with the potential for disease modification have been found clinically until now. One of the major limitations in assessing the usefulness of drug treatments in HD is the lack of well-designed, double-blind, placebo-controlled clinical trials. Most studies have been open-label, using a small number of patients and tend to concentrate on the motor features of the disease, primarily the chorea. This review discusses the treatments now used for HD before evaluating the newer drugs at present being explored in both the clinic and in the laboratory in mouse models of the disease.
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Affiliation(s)
- Sarah L Mason
- Cambridge Centre for Brain Repair, ED Adrian Building, Forvie Site, Robinson Way, Cambridge CB20PY, UK.
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34
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Phillips W, Shannon KM, Barker RA. The current clinical management of Huntington's disease. Mov Disord 2009; 23:1491-504. [PMID: 18581443 DOI: 10.1002/mds.21971] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Huntington's disease is a neurodegenerative condition, characterized by movement disorders, cognitive decline, and psychiatric disturbance. We review the pharmacological management of the various movement disorders associated with the disease, the cognitive decline and the commonly encountered behavioral disturbances. We discuss the nonclassical features of the disease, important in the management of these patients. Nonpharmacological support including genetic counseling and therapy and the importance of palliative care are also addressed. Finally, experimental approaches that may soon impact upon clinical practice are discussed.
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Affiliation(s)
- Wendy Phillips
- Cambridge Centre for Brain Repair, E.D. Adrian Building, Forvie Site, Cambridge, United Kingdom
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35
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Harrison M, Leszczyszyn D, Nohria V, Anderson S, Kelly T. Destiny’s child. Mov Disord 2008. [DOI: 10.3109/9780203008454-34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Huntington disease (HD) is a progressive heredoneurodegenerative disease manifested by chorea and other hyperkinetic (dystonia, myoclonus, tics) and hypokinetic (parkinsonism) movement disorders. In addition, a variety of psychiatric and behavioral symptoms, along with cognitive decline, contribute significantly to the patient's disability. Because there are no effective neuroprotective therapies that delay the progression of the disease, symptomatic treatment remains the cornerstone of medical management. Several classes of medications have been used to ameliorate the various symptoms of HD, including typical and atypical neuroleptics, dopamine depleters, antidepressants, antiglutamatergic drugs, GABA agonists, antiepileptic medications, acetylcholinesterase inhibitors, and botulinum toxin. Recently, surgical approaches including pallidotomy, deep brain stimulation, and fetal cell transplants have been used for the symptomatic treatment of HD. The selected therapy must be customized to the needs of each patient, minimizing the potential adverse effects. The primary aim of this article is to review the role of the different therapies, both available and investigational, for the treatment of the motor, psychiatric, behavioral, and cognitive symptoms of HD, and to examine their impact on the patient's functionality and quality of life.
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Affiliation(s)
- Octavian R. Adam
- grid.39382.33000000012160926XParkinson’s Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, 6550 Fannin, Suite 1801, 77030 Houston, TX
| | - Joseph Jankovic
- grid.39382.33000000012160926XParkinson’s Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, 6550 Fannin, Suite 1801, 77030 Houston, TX
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Yoshida K, Yanagawa S, Tsuchiya A, Nakajima T, Fukushima Y, Ikeda SI. Huntington?s disease with onset ages greater than 60�years. Geriatr Gerontol Int 2007. [DOI: 10.1111/j.1447-0594.2007.00372.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bonelli RM, Hofmann P. A systematic review of the treatment studies in Huntington's disease since 1990. Expert Opin Pharmacother 2007; 8:141-53. [PMID: 17257085 DOI: 10.1517/14656566.8.2.141] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Huntington's disease (HD) is an autosomal dominant, inherited, neuropsychiatric disease that gives rise to progressive motor, cognitive and behavioural symptoms. Current drug therapy has no effect on the progression of disability, and the need for any pharmacological treatment should be carefully considered. Hyperkinesias and psychiatric symptoms may respond well to pharmacotherapy, but neuropsychological deficits and dementia remain untreatable. Pharmacological intervention in the treatment of the movement disorder of HD is aimed at restoring the balance of neurotransmitters in the basal ganglia. A surprising amount of current drug therapy of HD in clinical practice is based on studies published before 1990. The authors conducted a systematic review of pharmacological therapy in HD using the available papers that were published between 1990 and 2006.
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Affiliation(s)
- Raphael M Bonelli
- University Clinic of Psychiatry, Graz Medical University, Auenbruggerplatz 31, A-8036 Graz, Austria.
