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Konvalinkova R, Srp M, Doleckova K, Capek V, Gal O, Hoskovcova M, Kliment R, Muzik J, Ruzicka E, Klempir J. The impact of expiratory muscle strength training on voluntary cough effectiveness in Huntington's disease. Eur J Neurol 2024:e16500. [PMID: 39344651 DOI: 10.1111/ene.16500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 08/31/2024] [Accepted: 09/16/2024] [Indexed: 10/01/2024]
Abstract
BACKGROUND AND PURPOSE Dysfunction of the airway defence system in Huntington's disease (HD) is a significant but often overlooked problem. Although expiratory muscle strength training (EMST) is frequently utilized in cough effectiveness treatment, its specific impact in HD patients has not yet been explored. This study investigated the effects of EMST on voluntary peak cough flow (vPCF) in HD patients and evaluated the retention of potential gains post-intervention. METHODS In this prospective case-controlled trial, 29 HD patients completed an 8-week wait-to-start period, which served to identify the natural development of expiratory muscle strength and vPCF. This was followed by 8 weeks of EMST training and an additional 8 weeks of follow-up. The study's outcome parameters, vPCF and maximum expiratory pressure (MEP), were measured against those of age- and sex-matched healthy controls. RESULTS Huntington's disease patients had significantly lower MEP (p < 0.001) and vPCF (p = 0.012) compared to healthy controls at baseline. Following the EMST, significant improvements in MEP (d = 1.39, p < 0.001) and vPCF (d = 0.77, p = 0.001) were observed, with HD patients reaching the cough performance levels of healthy subjects. However, these gains diminished during the follow-up, with a significant decline in vPCF (d = -0.451, p = 0.03) and in MEP (d = -0.71; p = 0.002). CONCLUSIONS Expiratory muscle strength training improves expiratory muscle strength and voluntary cough effectiveness in HD patients, but an ongoing maintenance programme is necessary to sustain the improvements.
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Affiliation(s)
- Romana Konvalinkova
- Department of Neurology and Centre of Clinical Neuroscience, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Martin Srp
- Department of Neurology and Centre of Clinical Neuroscience, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Kristyna Doleckova
- Department of Neurology and Centre of Clinical Neuroscience, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Vaclav Capek
- Department of Neurology and Centre of Clinical Neuroscience, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ota Gal
- Department of Neurology and Centre of Clinical Neuroscience, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Martina Hoskovcova
- Department of Neurology and Centre of Clinical Neuroscience, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Radim Kliment
- Faculty of Biomedical Engineering, Czech Technical University, Prague, Czech Republic
| | - Jan Muzik
- Faculty of Biomedical Engineering, Czech Technical University, Prague, Czech Republic
| | - Evzen Ruzicka
- Department of Neurology and Centre of Clinical Neuroscience, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiri Klempir
- Department of Neurology and Centre of Clinical Neuroscience, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
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Dickson SP, Mallinckrodt CH, Rogula B, Powell LC, Potashman MH, Coric V, L'Italien GJ, Hendrix SB. Development of a General Composite Scale (GENCOMS) for Progressive Neurodegenerative Diseases and Implications for the Assessment of Disease-Modifying Therapies. Neurol Ther 2024:10.1007/s40120-024-00661-2. [PMID: 39287752 DOI: 10.1007/s40120-024-00661-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 08/30/2024] [Indexed: 09/19/2024] Open
Abstract
INTRODUCTION The reliable assessment of treatment outcomes for disease-modifying therapies (DMT) in neurodegenerative disease is challenging. The objective of this paper is to describe a generalized framework for developing composite scales that can be applied in diverse, degenerative conditions, termed "GENCOMS." Composite scales optimize the sensitivity for detecting clinically meaningful effects that slow disease progression. METHODS The GENCOMS method relies on robust natural history data and/or placebo arm data from DMT trials. Validated scales that are core to the disease process have been identified, and item level data obtained to standardize the response outcomes from 0 (best possible score) to 1 (worst possible score). A partial least squares regression analysis was conducted with temporal change as the dependent variable and change scores in standardized items as the explanatory variables. The derived model coefficients constitute a weighted sum of items that most effectively measure disease progression. RESULTS The resultant composite scale was optimized to detect disease progression and can be examined in a range of slow or fast progressing populations. The scale can be used in studies with comparable patient populations as an endpoint optimized to measure disease progression and therefore ideally suited to assess treatment effects in DMTs. CONCLUSION The methodology presented here provides a generalizable framework for developing composite scales in the assessment of neurodegenerative disease progression and evaluation of DMT effects. By objectively selecting and weighting items from previously validated measures based solely on their sensitivity to disease progression, this methodology allows for the creation of a more responsive measurement of clinical decline. This heightened sensitivity to clinical decline can be utilized to detect modest yet meaningful treatment effects in the early stages of neurogenerative diseases, when it is optimal to begin a DMT.
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Affiliation(s)
| | | | - Basia Rogula
- Broadstreet Health Economics and Outcomes Research, 201-343 Railway Street, Vancouver, BC, Canada
| | - Lauren C Powell
- Broadstreet Health Economics and Outcomes Research, 201-343 Railway Street, Vancouver, BC, Canada
| | | | - Vladimir Coric
- Biohaven Pharmaceuticals, Inc 215 Church St, New Haven, CT, USA
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Farag M, Coleman A, Knights H, Murphy MJ, Rajagopal S, Touzé A, Shoai M, Hearst C, Salanio DM, Wild EJ, Tabrizi SJ. Outcomes of Percutaneous Endoscopic Gastrostomy in Huntington's Disease at a Tertiary Center. Mov Disord Clin Pract 2024; 11:998-1007. [PMID: 38853375 PMCID: PMC11329559 DOI: 10.1002/mdc3.14130] [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] [Received: 12/13/2023] [Accepted: 05/19/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND Clinically assisted nutrition and hydration via percutaneous endoscopic gastrostomy (PEG) is a therapeutic option to ameliorate the difficulties associated with enhanced catabolism, weight loss, and dysphagia in Huntington's disease (HD). OBJECTIVES The objective is to provide insights into demographics, staging (Shoulson-Fahn), complications, weight trajectories, and survival rates in people with HD (pwHD) who underwent PEG. METHODS This retrospective study included 705 consecutive pwHD who attended our HD clinic between July 2006 and March 2024, of whom 52 underwent PEG. A control group (n = 52), comprising pwHD without PEG, were closely matched for sex, stage, age, CAG length, and disease burden score at PEG. The study was registered as a service evaluation at the National Hospital for Neurology and Neurosurgery. RESULTS PEG prevalence was 15.0% (n = 52/347) among manifest pwHD: 4.8% (n = 3/62) for Stage 3; 33.3% (n = 16/48) for stage 4; and 44.1% (n = 30/68) for stage 5. Commonest indications were dysphagia, weight loss, and inadequate oral intake. Complications included chest infection, tube dislodgement, and peristomal and skin infections. Modeling of weight trajectories after PEG found no difference between PEG and non-PEG groups. Mortality rate was 34.6% (n = 18/52) in the PEG and 36.5% (n = 19/52) in the non-PEG groups (P = 0.84). Treatment duration (until study endpoint or death) was 3.48 years (interquartile range = 1.71-6.02; range = 0.23-18.8), with 65.4% (n = 34/52) alive at the study endpoint. CONCLUSION PEG in pwHD at-risk for weight loss may help slow weight loss. Prospective studies are required to strengthen PEG decision-making in pwHD. PEG survival was much longer than other dementias, highlighting the need to consider PEG independently in pwHD.
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Affiliation(s)
- Mena Farag
- Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- The National Hospital for Neurology and Neurosurgery (NHNN), Queen Square, London, United Kingdom
| | - Annabelle Coleman
- Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- The National Hospital for Neurology and Neurosurgery (NHNN), Queen Square, London, United Kingdom
| | - Harry Knights
- Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- The National Hospital for Neurology and Neurosurgery (NHNN), Queen Square, London, United Kingdom
| | - Michael J Murphy
- Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- The National Hospital for Neurology and Neurosurgery (NHNN), Queen Square, London, United Kingdom
| | - Sangeerthana Rajagopal
- Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- The National Hospital for Neurology and Neurosurgery (NHNN), Queen Square, London, United Kingdom
| | - Alexiane Touzé
- Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- The National Hospital for Neurology and Neurosurgery (NHNN), Queen Square, London, United Kingdom
| | - Maryam Shoai
- Department of Neurodegenerative Diseases, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Cara Hearst
- Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- The National Hospital for Neurology and Neurosurgery (NHNN), Queen Square, London, United Kingdom
| | - Desiree M Salanio
- Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- The National Hospital for Neurology and Neurosurgery (NHNN), Queen Square, London, United Kingdom
| | - Edward J Wild
- Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- The National Hospital for Neurology and Neurosurgery (NHNN), Queen Square, London, United Kingdom
| | - Sarah J Tabrizi
- Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- The National Hospital for Neurology and Neurosurgery (NHNN), Queen Square, London, United Kingdom
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Grimaldi A, Veneziani I, Culicetto L, Quartarone A, Lo Buono V. Risk Factors and Interventions for Suicide in Huntington's Disease-A Systematic Review. J Clin Med 2024; 13:3437. [PMID: 38929966 PMCID: PMC11205005 DOI: 10.3390/jcm13123437] [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: 04/22/2024] [Revised: 05/31/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024] Open
Abstract
Background/Objectives: Huntington's disease (HD) is an autosomal dominant genetic disorder causing progressive neurodegeneration which, aside from symptomatic therapies for controlling psychological and motor problems, currently has no effective treatment. People who receive this diagnosis often feel disoriented and lost without guidance. Furthermore, HD patients are estimated to have a two to seven times greater risk of suicide death compared to the general population. The current review investigates the complex relationship between HD and suicide, seeking to identify key risk factors influencing suicidal ideation and behaviour in affected individuals. Methods: We conducted a systematic review following the PRISMA guidelines. Studies were searched for on the PubMed, Cochrane, and Web of Science databases, and 17 articles met the inclusion criteria. Results: The findings reveal that emotional strain, neuropsychiatric symptoms, and the absence of a cure contribute to heightened suicidal tendencies in HD patients. Critical periods for suicide risk coincide with early symptomatic stages of disease or the successive phase, with the loss of independence impacting on daily functioning. Risk factors associated with HD include a depressive mood, cognitive impairments, and a history of suicide attempts. Conclusions: From a prevention perspective, a comprehensive multidisciplinary and multidimensional approach could enhance the overall well-being of people with HD. In particular, screening for suicidal thoughts in people with HD could mitigate suicide risk.
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Affiliation(s)
- Alessandro Grimaldi
- Department of Nervous System and Behavioural Sciences, Psychology Section, University of Pavia, Piazza Botta, 11, 27100 Pavia, Italy; (A.G.); (I.V.)
| | - Isabella Veneziani
- Department of Nervous System and Behavioural Sciences, Psychology Section, University of Pavia, Piazza Botta, 11, 27100 Pavia, Italy; (A.G.); (I.V.)
| | - Laura Culicetto
- IRCCS Centro Neurolesi “Bonino-Pulejo”, S.S. 113 Via Palermo C. da Casazza, 98124 Messina, Italy; (A.Q.); (V.L.B.)
| | - Angelo Quartarone
- IRCCS Centro Neurolesi “Bonino-Pulejo”, S.S. 113 Via Palermo C. da Casazza, 98124 Messina, Italy; (A.Q.); (V.L.B.)
| | - Viviana Lo Buono
- IRCCS Centro Neurolesi “Bonino-Pulejo”, S.S. 113 Via Palermo C. da Casazza, 98124 Messina, Italy; (A.Q.); (V.L.B.)
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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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Cooper H, Simpson J, Dale M, Eccles FJR. Experiences of young people growing up in a family with Huntington's disease: A meta-ethnography of qualitative research. J Genet Couns 2024. [PMID: 38469914 DOI: 10.1002/jgc4.1886] [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: 11/14/2023] [Revised: 01/19/2024] [Accepted: 02/22/2024] [Indexed: 03/13/2024]
Abstract
Huntington's disease is a genetic neurodegenerative condition with wide physical and psychological impacts. Children of a parent with the condition have a 50% chance of carrying the gene expansion and developing the condition themselves. This systematic review and meta-ethnography presents a synthesis of the qualitative research on the experiences of young people growing up in a family with Huntington's disease. The MEDLINE, PsycINFO, and CINAHL databases were systematically searched, and 13 papers met the inclusion criteria. Through the process of meta-ethnography, four themes were identified highlighting aspects of childhood that were stolen and fought for: thief of relationships, thief of self, thief of transparency, and search for reclamation. Within the themes, the complex challenges young people faced when growing up in a HD family were explored such as the impact of adverse childhood experiences and the possible effects of HD on attachment and social relationships. Clinical implications are considered, and recommendations are made for future research.
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Affiliation(s)
- Hollie Cooper
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Jane Simpson
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Maria Dale
- Leicestershire Partnership NHS Trust, Leicestershire, UK
| | - Fiona J R Eccles
- Division of Health Research, Lancaster University, Lancaster, UK
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Bin Kashif MA, Mahmood S, Saqib T, Waheed ST, Kumar P, Javaid A, Riaz MA, Fatima U, Nadeem ZA, Nasir SA, Hassan A. Huntington's Disease-Related Mortality Patterns: A Two-Decade Analysis of Mortality Trends in the United States, from 1999-2019. J Huntingtons Dis 2024; 13:329-338. [PMID: 39213086 DOI: 10.3233/jhd-240037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Background Huntington's disease (HD) is an autosomal dominant, progressive neurodegenerative disorder debilitating mainly in adults. Objective This study aimed to assess the trends in HD-related mortality regarding various demographic factors. Methods Death certificates from the CDC WONDER were studied from 1999 to 2019, for HD-related mortality in adults aged 25 + years. Age-adjusted Mortality Rate (AAMR) per 100,000 persons and Annual Percentage Change (APC) were calculated and stratified by year, age groups, gender, race/ethnicity, state, census region, urbanization, and place of death. Results Between 1999 to 2019, 22,595 deaths occurred in adults due to HD. The AAMR increased from 0.43 to 0.54 during this period (APC = 0.50; 95% CI: 0.18 to 0.84). Old adults (65-85 + years) had the highest overall AAMR, followed by middle-aged adults (45-64 years) and young adults (25-44 years) (AAMR old: 1.01 vs. AAMR middle-age: 0.68 vs. AAMR young: 0.16). Men had slightly greater overall AAMRs than women (AAMR men: 0.54 vs. AAMR women: 0.48). When stratified by race, non-Hispanic (NH) Whites had significantly higher mortality rates than NH African Americans (AAMR NH White: 0.61 vs. NH African American: 0.35), while the AAMR were lowest in Hispanic/Latino (0.28). The AAMRs also showed variation by region (overall AAMR: Midwest: 0.63, Northeast: 0.47, West: 0.48, South: 0.46), and non-metropolitan areas had higher HD-related AAMR (0.66) than metropolitan areas (0.47). Conclusions HD-related mortality in US adults has increased since 1999. Reflecting on the variations in trends observed, new strategies are required to optimize the quality of care in long-term care facilities.
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Affiliation(s)
| | - Samar Mahmood
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Tahrim Saqib
- Department of Internal Medicine, Foundation University Medical College, Islamabad, Pakistan
| | - Syeda Tahira Waheed
- Department of Internal Medicine, Liaquat National Medical College and Hospital, Karachi, Pakistan
| | - Piresh Kumar
- Department of Internal Medicine, Bahria University Health Sciences, Karachi, Pakistan
| | - Aima Javaid
- Department of Internal Medicine, Fatima Jinnah Medical University, Lahore, Pakistan
| | - Muhammad Asjad Riaz
- Department of Internal Medicine, Allama Iqbal Medical College, Lahore, Pakistan
| | - Urooj Fatima
- Department of Internal Medicine, Karachi Medical and Dental College, Karachi, Pakistan
| | - Zain Ali Nadeem
- Department of Internal Medicine, Allama Iqbal Medical College, Lahore, Pakistan
| | - Shahbaz Ali Nasir
- Department of Internal Medicine, Indus Hospital Kahna Nau, Lahore, Pakistan
| | - Afrah Hassan
- Department of Internal Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
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Felthous AR, Kulkarni N, Belean C. DSM-5-TR diagnosis as a guide to suicide risk assessment. BEHAVIORAL SCIENCES & THE LAW 2023; 41:373-396. [PMID: 37076959 DOI: 10.1002/bsl.2617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 05/03/2023]
Abstract
A specific mental disorder can itself constitute a risk factor for a completed suicide. Even more important, the disorder is typically a modifiable risk factor which informs its own treatment. Recent editions of the DSM have included "suicide subsections" for specific mental disorders and conditions in which the risks of suicidal thoughts and behaviors for the disorder are noted in the literature. The DSM-5-TR can therefore serve as a compendium to be referred to for initial guidance as to whether a specific disorder could contribute to the risk. Adding completed suicides and suicide attempts, also addressed in these subsections, the sections were examined individually for the four parameters of suicidality. Accordingly, the four parameters of suicidality examined here are: suicide, suicidal thoughts, suicidal behavior, and suicide attempts. After providing interpretive comments for each, the parameters for all disorders with a suicide subsection were tabulated for ease of reference. Because specific medical disorders are also associated with elevated rates of suicide, these disorders and the supporting research are tabulated and briefly acknowledged. Allowing for the limitations of the suicide subsections and their analysis, this exegesis is proposed to contribute to training in risk assessment for forensic psychiatry and psychology fellows and to highlight the potential referential value of the DSM-5-TR's suicide subsections for clinical practitioners and those who pursue research on suicide.