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Abstract
Chorea is one of the major types of involuntary movement disorders originating from dysfunctional neuronal networks interconnecting the basal ganglia and frontal cortical motor areas. The syndrome is characterised by a continuous flow of random, brief, involuntary muscle contractions and can result from a wide variety of causes. Diagnostic work-up can be straightforward in patients with a positive family history of Huntington's disease or acute-onset hemichorea in patients with lacunar stroke, but it can be a challenging and complex task in rare autoimmune or genetic choreas. Principles of management focus on establishing an aetiological classification and, if possible, removal of the cause. Preventive strategies may be possible in Huntington's disease where genetic counselling plays a major part. In this review we summarise the current understanding of the neuroanatomy and pathophysiology of chorea, its major aetiological classes, and principles of diagnostic work-up and management.
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Magnet MK, Kapfhammer HP, Bonelli RM. Cabergoline in Huntington's disease: the first case report. Acta Neurol Scand 2006; 113:355-6. [PMID: 16629775 DOI: 10.1111/j.1600-0404.2006.00583.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Handley OJ, Naji JJ, Dunnett SB, Rosser AE. Pharmaceutical, cellular and genetic therapies for Huntington's disease. Clin Sci (Lond) 2005; 110:73-88. [PMID: 16336206 DOI: 10.1042/cs20050148] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
HD (Huntington's disease) is a devastating neurodegenerative disorder caused by a polyglutamine expansion in the gene encoding the huntingtin protein. Presently, there is no known cure for HD and existing symptomatic treatments are limited. However, recent advances have identified multiple pathological mechanisms involved in HD, some of which have now become the focus of therapeutic intervention. In this review, we consider progress made towards developing safe and effective pharmaceutical-, cell- and genetic-based therapies, and discuss the extent to which some of these therapies have been successfully translated into clinical trials. These new prospects offer hope for delaying and possibly halting this debilitating disease.
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Affiliation(s)
- Olivia J Handley
- The Brain Repair Group, School of Biosciences, Cardiff University, Cardiff CF10 3US, UK.
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Affiliation(s)
- Karen E Anderson
- Department of Psychiatry; Maryland Parkinson's and Movement Disorders Center, Movement Disorders Division, University of Maryland School of Medicine, Room N4W49A, 22 South Greene Street, Baltimore, MD 21201, USA.
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Abstract
PURPOSE OF REVIEW Marked olfactory dysfunction (hyposmia) is a frequent and early abnormality in Parkinson's disease. We review recent advances related to its cause and its clinical relevance with respect to the differential diagnosis of Parkinsonian syndromes. RECENT FINDINGS Marked olfactory dysfunction occurs in Parkinson's disease and dementia with Lewy bodies but is not found in progressive supranuclear palsy and corticobasal degeneration. In multiple system atrophy, the deficit is mild and indistinguishable from cerebellar syndromes of other aetiologies, including the spino-cerebllar ataxias. This is in keeping with evidence of cerebellar involvement in olfactory processing, which may also help to explain recent findings of mild olfactory dysfunction in essential tremor. Smell testing remains, however, a clinically relevant tool in the differential diagnosis of indeterminate tremors. Intact olfaction has also been reported recently in Parkin disease (PARK 2) and vascular Parkinsonism. The relevance of sniffing ability to olfaction and a possible role of increased tyrosine hydroxylase and dopamine in parts of the olfactory bulb are issues of current interest with respect to pathophysiology. The early or 'pre-clinical' detection of Parkinson's disease is increasingly recognized as an area in which olfactory testing may be of value. SUMMARY Research findings have confirmed a role for olfactory testing in the differential diagnosis of movement disorders, and suggest that this approach is currently underused in clinical practice. Validated test batteries are now available that may prove to be of practical use in the differential diagnosis of Parkinsonian syndromes and indeterminate tremors.
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Wang CK, Wu YR, Hwu WL, Chen CM, Ro LS, Chen ST, Gwinn-Hardy K, Yang CC, Wu RM, Chen TF, Wang HC, Chao MC, Chiu MJ, Lu CJ, Lee-Chen GJ. DNA haplotype analysis of CAG repeat in Taiwanese Huntington's disease patients. Eur Neurol 2004; 52:96-100. [PMID: 15273431 DOI: 10.1159/000079938] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2003] [Accepted: 05/25/2004] [Indexed: 11/19/2022]
Abstract
We studied the expanded CAG repeat and adjacent CCG repeat in 53 Huntington's disease (HD) patients and 172 unrelated normal subjects matched to the patients for ethnic origin. The range of the CAG repeat varied from 38 to 109 in the HD patients and from 10 to 29 in the control group. A significant negative correlation was found between the age at onset and the CAG expansion, with no significant influence of the adjacent CCG repeat on the age at onset by multiple regression analysis. Allelic association using CCG repeat and 2 flanking dinucleotide repeat markers within 150 kb of the HD gene revealed linkage disequilibrium for 2 of 3 markers. Haplotype analysis of 24 HD families using these markers identified 3 major haplotypes underlying 87.5% of HD chromosomes. The data suggested frequent haplotypes in the Taiwanese population on which one or more mutational events leading to the disease occurred.
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Affiliation(s)
- C K Wang
- Department of Life Science, National Taiwan Normal University, Taipei, Taiwan, ROC
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Magnet MK, Bonelli RM, Kapfhammer HP. Amantadine in the Akinetic-Rigid Variant of Huntington's Disease. Ann Pharmacother 2004; 38:1194-6. [PMID: 15178736 DOI: 10.1345/aph.1e004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE: To report the effects of amantadine on an akinetic-rigid variant of Huntington's disease (HD). CASE SUMMARY: We describe a 36-year-old woman with HD who was treated with intravenous amantadine for 5 days. The woman was evaluated with the Unified Huntington's Disease Rating Scale before and after treatment. Parkinsonism, bradykinesia, and dystonia improved significantly. DISCUSSION: Amantadine is a noncompetitive N-methyl D-aspartate receptor antagonist. It is mainly used in the treatment of Parkinson's disease, as it increases dopamine levels in the brain. This effect is said to ameliorate akinesia. Although the effect of amantadine on choreatic dystonia in HD has been reported in several studies, to the best of our knowledge, this is the first report of the ameliorative effects of amantadine on the rigid form of HD. Our patient showed improvements of gait, parkinsonism, and dystonia. Fine-motor tasks and eye movement did not change significantly. CONCLUSIONS: We suggest that amantadine treatment might be of value to patients with the akinetic-rigid variant of HD.
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Wang SC, Lee-Chen GJ, Wang CK, Chen CM, Tang LM, Wu YR. Markedly asymmetrical parkinsonism as a leading feature of adult-onset Huntington's disease. Mov Disord 2004; 19:854-856. [PMID: 15254954 DOI: 10.1002/mds.20093] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
We report on a 28-year-old man who presented with right hand tremor, bradykinesia, and rigidity of his right side extremities. Our case report emphasizes that markedly asymmetrical parkinsonism can be an initial presentation of adult-onset Huntington's disease (HD), and different clinical presentations can be observed in members of an individual HD family with the same CAG repeat length.
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Affiliation(s)
- Shih-Ching Wang
- Second Department of Neurology, Chang Gung Memorial Hospital, LinKou Medical Center, Taipei, Taiwan
| | - Guey-Jen Lee-Chen
- Department of Life Science, National Taiwan Normal University, Taipei, Taiwan
| | - Cheng-Kung Wang
- Department of Life Science, National Taiwan Normal University, Taipei, Taiwan
- Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
| | - Chiung-Mei Chen
- Second Department of Neurology, Chang Gung Memorial Hospital, LinKou Medical Center, Taipei, Taiwan
| | - Lok-Ming Tang
- Second Department of Neurology, Chang Gung Memorial Hospital, LinKou Medical Center, Taipei, Taiwan
| | - Yih-Ru Wu
- Second Department of Neurology, Chang Gung Memorial Hospital, LinKou Medical Center, Taipei, Taiwan
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Bonelli RM, Wenning GK, Kapfhammer HP. Huntington's disease: present treatments and future therapeutic modalities. Int Clin Psychopharmacol 2004; 19:51-62. [PMID: 15076012 DOI: 10.1097/00004850-200403000-00001] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Huntington's disease (HD) is a devastating neuropsychiatric disorder for which therapeutic interventions have been rather fruitless to date, except in a slight symptomatic relief. Even the discovery of the gene related to HD in 1993 has not effectively advanced treatments. This article is essentially a review of available double-blind, placebo-controlled trials of therapy for this condition which also includes relevant open label trials. Unfortunately, HD research has tended to concentrate on the motor aspects of the disorder, whereas the major problems are behavioural (e.g. dementia, depression, psychosis), and the chorea is often least relevant in terms of management. We conclude that there is definitely poor evidence in management of HD. The analysis of the 24 best studies fails to result in a treatment recommendation of clinical relevance. Based on data of open-label studies, or even case reports, we recommend riluzole, olanzapine and amantadine for the treatment of the movement disorders associated with HD, selective serotonin reuptake inhibitors and mirtazapine for the treatment of depression, and atypical antipsychotic drugs for HD psychosis and behavioural problems. Moreover, adjuvant psychotherapy, physiotherapy and speech therapy should be applied to supply the optimal management. Finally, some cellular mechanisms are discussed in this paper because they are essential for future neuroprotective modalities, such as minocycline, unsaturated fatty acids or riluzole.