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Affiliation(s)
- Alan R Felthous
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Neha Kulkarni
- Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Catalina Belean
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
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Sokol LL, Nance M, Kluger BM, Yeh C, Paulsen JS, Smith AK, Bega D. Factors Associated With the Place of Death in Huntington Disease: Analysis of Enroll-HD. J Palliat Med 2023; 26:915-921. [PMID: 36706436 PMCID: PMC10316529 DOI: 10.1089/jpm.2022.0143] [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] [Accepted: 12/12/2022] [Indexed: 01/28/2023] Open
Abstract
Background: Most people prefer to die at home. Hospice is the standard in end-of-life care for people with Huntington disease (HD), a neurodegenerative genetic disorder that affects people in middle adulthood. Yet, we have little knowledge regarding the place of death for people with HD. Therefore, the current state of knowledge limits HD clinicians' ability to conduct high-quality goals of care conversations. Objectives: We sought to determine the factors associated with the place of death in people with HD. Design: We obtained cross-sectional data from Enroll-HD and included participants with a positive HD mutation of 36 or more CAG repeats. Results: Out of 16,120 participants in the Enroll-HD study, 536 were reported as deceased. The mean age at death was 60. The leading place of death was home (29%), followed by the hospital (23%). The adjusted odds ratio (aOR) of dying at a skilled nursing facility was significantly lower for those partnered (aOR: 0.48, confidence interval [95% CI]: 0.26-0.86). The aOR for dying on hospice compared to home was increased in a person with some college and above (aOR: 2.40, 95% CI: 1.21-4.75). Conclusions: Our data further suggest that models that predict the place of death for serious illnesses do not appear to generalize to HD. The distribution in the places of death within HD was not uniform. Our findings may assist HD clinicians in communication during goals of care conversations.
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Affiliation(s)
- Leonard L. Sokol
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- McGaw Bioethics Scholars Program, Center for Bioethics and Humanities, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Palliative Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Martha Nance
- Struthers Parkinson's Center, Golden Valley, Minnesota, USA
- Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Benzi M. Kluger
- Departments of Neurology and Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Chen Yeh
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jane S. Paulsen
- Department of Neurology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Alexander K. Smith
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Danny Bega
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Movement Disorders, The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Bhatnagar A, Parmar V, Barbieri N, Bearoff F, Elefant F, Kortagere S. Novel EAAT2 activators improve motor and cognitive impairment in a transgenic model of Huntington's disease. Front Behav Neurosci 2023; 17:1176777. [PMID: 37351153 PMCID: PMC10282606 DOI: 10.3389/fnbeh.2023.1176777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/19/2023] [Indexed: 06/24/2023] Open
Abstract
Introduction Glutamate excitotoxicity is causal in striatal neurodegeneration underlying motor dysfunction and cognitive deficits in Huntington's disease (HD). Excitatory amino acid transporter 2 (EAAT2), the predominant glutamate transporter accounting for >90% of glutamate transport, plays a key role in preventing excitotoxicity by clearing excess glutamate from the intrasynaptic cleft. Accordingly, EAAT2 has emerged as a promising therapeutic target for prevention of neuronal excitotoxicity underlying HD and other neurodegenerative diseases. Methods We have previously designed novel EAAT2 positive allosteric modulator GT951, GTS467, and GTS551, with low nanomolar efficacy in glutamate uptake and favorable pharmacokinetic properties. In this study, we test the neuroprotective abilities of these novel EAAT2 activators in vivo using the robust Drosophila HD transgenic model expressing human huntingtin gene with expanded repeats (Htt128Q). Results All three compounds significantly restored motor function impaired under HD pathology over a wide dose range. Additionally, treatment with all three compounds significantly improved HD-associated olfactory associative learning and short-term memory defects, while GT951 and GTS551 also improved middle-term memory in low-performing group. Similarly, treatment with GT951 and GTS551 partially protected against early mortality observed in our HD model. Further, treatment with all three EAAT2 activators induced epigenetic expression of EAAT2 Drosophila homolog and several cognition-associated genes. Conclusion Together, these results highlight the efficacy of GT951, GTS467 and GTS551 in treating motor and cognitive impairments under HD pathology and support their development for treatment of HD.
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Affiliation(s)
- Akanksha Bhatnagar
- Department of Biology, Papadakis Integrated Sciences Building, Drexel University, Philadelphia, PA, United States
| | - Visha Parmar
- Department of Biology, Papadakis Integrated Sciences Building, Drexel University, Philadelphia, PA, United States
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, United States
| | - Nicholas Barbieri
- Department of Biology, Papadakis Integrated Sciences Building, Drexel University, Philadelphia, PA, United States
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, United States
| | - Frank Bearoff
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, United States
| | - Felice Elefant
- Department of Biology, Papadakis Integrated Sciences Building, Drexel University, Philadelphia, PA, United States
| | - Sandhya Kortagere
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, United States
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Páramo-Rodríguez L, Moreno-Marro S, Guardiola-Vilarroig S, Zurriaga O, Cavero-Carbonell C. [Huntington disease in the Valencian Region]. Rev Neurol 2023; 76:343-350. [PMID: 37231547 PMCID: PMC10478134 DOI: 10.33588/rn.7611.2022088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Huntington disease (HD) is a rare neurodegenerative disorder of the central nervous system characterized by unwanted choreatic movements, behavioral and psychiatric disturbances and dementia. OBJECTIVE Describe the geographical, age and sex distribution of HD in the Valencia Region (VR) and determine its prevalence and mortality. MATERIALS AND METHODS Cross-sectional study for the period 2010-2018. Confirmed cases of HD were identified through the Rare Disease Information System of the VR. Sociodemographic characteristics were described, and the prevalence and mortality rate were obtained. RESULTS 225 cases were identified, 50.2% women. 52.0% lived in the province of Alicante. 68.9% were verified by their clinical diagnosis. The median age at diagnosis was 54.1 years, 54.7 years in men and 53.0 years in women. The prevalence in 2018 was 1.97/100,000 inhabitants (95%; CI: 0.39-2.37), showing a no significant increasing trend, overall and by sex. 49.8% died, 51.8% men. The median age at death was 62.7 years, being lower in men than in women. The mortality rate in 2018 was 0.32/100,000 inhabitants (95%; CI: 0.32-2.28), with no statistically significant differences. CONCLUSIONS The prevalence obtained was within the range estimated by Orphanet (1-9/100,000). A difference between sexes was observed in the diagnosis age. Men are the group with the highest mortality and the earliest age of death. It is a disease with high mortality with an average of 6.5 years between diagnosis and death.
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Affiliation(s)
- L Páramo-Rodríguez
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, Valencia, España
| | - S Moreno-Marro
- Universitat de València, 46071 Valencia, España
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, Valencia, España
| | - S Guardiola-Vilarroig
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, Valencia, España
- Conselleria de Sanitat de la Comunitat Valenciana, Valencia, España
| | - O Zurriaga
- Universitat de València, 46071 Valencia, España
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, Valencia, España
- CIBER Epidemiología y Salud Pública. Instituto de Salud Carlos III, Madrid, España
| | - C Cavero-Carbonell
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, Valencia, España
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Loi SM, Tsoukra P, Sun E, Chen Z, Wibawa P, Biase MD, Farrand S, Eratne D, Kelso W, Evans A, Walterfang M, Velakoulis D. Survival in Huntington's disease and other young-onset dementias. Int J Geriatr Psychiatry 2023; 38:e5913. [PMID: 37062919 PMCID: PMC10946957 DOI: 10.1002/gps.5913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/04/2023] [Indexed: 04/18/2023]
Abstract
OBJECTIVES To compare survival and risk factors associated with mortality in common young-onset dementias (YOD) including Huntington's disease. METHODS This retrospective cohort study included inpatients from an Australian specialist neuropsychiatry service, over 20 years. Dementia diagnoses were based on consensus criteria and Huntington's disease (HD) was confirmed genetically. Mortality and cause of death were determined using linkage to the Australian Institute of Health and Welfare National Death Index. RESULTS There were 386 individuals with YOD included. The dementia types included frontotemporal dementia (FTD) (24.5%), HD (21.2%) and Alzheimer's disease (AD) (20.5%). 63% (n = 243) individuals had died. The longest median survival was for those who had HD, 18.8 years from symptom onset and with a reduced mortality risk compared to AD and FTD (hazard ratio 0.5). Overall, people with YOD had significantly increased mortality, of 5-8 times, compared to the general population. Females with a YOD had higher standardised mortality ratio compared to males (9.3 vs. 4.9) overall. The most frequent cause of death in those with HD was reported as HD, with other causes of death in the other YOD-subtypes related to dementia and mental/behavioural disorders. DISCUSSION This is the first Australian study to investigate survival and risk factors of mortality in people with YOD. YOD has a significant risk of death compared to the general population. Our findings provide useful clinical information for people affected by YOD as well as future planning and service provision.