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Affiliation(s)
- Raphael M Bonelli
- University Clinic of Psychiatry, Karl-Franzens University Graz, Graz; University Clinic of Neurology, University of Innsbruck, Innsbruck, Austria.
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Katzenschlager R, Cardozo A, Avila Cobo MR, Tolosa E, Lees AJ. Unclassifiable parkinsonism in two European tertiary referral centres for movement disorders. Mov Disord 2003; 18:1123-31. [PMID: 14534915 DOI: 10.1002/mds.10523] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In view of reports on high frequencies of atypical parkinsonism from different parts of the world and in non-white communities in the United Kingdom, we have prospectively surveyed 1,000 consecutive patients with parkinsonism presenting to two European tertiary referral centres for movement disorders (London, UK, and Barcelona, Spain). The aims of our study were to assess in a cross-sectional, prospective manner the proportion of patients who could not be classified diagnostically, to identify the factors precluding classification, and to determine which diagnostic measures would increase the rate of classifiable cases. Diagnoses were established using published clinical diagnostic criteria for Parkinson's disease (PD) and for other conditions associated with parkinsonism. Twenty-nine patients in London and 25 in Barcelona were initially considered unclassifiable; nine could be classified after further investigations. Levodopa (L-dopa) responsiveness was found to have a pivotal role in establishing a clinical diagnosis in previously unclassifiable patients: In those 45 patients who remained unclassifiable, failure to respond to L-dopa without other exclusion criteria for PD was the most common finding in each centre. Our results show that 4.0 to 5.0% of parkinsonian patients presenting to specialist clinics in Western Europe cannot be categorised using currently available clinical diagnostic criteria for parkinsonian syndromes. Prolonged follow-up and neuropathological diagnosis will be needed to determine whether all these cases represent atypical presentations of established clinico-pathological entities or whether some represent unrecognised new disorders.
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Affiliation(s)
- Regina Katzenschlager
- National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
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Abstract
Huntington's disease is an autosomal dominant progressive neurodegenerative disorder characterized by involuntary movements, cognitive decline, and behavioral disorders leading to functional disability. In contrast to patients with adult onset, in which chorea is the major motor abnormality, children often present with spasticity, rigidity, and significant intellectual decline associated with a more rapidly progressive course. An unusual early-onset Huntington's disease case of an 11-year-old boy with severe hypokinetic/rigid syndrome appearing at the age of 2.5 years is presented. Clinical diagnosis was confirmed by polymerase chain reaction study of the expanded IT-15 allele with a compatible size of 102 cytosine-adenosine-guanosine repeats L-Dopa mildly ameliorated rigidity, bradykinesia, and dystonia. We conclude that Huntington's disease should be included in the differential diagnoses of regressive syndromes of early childhood.
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SuttonBrown M, Suchowersky O. Clinical and research advances in Huntington's disease. Can J Neurol Sci 2003; 30 Suppl 1:S45-52. [PMID: 12691476 DOI: 10.1017/s0317167100003231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Huntington's disease (HD) is an autosomal dominant neurodegenerative disorder characterized by abnormalities of movement and dementia. No curative treatment is available and HD results in gradually increasing disability. Characterization of the genetic abnormality has dramatically increased our understanding of the underlying mechanisms of the disease process, and has resulted in the development of a number of genetic models. These research tools are forming the basis of advanced work into the diagnosis, pathophysiology, and potential treatment of the disease. Clinically, the availability of genetic testing has eased confirmation of diagnosis in symptomatic individuals. Presymptomatic testing allows at-risk individuals to make informed choices but requires supportive care from physicians. Current clinical treatment is focused on symptom control. Advances in research have resulted in the development of potential neuroprotective strategies which are undergoing clinical testing.
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Affiliation(s)
- M SuttonBrown
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
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