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Affiliation(s)
- Samantha M. Loi
- NeuropsychiatryNorthWestern Mental Health, Melbourne HealthRoyal Melbourne HospitalParkvilleVictoriaAustralia
- Department of PsychiatryThe University of MelbourneParkvilleVictoriaAustralia
| | | | - Emily Sun
- NeuropsychiatryNorthWestern Mental Health, Melbourne HealthRoyal Melbourne HospitalParkvilleVictoriaAustralia
| | - Zhibin Chen
- School of Public Health and Preventive MedicineMonash UniversityClaytonVictoriaAustralia
| | - Pierre Wibawa
- NeuropsychiatryNorthWestern Mental Health, Melbourne HealthRoyal Melbourne HospitalParkvilleVictoriaAustralia
| | - Maria di Biase
- Department of PsychiatryThe University of MelbourneParkvilleVictoriaAustralia
| | - Sarah Farrand
- NeuropsychiatryNorthWestern Mental Health, Melbourne HealthRoyal Melbourne HospitalParkvilleVictoriaAustralia
| | - Dhamidhu Eratne
- NeuropsychiatryNorthWestern Mental Health, Melbourne HealthRoyal Melbourne HospitalParkvilleVictoriaAustralia
- Department of PsychiatryThe University of MelbourneParkvilleVictoriaAustralia
- Florey Institute of Neuroscience and Mental HealthParkvilleVictoriaAustralia
| | - Wendy Kelso
- NeuropsychiatryNorthWestern Mental Health, Melbourne HealthRoyal Melbourne HospitalParkvilleVictoriaAustralia
| | - Andrew Evans
- Department of MedicineRoyal Melbourne HospitalParkvilleVictoriaAustralia
| | - Mark Walterfang
- NeuropsychiatryNorthWestern Mental Health, Melbourne HealthRoyal Melbourne HospitalParkvilleVictoriaAustralia
- Department of PsychiatryThe University of MelbourneParkvilleVictoriaAustralia
- Florey Institute of Neuroscience and Mental HealthParkvilleVictoriaAustralia
| | - Dennis Velakoulis
- NeuropsychiatryNorthWestern Mental Health, Melbourne HealthRoyal Melbourne HospitalParkvilleVictoriaAustralia
- Department of PsychiatryThe University of MelbourneParkvilleVictoriaAustralia
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Cincotta MC, Walker RH. Diagnostic Uncertainties: Chorea. Semin Neurol 2023; 43:65-80. [PMID: 36882120 DOI: 10.1055/s-0043-1763506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Chorea is a hyperkinetic movement disorder with a multitude of potential etiologies, both acquired and inherited. Although the differential diagnosis for new-onset chorea is extensive, there are often clues in the history, exam, and basic testing that can help to narrow the options. Evaluation for treatable or reversible causes should take priority, as rapid diagnosis can lead to more favorable outcomes. While Huntington's disease is most common genetic cause of chorea, multiple phenocopies also exist and should be considered if Huntington gene testing is negative. The decision of what additional genetic testing to pursue should be based on both clinical and epidemiological factors. The following review provides an overview of the many possible etiologies as well as a practical approach for a patient presenting with new-onset chorea.
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Affiliation(s)
- Molly C Cincotta
- Department of Neurology, Temple University, Philadelphia, Pennsylvania
| | - Ruth H Walker
- Department of Neurology, James J. Peters Veterans Affairs Medical Center and Mount Sinai School of Medicine, Bronx, New York
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14
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Comorbidities and clinical outcomes in adult- and juvenile-onset Huntington's disease: a study of linked Swedish National Registries (2002-2019). J Neurol 2023; 270:864-876. [PMID: 36253622 PMCID: PMC9886595 DOI: 10.1007/s00415-022-11418-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/30/2022] [Accepted: 10/02/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Huntington's disease (HD) is a rare, neurodegenerative disease and its complex motor, cognitive and psychiatric symptoms exert a lifelong clinical burden on both patients and their families. OBJECTIVE To describe the clinical burden and natural history of HD. METHODS This longitudinal cohort study used data from the linked Swedish national registries to describe the occurrence of comorbidities (acute and chronic), symptomatic treatments and mortality in an incident cohort of individuals who either received the first diagnosis of HD above (adult onset HD; AoHD) or below (juvenile-onset HD; JoHD) 20 years of age, compared with a matched cohort without HD from the general population. Disease burden of all individuals alive in Sweden was described during a single calendar year (2018), including the occurrence of key symptoms, treatments and hospitalizations. RESULTS The prevalence of HD in 2018 was approximately 10.2 per 100,000. Of 1492 individuals with a diagnosis of HD during 2002 and 2018, 1447 had AoHD and 45 had JoHD. Individuals with AoHD suffered a higher incidence of obsessive-compulsive disorder, acute psychotic episodes, pneumonia, constipation and fractures compared with matched controls. Individuals with JoHD had higher incidence rates of epilepsy, constipation and acute respiratory symptoms. Median time to all-cause mortality in AoHD was 12.1 years from diagnosis. Patients alive with HD in Sweden in 2018 displayed a pattern of increased clinical burden for a number of years since diagnosis. CONCLUSIONS This study demonstrates the significant and progressive clinical burden in individuals with HD and presents novel insights into the natural history of JoHD.
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15
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Leidl BF, Fox-Davis D, Walker FO, Gabbard J, Marterre B. Layers of Loss: A Scoping Review and Taxonomy of HD Caregivers' Spiritual Suffering, Grief/Loss and Coping Strategies. J Pain Symptom Manage 2023; 65:e29-e50. [PMID: 36198334 PMCID: PMC9790041 DOI: 10.1016/j.jpainsymman.2022.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/16/2022] [Accepted: 09/23/2022] [Indexed: 02/03/2023]
Abstract
CONTEXT Huntington's disease (HD), an incurable, multi-generational, autosomal dominant disorder, creating unique challenges and a myriad of spiritually-related stressors in those affected and their familial caregivers. Spiritual suffering, experiences of grief/loss, and coping strategies have not been systematically studied in HD caregivers. OBJECTIVES To comprehensively define spiritual suffering, grief/loss, and coping strategies used by HD caregivers. METHODS A PRISMA-ScR scoping literature review was conducted. Data from included research articles were organized thematically using induction and open coding. A grounded, deductive approach was used to delineate a demarcated taxonomy of themes, which encompasses all three over-arching domains. Four reviewers, employing a modified Delphi approach, ascertained which themes were demonstrated by research participants in each study. RESULTS 36 of 583 articles met the review criteria; none were published in the palliative care literature. Investigations primarily focused on intrapersonal (self-image) distress and existential angst; only rarely looking deeper into divine/transpersonal suffering, disrupted religious relationships, or meaning distress. HD caregivers experience profound grief/loss, expressed as disenfranchised grief that is associated with the ambiguous loss of their loved one, loss of family structure, social connectedness, and personal losses. Half of the studies reported maladaptive HD caregiver coping strategies-characterized by dysfunctional escape schemes; in contrast, transcendent/creative strategies were often unexplored. CONCLUSION HD caregivers experience prolonged grief and other forms of spiritual suffering as they progressively lose their loved ones and disruption to their own lives. With an improved assessment tool, teams with spiritual and palliative care experts will better be able to support HD family caregivers.
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Affiliation(s)
- Bethany Faith Leidl
- Wake Forest University School of Medicine, (B.F.L., B.M.) Winston-Salem, North Carolina
| | | | - Francis O Walker
- Department of Neurology, Emeritus, Winston-Salem, (F.O.W.) North Carolina, USA
| | - Jennifer Gabbard
- Department of Internal Medicine, Section on Gerontology and Geriatrics (Palliative Care), (J.G., B.M.) Winston-Salem, North Carolina
| | - Buddy Marterre
- Wake Forest University School of Medicine, (B.F.L., B.M.) Winston-Salem, North Carolina; Department of Internal Medicine, Section on Gerontology and Geriatrics (Palliative Care), (J.G., B.M.) Winston-Salem, North Carolina; Department of General Surgery, (B.M.) Winston-Salem, North Carolina.
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16
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Sun E, Kang M, Wibawa P, Tsoukra V, Chen Z, Farrand S, Eratne D, Kelso W, Evans A, Walterfang M, Velakoulis D, Loi SM. Huntington's disease: Mortality and risk factors in an Australian cohort. J Neurol Sci 2022; 442:120437. [PMID: 36179426 DOI: 10.1016/j.jns.2022.120437] [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: 06/28/2022] [Revised: 09/06/2022] [Accepted: 09/20/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION There has not been any examination of the risk factors associated with mortality in Huntington's Disease (HD) in an Australian cohort. METHOD This retrospective study included inpatients admitted to a specialist neuropsychiatry service in Melbourne, Australia. HD status was based on genetic testing. Risk factors included age of onset, CAG repeat length and neuroimaging. Mortality data was acquired through the Australian Institute of Health and Welfare National Death Index. RESULTS The cohort included 83 participants, with 44 (53%) deceased. The median age of death was 59 years and median survival was 18.8 years from onset age (median 41.0 years). CAG repeat length (median 44.0, IQR 42.5, 47.0) was inversely correlated with age of onset (r = -0.73) and age at death (r = -0.80) but was not correlated with mortality status. There was no difference in functional and cognitive assessments, nor brain volumes, in the alive group compared to the deceased group. There were more people who were alive who had a positive family history of a psychiatric condition (p = 0.006) or dementia (p = 0.009). Standardised mortality ratios demonstrated a 5.9× increased risk of death for those with HD compared to the general population. CONCLUSIONS This is the first study to examine risk factors of mortality in HD in an Australian cohort. Median survival in our cohort is consistent with previous studies in HD, and markedly reduced compared to the general Australian population. CAG repeat length was not associated with mortality suggesting that non-genetic factors contribute to mortality status and warrant further investigation.
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Affiliation(s)
- Emily Sun
- Neuropsychiatry, NorthWestern Mental Health, Melbourne Health, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia.
| | - Matthew Kang
- Neuropsychiatry, NorthWestern Mental Health, Melbourne Health, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia.
| | - Pierre Wibawa
- Neuropsychiatry, NorthWestern Mental Health, Melbourne Health, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia.
| | - Vivian Tsoukra
- Department of Neurology, Evaggelismos Hospital, Athens, Greece
| | - Zhibin Chen
- School of Public Health and Preventive Medicine, Monash University, Clayton 3168, Australia.
| | - Sarah Farrand
- Neuropsychiatry, NorthWestern Mental Health, Melbourne Health, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia.
| | - Dhamidhu Eratne
- Neuropsychiatry, NorthWestern Mental Health, Melbourne Health, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia; Department of Psychiatry, The University of Melbourne, Grattan Street, Parkville 3052, Australia; Florey Institute of Neuroscience and Mental Health, Parkville 3052, Australia.
| | - Wendy Kelso
- Neuropsychiatry, NorthWestern Mental Health, Melbourne Health, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia.
| | - Andrew Evans
- Department of Medicine, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia.
| | - Mark Walterfang
- Neuropsychiatry, NorthWestern Mental Health, Melbourne Health, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia; Department of Psychiatry, The University of Melbourne, Grattan Street, Parkville 3052, Australia; Florey Institute of Neuroscience and Mental Health, Parkville 3052, Australia.
| | - Dennis Velakoulis
- Neuropsychiatry, NorthWestern Mental Health, Melbourne Health, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia; Department of Psychiatry, The University of Melbourne, Grattan Street, Parkville 3052, Australia.
| | - Samantha M Loi
- Neuropsychiatry, NorthWestern Mental Health, Melbourne Health, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia; Department of Psychiatry, The University of Melbourne, Grattan Street, Parkville 3052, Australia.
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Al-Wardat M, Schirinzi T, Hadoush H, Kassab M, Yabroudi MA, Opara J, Nawrat-Szołtysik A, Khalil H, Etoom M. Home-Based Exercise to Improve Motor Functions, Cognitive Functions, and Quality of Life in People with Huntington's Disease: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14915. [PMID: 36429634 PMCID: PMC9690643 DOI: 10.3390/ijerph192214915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 06/16/2023]
Abstract
Exercise in different settings has become a fundamental part of Huntington's disease (HD) management. The aim of this systematic review and meta-analysis was to investigate the effectiveness of home-based exercises (HBE) in HD. Randomized controlled trials (RCTs) investigating the effect of HBE on motor, cognitive, or health-related quality of life (QoL) outcomes in HD were included. Standardized mean difference (SMD), the 95% confidence interval, and p-values were calculated by comparing the outcomes change between HBE and control groups. Seven RCTs met the inclusion criteria. The included RCTs prescribed different types of HBEs, i.e., aerobic strengthening, walking, balance, and fine motor exercises. The HBE protocol length was between 6 and 36 weeks. The meta-analyses showed a significant effect of HBE intervention on motor function measure by Unified Huntington Disease Rating and overall QoL measure by Short Form-36 post-treatment respectively, [SMD = 0.481, p = 0.048], [SMD = 0.378, p = 0.003]. The pooled analysis did not detect significant changes in cognition, gait characteristics, or functional balance scales. The current study shows the positive effect of HBE in HD, especially on motor function and QoL. No significant adverse events were reported. The current results support the clinical effect of HBE intervention on motor function and QoL in HD patients. However, these results should be taken with caution due to the limited available evidence. Well-designed clinical studies that consider the disease severity and stages are required in the future.
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Affiliation(s)
- Mohammad Al-Wardat
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid P.O. Box 3030, Jordan
| | - Tommaso Schirinzi
- Department of Systems Medicine, University of Roma Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Hikmat Hadoush
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid P.O. Box 3030, Jordan
| | - Manal Kassab
- Department of Maternal and Child Health, Faculty of Nursing, Jordan University of Science and Technology, Irbid P.O. Box 3030, Jordan
| | - Mohammad A. Yabroudi
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid P.O. Box 3030, Jordan
| | - Józef Opara
- Department of Physiotherapy, The Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland
| | | | - Hanan Khalil
- Department of Physical Therapy and Rehabilitation Sciences, College of Health Sciences, Qatar University, Doha P.O. Box 2713, Qatar
| | - Mohammad Etoom
- Physical Therapy Department, Aqaba University of Technology, Aqaba 77110, Jordan
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Morais RDVS, Sogorb-González M, Bar C, Timmer NC, Van der Bent ML, Wartel M, Vallès A. Functional Intercellular Transmission of miHTT via Extracellular Vesicles: An In Vitro Proof-of-Mechanism Study. Cells 2022; 11:2748. [PMID: 36078156 PMCID: PMC9455173 DOI: 10.3390/cells11172748] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/11/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2022] Open
Abstract
Huntington's disease (HD) is a fatal neurodegenerative disorder caused by GAG expansion in exon 1 of the huntingtin (HTT) gene. AAV5-miHTT is an adeno-associated virus serotype 5-based vector expressing an engineered HTT-targeting microRNA (miHTT). Preclinical studies demonstrate the brain-wide spread of AAV5-miHTT following a single intrastriatal injection, which is partly mediated by neuronal transport. miHTT has been previously associated with extracellular vesicles (EVs), but whether EVs mediate the intercellular transmission of miHTT remains unknown. A contactless culture system was used to evaluate the transport of miHTT, either from a donor cell line overexpressing miHTT or AAV5-miHTT transduced neurons. Transfer of miHTT to recipient (HEK-293T, HeLa, and HD patient-derived neurons) cells was observed, which significantly reduced HTT mRNA levels. miHTT was present in EV-enriched fractions isolated from culture media. Immunocytochemical and in situ hybridization experiments showed that the signal for miHTT and EV markers co-localized, confirming the transport of miHTT within EVs. In summary, we provide evidence that an engineered miRNA-miHTT-is loaded into EVs, transported across extracellular space, and taken up by neighboring cells, and importantly, that miHTT is active in recipient cells downregulating HTT expression. This represents an additional mechanism contributing to the widespread biodistribution of AAV5-miHTT.
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Affiliation(s)
- Roberto D. V. S. Morais
- Department of Research and Development, uniQure Biopharma B.V., 1105 BP Amsterdam, The Netherlands
| | - Marina Sogorb-González
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Citlali Bar
- Department of Research and Development, uniQure Biopharma B.V., 1105 BP Amsterdam, The Netherlands
| | - Nikki C. Timmer
- Department of Research and Development, uniQure Biopharma B.V., 1105 BP Amsterdam, The Netherlands
| | - M. Leontien Van der Bent
- Department of Research and Development, uniQure Biopharma B.V., 1105 BP Amsterdam, The Netherlands
| | - Morgane Wartel
- Department of Research and Development, uniQure Biopharma B.V., 1105 BP Amsterdam, The Netherlands
| | - Astrid Vallès
- Department of Research and Development, uniQure Biopharma B.V., 1105 BP Amsterdam, The Netherlands
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Collazo C, Soto-Célix M, Raya-González J, Castillo-Alvira D, Rivadeneyra-Posadas J, Calvo S, Simón-Vicente L, Rodríguez-Fernández A, Cubo E. Protocol of Energy balance estimates in Huntington's disease: an observational, case-control, multicenter pilot study. (Preprint). JMIR Res Protoc 2022. [DOI: 10.2196/41757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
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20
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Youssov K, Audureau E, Vandendriessche H, Morgado G, Layese R, Goizet C, Verny C, Bourhis ML, Bachoud-Lévi AC. The burden of Huntington's disease: A prospective longitudinal study of patient/caregiver pairs. Parkinsonism Relat Disord 2022; 103:77-84. [DOI: 10.1016/j.parkreldis.2022.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/12/2022] [Accepted: 08/19/2022] [Indexed: 10/15/2022]
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Furby H, Siadimas A, Rutten-Jacobs L, Rodrigues FB, Wild EJ. Natural History and Burden of Huntington's Disease in the UK: A Population-Based Cohort Study. Eur J Neurol 2022; 29:2249-2257. [PMID: 35514071 PMCID: PMC9542098 DOI: 10.1111/ene.15385] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/21/2022] [Accepted: 04/24/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Huntington's disease (HD) is a rare neurodegenerative disease that presents with progressive psychological, cognitive and motor impairment. These diverse symptoms place a high burden on the patient, families and the healthcare systems they rely on. This study aimed to describe the epidemiology and clinical burden in individuals with HD compared with controls from the general population. METHODS This cohort study utilised data from general practitioner (GP) medical records to estimate the prevalence and incidence of HD between Jan 2000 and Dec 2018. A cohort of incident HD cases were matched 1:3 to controls from the general population, in whom common clinical diagnoses, medications and healthcare interventions were compared at the time of first recorded diagnosis and at a time close to death. Incidence rates of common diagnoses and mortality were compared with matched controls in the time following HD diagnosis. RESULTS Prevalence of HD increased between 2000 and 2018, whilst incidence remained stable. Prevalence of psychiatric diagnoses and symptomatic treatments were higher in HD cases than controls. A higher relative risk of psychotic disorders, depression, insomnia, dementia, weight loss, pneumonia and falls was observed in HD cases. Risk of death was >4 times higher in HD, with a median survival of ~12 years from first recorded diagnosis. CONCLUSIONS This study demonstrates the significant and progressive clinical burden in individuals up to 18 years after first recorded diagnosis.
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Affiliation(s)
| | | | | | - Filipe B Rodrigues
- Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Edward J Wild
- Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
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22
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Rodrigues FB, Owen G, Sathe S, Pak E, Kaur D, Ehrhardt AG, Lifer S, Townhill J, Schubert K, Leavitt BR, Guttman M, Bang J, Lewerenz J, Levey J, Sampaio C, Wild EJ. Safety and Feasibility of Research Lumbar Puncture in Huntington's Disease: The HDClarity Cohort and Bioresource. J Huntingtons Dis 2022; 11:59-69. [PMID: 35253773 DOI: 10.3233/jhd-210508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Biomarkers are needed to monitor disease progression, target engagement and efficacy in Huntington's disease (HD). Cerebrospinal fluid (CSF) is an ideal medium to research such biomarkers due to its proximity to the brain. OBJECTIVE To investigate the safety and feasibility of research lumbar punctures (LP) in HD. METHODS HDClarity is an ongoing international biofluid collection initiative built on the Enroll-HD platform, where clinical assessments are recorded. It aims to recruit 1,200 participants. Biosamples are collected following an overnight fast: blood via venipuncture and CSF via LP. Participants are healthy controls and HD gene expansion carriers across the disease spectrum. We report on monitored data from February 2016 to September 2019. RESULTS Of 448 participants screened, 398 underwent at least 1 sampling visit, of which 98.24% were successful (i.e., CSF was collected), amounting to 10,610 mL of CSF and 8,200 mL of plasma. In the total 572 sampling visits, adverse events were reported in 24.13%, and headaches of any kind and post-LP headaches in 14.86% and 12.24%, respectively. Frequencies were less in manifest HD; gender, age, body mass index and disease burden score were not associated with the occurrence of the events in gene expansion carriers. Headaches and back pain were the most frequent adverse events. CONCLUSION HDClarity is the largest CSF collection initiative to support scientific research into HD and is now stablished as a leading resource for HD research. Our data confirm that research LP in HD are feasible and acceptable to the community, and have a manageable safety profile.
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Affiliation(s)
- Filipe B Rodrigues
- UCL Huntington's Disease Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Gail Owen
- UCL Huntington's Disease Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Swati Sathe
- CHDI Management/CHDI Foundation, Princeton, NJ, USA
| | - Elena Pak
- CHDI Management/CHDI Foundation, Princeton, NJ, USA
| | | | | | - Sherry Lifer
- CHDI Management/CHDI Foundation, Princeton, NJ, USA
| | - Jenny Townhill
- Enroll-HD platform, European Huntington's Disease Network, University Hospital of Ulm, Ulm, Germany
| | - Katarzyna Schubert
- UCL Huntington's Disease Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Blair R Leavitt
- Centre for Molecular Medicine and Therapeutics, Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Mark Guttman
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jee Bang
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jan Lewerenz
- Department of Neurology, Ulm University, Ulm, Germany
| | - Jamie Levey
- CHDI Management/CHDI Foundation, Princeton, NJ, USA.,Enroll-HD platform, European Huntington's Disease Network, University Hospital of Ulm, Ulm, Germany
| | | | | | - Edward J Wild
- UCL Huntington's Disease Centre, UCL Queen Square Institute of Neurology, London, UK
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23
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Pham Nguyen TP, Bravo L, Gonzalez-Alegre P, Willis AW. Geographic Barriers Drive Disparities in Specialty Center Access for Older Adults with Huntington's Disease. J Huntingtons Dis 2022; 11:81-89. [PMID: 35253771 DOI: 10.3233/jhd-210489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Huntington's Disease Society of America Centers of Excellence (HDSA COEs) are primary hubs for Huntington's disease (HD) research opportunities and accessing new treatments. Data on the extent to which HDSA COEs are accessible to individuals with HD, particularly those older or disabled, are lacking. OBJECTIVE To describe persons with HD in the U.S. Medicare program and characterize this population by proximity to an HDSA COE. METHODS We conducted a cross-sectional study of Medicare beneficiaries ages ≥65 with HD in 2017. We analyzed data on benefit entitlement, demographics, and comorbidities. QGis software and Google Maps Interface were employed to estimate the distance from each patient to the nearest HDSA COE, and the proportion of individuals residing within 100 miles of these COEs at the state level. RESULTS Among 9,056 Medicare beneficiaries with HD, 54.5% were female, 83.0% were white; 48.5% were ≥65 years, but 64.9% originally qualified for Medicare due to disability. Common comorbidities were dementia (32.4%) and depression (35.9%), and these were more common in HD vs. non-HD patients. Overall, 5,144 (57.1%) lived within 100 miles of a COE. Race/ethnicity, sex, age, and poverty markers were not associated with below-average proximity to HDSA COEs. The proportion of patients living within 100 miles of a center varied from < 10% (16 states) to > 90% (7 states). Most underserved states were in the Mountain and West Central divisions. CONCLUSION Older Medicare beneficiaries with HD are frequently disabled and have a distinct comorbidity profile. Geographical, rather than sociodemographic factors, define the HD population with limited access to HDSA COEs.
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Affiliation(s)
- Thanh Phuong Pham Nguyen
- Center for Pharmacoepidemiology Research and Training, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Neurology Translational Center for Excellence for Neuroepidemiology and Neurological Outcomes Research, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Licia Bravo
- Xavier University of Louisiana, New Orleans, LA, USA.,Penn Access Summer Scholars Program, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Pedro Gonzalez-Alegre
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Raymond G. Perelman Center for Cellular & Molecular Therapy, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Allison W Willis
- Center for Pharmacoepidemiology Research and Training, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Neurology Translational Center for Excellence for Neuroepidemiology and Neurological Outcomes Research, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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24
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Alothman D, Marshall CR, Tyrrell E, Lewis S, Card T, Fogarty A. Risk of mortality from suicide in patients with Huntington's disease is increased compared to the general population in England. J Neurol 2022; 269:4436-4439. [PMID: 35344078 PMCID: PMC9293836 DOI: 10.1007/s00415-022-11085-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 02/06/2022] [Accepted: 03/15/2022] [Indexed: 12/02/2022]
Abstract
Objective To examine the relative risk of suicide mortality in patients with Huntington’s disease (HD). Methods A case–control study design was used. We used linked electronic records from primary care, secondary care and Office for National Statistics from England from 2001 through 2019. Controls were matched to cases by general practice and suicide date. Odds ratios (ORs) were adjusted for gender and age at suicide/index date. Results Data were available for 594,674 individuals. Patients with HD who died from suicide were significantly younger at time of death than patients with HD who died from causes other than suicide (p < 0.001). The adjusted OR for HD was 9.2 (95% confidence intervals, CI 4.9–17.4) compared to those without HD. The increase in risk was higher amongst the younger age group who were ≤ 45.8 years at suicide/index date (OR 54.5, 95% CI 10.8–276.1). Conclusion The markedly elevated suicide risk in patients with HD suggests that implementation of suicide risk assessment may improve survival in individuals with these diseases, especially in younger patients. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-022-11085-z.
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Affiliation(s)
- Danah Alothman
- School of Medicine, University of Nottingham, Nottingham, UK.
| | - Charles R Marshall
- Preventive Neurology Unit, Wolfson Institute of Population Health, London, EC1M 6BQ, UK
| | - Edward Tyrrell
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Sarah Lewis
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Timothy Card
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Andrew Fogarty
- School of Medicine, University of Nottingham, Nottingham, UK
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25
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Frank E, Dyke A, MacKenzie S, Maskwa E, Frank S. Effects of Percutaneous Endoscopic Gastrostomy in Patients With Huntington Disease. Neurol Clin Pract 2022; 11:517-520. [PMID: 34992958 DOI: 10.1212/cpj.0000000000001094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 03/19/2021] [Indexed: 11/15/2022]
Abstract
Objective To determine the impact of percutaneous endoscopic gastrostomy (PEG) tubes in patients with advanced Huntington disease (HD). Methods A retrospective chart review of patients with HD was conducted to assess the rate of pneumonia and pressure ulcer, length of life, changes in weight, and serologic nutritional measures. Surviving and deceased patients with and without PEG tubes were compared using descriptive statistical analysis. Results One hundred forty-eight records were reviewed (39 patients with PEG tubes). The mean age of patients still alive and diagnosed with HD was 58.3 ± 12.7 years and age at death (n = 62) 57.7 ± 10.3 years. At the time of analysis, the mean duration of HD was 14.2 ± 7 years. Groups were similar in sex, age, and weight at admission. In those deceased, insertion of a PEG tube increased the length of life with HD by 3.6 years (16.2 ± 6.7 vs 13.2 ± 4.9 years). PEG tube placement significantly reduced cholesterol levels, increased the prevalence of skin ulcers and the rate of pneumonia. Insertion of a PEG tube did not significantly change weight or albumin levels. Conclusions PEG tube placement in advanced HD provided benefit in the length of life, but weight, other nutritional measures, and the rate of pneumonia were either not impacted or worsened with the insertion of a PEG tube. Impact on quality of life needs further study, but providers, patients, and families should consider all options when discussing preferences for interventions. Classification of Evidence This study provides Class IV evidence that for patients with advanced HD, PEG tube placement increases the length of life but has no or negative impacts on nutritional measures.
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Affiliation(s)
- Emma Frank
- University of Vermont (EF), Burlington, VT; University of New Hampshire (AD), Manchester, NH; and Beth Israel Deaconess Medical Center (SM, EM, SF), Boston, MA
| | - Allison Dyke
- University of Vermont (EF), Burlington, VT; University of New Hampshire (AD), Manchester, NH; and Beth Israel Deaconess Medical Center (SM, EM, SF), Boston, MA
| | - Sarah MacKenzie
- University of Vermont (EF), Burlington, VT; University of New Hampshire (AD), Manchester, NH; and Beth Israel Deaconess Medical Center (SM, EM, SF), Boston, MA
| | - Evagelia Maskwa
- University of Vermont (EF), Burlington, VT; University of New Hampshire (AD), Manchester, NH; and Beth Israel Deaconess Medical Center (SM, EM, SF), Boston, MA
| | - Samuel Frank
- University of Vermont (EF), Burlington, VT; University of New Hampshire (AD), Manchester, NH; and Beth Israel Deaconess Medical Center (SM, EM, SF), Boston, MA
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26
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Ferreira JJ, Rodrigues FB, Duarte GS, Mestre TA, Bachoud-Levi AC, Bentivoglio AR, Burgunder JM, Cardoso F, Claassen DO, Landwehrmeyer GB, Kulisevsky J, Nirenberg MJ, Rosser A, Roth J, Seppi K, Slawek J, Furr-Stimming E, Tabrizi SJ, Walker FO, Vandenberghe W, Costa J, Sampaio C. A MDS Evidence-Based Review on Treatments for Huntington's Disease. Mov Disord 2021; 37:25-35. [PMID: 34842303 DOI: 10.1002/mds.28855] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 09/30/2021] [Accepted: 10/04/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Huntington's disease (HD) is a rare neurodegenerative disorder with protean clinical manifestations. Its management is challenging, consisting mainly of off-label treatments. OBJECTIVES The International Parkinson and Movement Disorder Society commissioned a task force to review and evaluate the evidence of available therapies for HD gene expansion carriers. METHODS We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Eligible randomized controlled trials were identified via an electronic search of the CENTRAL, MEDLINE, and EMBASE databases. All eligible trials that evaluated one or more of 33 predetermined clinical questions were included. Risk of bias was evaluated using the Cochrane Risk of Bias tool. A framework was adapted to allow for efficacy and safety conclusions to be drawn from the balance between the GRADE level of evidence and the importance of the benefit/harm of the intervention. RESULTS Twenty-two eligible studies involving 17 interventions were included, providing data to address 8 clinical questions. These data supported a likely effect of deutetrabenazine on motor impairment, chorea, and dystonia and of tetrabenazine on chorea. The data did not support a disease-modifying effect for premanifest and manifest HD. There was no eligible evidence to support the use of specific treatments for depression, psychosis, irritability, apathy, or suicidality. Similarly, no evidence was eligible to support the use of physiotherapy, occupational therapy, exercise, dietary, or surgical treatments. CONCLUSIONS Data for therapeutic interventions in HD are limited and support only the use of VMAT2 inhibitors for specific motor symptoms. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Joaquim J Ferreira
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Instituto de Medicina Molecular João Lobo Antunes, Lisbon, Portugal.,CNS - Campus Neurológico, Torres Vedras, Portugal
| | - Filipe B Rodrigues
- Instituto de Medicina Molecular João Lobo Antunes, Lisbon, Portugal.,CNS - Campus Neurológico, Torres Vedras, Portugal.,UCL Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Gonçalo S Duarte
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Instituto de Medicina Molecular João Lobo Antunes, Lisbon, Portugal.,Centro de Estudos de Medicina Baseada na Evidência, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Tiago A Mestre
- Parkinson disease and Movement Disorders Centre, Division of Neurology, Department of Medicine, The Ottawa Hospital Research Institute, The University of Ottawa Brain and Mind Research Institute, Ottawa, Ontario, Canada
| | - Anne-Catherine Bachoud-Levi
- National Centre of Reference for Huntington's Disease, Neurology Department, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France.,Neuropsychologie Interventionelle Lab, INSERM U955 E01B, PSL University, Paris, France.,Université Paris Est Créteil, Créteil, France
| | - Anna Rita Bentivoglio
- Istituto di Neurologia, Università Cattolica del Sacro Cuore, Rome, Italy.,Movement Disorder Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Jean-Marc Burgunder
- Swiss Huntington Center, Neurozentrum Siloah AG, Muri bei Bern, Switzerland.,Department of Neurology, University of Bern, Bern, Switzerland
| | - Francisco Cardoso
- Movement Disorders Unit, Neurology Service, Internal Medicine Department of the Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Daniel O Claassen
- Department of Neurology, Division of Behavioral and Cognitive Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Jaime Kulisevsky
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Institut d´Investigacions Biomèdiques Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,Centro de Investigación en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Melissa J Nirenberg
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Anne Rosser
- Neuroscience and Mental Health Research Institute (Brain Research And Intracranial Neurotherapeutics Unit), Cardiff, United Kingdom
| | - Jan Roth
- Department of Neurology and Center of Clinical Neuroscience, 1st Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Klaus Seppi
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Jaroslaw Slawek
- Division of Psychiatric-Neurological Nursing, Faculty of Health Sciences, Medical University of Gdansk, Gdansk, Poland.,Neurology and Stroke Department, St. Adalbert Hospital, Gdansk, Poland
| | - Erin Furr-Stimming
- Department of Neurology, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas, USA
| | - Sarah J Tabrizi
- UCL Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom.,Department of Neurodegenerative Disease, Queen Square Institute of Neurology, University College London, London, United Kingdom.,UK Dementia Research Institute, University College London, London, United Kingdom
| | - Francis O Walker
- Division of Neuromuscular Disorders, Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Wim Vandenberghe
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium.,Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - João Costa
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Instituto de Medicina Molecular João Lobo Antunes, Lisbon, Portugal.,Centro de Estudos de Medicina Baseada na Evidência, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Cristina Sampaio
- Instituto de Medicina Molecular João Lobo Antunes, Lisbon, Portugal.,CHDI Management/CHDI Foundation, Princeton, New Jersey, USA
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27
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Gavrielov-Yusim N, Barer Y, Martinec M, Siadimas A, Roumpanis S, Furby H, Goldshtein I, Jan A, Coloma PM. Huntington's Disease in Israel: A Population-Based Study Using 20 Years of Routinely-Collected Healthcare Data. J Huntingtons Dis 2021; 10:469-477. [PMID: 34602495 DOI: 10.3233/jhd-210500] [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] [Indexed: 12/30/2022]
Abstract
BACKGROUND Huntington's disease (HD) is a rare, genetic, neurodegenerative disease. Obtaining population-level data on epidemiology and disease management is challenging. OBJECTIVE To investigate the epidemiology, clinical manifestations, treatment, and healthcare utilization of patients with HD in Israel. METHODS Retrospective population-based cohort study, including 20 years of routinely collected data from Maccabi Healthcare Services, an insurer and healthcare provider for one-quarter of the Israeli population. RESULTS The study cohort included 109 adult patients (aged ≥18 years) diagnosed with HD, with mean age of 49.9 years and 56%females. The most common HD-related conditions were anxiety (40%), behavioral problems (34%), sleep disorders (21%), and falls (13%). Annual incidence rates for HD ranged from 0.17 to 1.34 per 100,000 from 2000 to 2018; the 2018 crude prevalence in adults was 4.36 per 100,000. Median survival from diagnosis was approximately 12 years (95%CI: 10.4-15.3). The most frequent symptomatic treatments were antidepressants (69%), antipsychotics (63%), and tetrabenazine (63%), the only drug approved for the treatment of HD chorea in Israel during the examined period. Patterns of healthcare utilization changed as disease duration increased, reflected by increased frequency of emergency department visits and home visits. CONCLUSION This retrospective population-based study provides insights into the prevalence, incidence, clinical profile, survival, and resource utilization of patients with HD in ethnically diverse Israel. The findings in this study are generally consistent with the international literature and demonstrate the value of routinely collected healthcare data as a complementary resource in HD research.
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Affiliation(s)
- Natalie Gavrielov-Yusim
- Product Development Personalized Health Care - Data Science, Roche Pharmaceuticals, Hod HaSharon, Israel
| | - Yael Barer
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Michael Martinec
- Product Development Personalized Health Care - Data Science, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Athanasios Siadimas
- Product Development Personalized Health Care - Data Science, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Spyros Roumpanis
- Product Development Personalized Health Care - Data Science, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Hannah Furby
- Product Development Personalized Health Care - Data Science, Roche, Welwyn, UK
| | - Inbal Goldshtein
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel.,Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asif Jan
- Product Development Personalized Health Care - Data Science, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Preciosa M Coloma
- Product Development Personalized Health Care - Data Science, F. Hoffmann-La Roche Ltd., Basel, Switzerland
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28
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van Duijn E, Fernandes AR, Abreu D, Ware JJ, Neacy E, Sampaio C. Incidence of completed suicide and suicide attempts in a global prospective study of Huntington's disease. BJPsych Open 2021; 7:e158. [PMID: 34462049 PMCID: PMC8444051 DOI: 10.1192/bjo.2021.969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Risk of death from suicide in Huntington's disease is notably elevated relative to that in the general population, although the incidence within HD populations has not been precisely defined. Robust incidence estimates of suicidal behavior can serve as references for HD therapeutic research and post-marketing surveillance to help evaluate the suicidality risk of novel therapeutics. AIMS To estimate the incidence rate of completed suicide and suicide attempt in the global, prospective HD cohort study Enroll-HD that records these events per protocol. METHOD A total of 20 912 participants were available for analysis (HD gene-expansion carriers (HDGECs) n = 15 924; non-HDGECs n = 4988) representing a collective observation period of 53 390 participant-years. Each observed event was subject to clinical review and evaluation. We generated incidence rates (events per 100 000 person-years) for suicides and suicide attempts using all available data, as well as by year of study and geographical region. Proportionate mortality statistics for suicide and respective 95% confidence intervals were also generated. RESULTS The overall incidence rate of suicide in HDGECs was 72 per 100 000 person-years, and 8 per 100 000 person-years in non-HDGECs. Proportionate mortality attributable to suicide in HDGECs was 4.6%. For suicide attempts, the global overall incidence rate observed in HDGECs was 306-375 per 100 000 person-years, and 23-38 per 100 000 person-years in non-HDGECs. CONCLUSIONS The incidence estimates calculated here can be used as a reference to help evaluate drug safety and may also be useful in assessing progress in clinical care for HDGECs once therapeutic interventions become widely available.
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Affiliation(s)
- Erik van Duijn
- Department of Psychiatry, Leiden University Medical Center, The Netherlands and Huntington Center Topaz Overduin, The Netherlands
| | - A Raquel Fernandes
- Association for Research and Development of the Faculty of Medicine, University of Lisbon, Portugal
| | - Daisy Abreu
- Association for Research and Development of the Faculty of Medicine, University of Lisbon, Portugal
| | | | - Eileen Neacy
- CHDI Management/CHDI Foundation, New Jersey, USA
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Sokol LL, Bega D, Yeh C, Kluger BM, Lum HD. Disparities in Palliative Care Utilization Among Hospitalized People With Huntington Disease: A National Cross-Sectional Study. Am J Hosp Palliat Care 2021; 39:516-522. [PMID: 34291654 DOI: 10.1177/10499091211034419] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND People with Huntington's disease (HD) often become institutionalized and more frequently die away from the home setting. The reasons behind differences in end-of-life care are poorly understood. Less than 5% of people with HD report utilization of palliative care (PC) or hospice services, regardless of the lack of curative therapies for this neurodegenerative disease. It is unknown what factors are associated with in-patient specialty PC consultation in this population and how PC might be related to discharge disposition. OBJECTIVES To determine what HD-specific (e.g., psychosis) and serious illness-specific factors (e.g., resuscitation preferences) are associated with PC encounters in people with HD and explore how PC encounters are associated with discharge disposition. DESIGN We analyzed factors associated with PC consultation for people with HD using discharge data from the National Inpatient Sample and the Nationwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality. An anonymized, cross-sectional, and stratified sample of 20% of United States hospitalizations from 2007 through 2014 were included using ICD-9 codes. RESULTS 8521 patients with HD were admitted to the hospital. Of those, 321 (3.8%) received specialty PC. Payer type, (specifically private insurer or other insurer as compared to Medicare), income, (specifically the top quartile as compared to the bottom quartile), mortality risk, D.N.R., aspiration pneumonia, and depression were significantly associated with PC in a multivariate model. Among those who received PC, the odds ratio (OR) of discharge to a facility was 0.43 (95% CI, 0.32-0.58), whereas the OR of discharge to home with services was 2.25 (95% CI 1.57-3.23), even after adjusting for possible confounders. CONCLUSIONS Among patients with HD, economic factors, depression, and serious illness-specific factors were associated with PC, and PC was associated with discharge disposition. These findings have implications for the adaptation of inpatient PC models to meet the needs of persons with HD.
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Affiliation(s)
- Leonard L Sokol
- The Ken and Ruth Davee Department of Neurology, 12244Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,McGaw Bioethics Scholars Program, Center for Bioethics and Humanities, 12244Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Danny Bega
- The Ken and Ruth Davee Department of Neurology, 12244Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Movement Disorders, The Ken and Ruth Davee Department of Neurology, 12244Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Chen Yeh
- Department of Preventive Medicine, 12244Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Benzi M Kluger
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA.,Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Hillary D Lum
- Eastern Colorado VA Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA.,Division of Geriatric Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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30
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Sokol LL, Troost JP, Kluger BM, Applebaum AJ, Paulsen JS, Bega D, Frank S, Hauser JM, Boileau NR, Depp CA, Cella D, Carlozzi NE. Meaning and purpose in Huntington's disease: a longitudinal study of its impact on quality of life. Ann Clin Transl Neurol 2021; 8:1668-1679. [PMID: 34288600 PMCID: PMC8351386 DOI: 10.1002/acn3.51424] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 12/31/2022] Open
Abstract
Objective Previous work in Huntington’s disease (HD) has shown that a sense of meaning and purpose (M&P) is positively associated with positive affect and well‐being (PAW); however, it was unknown whether HD‐validated patient‐reported outcomes (PROs) influence this association and how M&P impacts PROs in the future. Our study was designed to examine if HD‐validated PROs moderate the relationship between M&P and PAW and to evaluate if baseline M&P predicts 12‐ and 24‐month changes in HD‐validated PROs. Methods This was a longitudinal, multicenter study to develop several PROs (e.g., specific for the physical, emotional, cognitive, and social domains) for people with HD (HDQLIFE). The sample consisted of 322 people with HD (n = 50 prodromal, n = 171 early‐stage manifest, and n = 101 late‐stage manifest HD). A single, multivariate linear mixed‐effects model was performed with PAW as the outcome predicted by main effects for M&P and several moderators (i.e., an HD‐validated PRO) and interactions between M&P and a given PRO. Linear‐mixed models were also used to assess if baseline M&P predicted HD‐validated PROs at 12 and 24 months. Results Higher M&P was positively associated with higher PAW regardless of the magnitude of symptom burden, as represented by HD‐validated PROs, and independent of disease stage. In our primary analysis, baseline M&P predicted increased PAW and decreased depression, anxiety, anger, emotional/behavioral disruptions, and cognitive decline at 12 and 24 months across all disease stages. Interpretation These findings parallel those seen in the oncology population and have implications for adapting and developing psychotherapeutic and palliative HD interventions.
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Affiliation(s)
- Leonard L Sokol
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Center for Bioethics and Humanities, McGaw Bioethics Scholars Program, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jonathan P Troost
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Benzi M Kluger
- Departments of Neurology and Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Allison J Applebaum
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jane S Paulsen
- Department of Neurology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Danny Bega
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Samuel Frank
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Joshua M Hauser
- Department of Medicine, Feinberg School of Medicine and Palliative Care Service, Jesse Brown VA Medical Center, Chicago, Illinois, USA
| | - Nicholas R Boileau
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Colin A Depp
- Department of Psychiatry, University of California, San Diego, California, USA
| | - David Cella
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Noelle E Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
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Abreu D, Ware J, Georgiou-Karistianis N, Leavitt BR, Fitzer-Attas CJ, Lobo R, Fernandes AR, Handley O, Anderson KE, Stout JC, Sampaio C. Utility of Huntington's Disease Assessments by Disease Stage: Floor/Ceiling Effects. Front Neurol 2021; 12:595679. [PMID: 34335433 PMCID: PMC8320772 DOI: 10.3389/fneur.2021.595679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 06/10/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction: An understanding of the clinimetric properties of clinical assessments, including their constraints, is critical to sound clinical study and trial design. Utilizing data from Enroll-HD—a global, prospective HD observational study and clinical research platform—we examined several well-established HD clinical assessments across all stages of disease for evidence of instrument constraints, specifically floor/ceiling effects, to inform selection of appropriate instruments for use in future studies/trials and identify gaps in instrument utility over the life-course of the disease. Material and Methods: Analyzing publicly available data from 6,614 HD gene-expansion carriers (HDGECs), we grouped participants into deciles based on baseline CAP score, which ranged from 26 to 229. We used descriptive statistics to characterize data distribution for 25 outcome measures (encompassing motor, function, cognition, and psychiatric/behavioral domains) in each CAP decile. A skewness statistic threshold of ±2 was defined a priori to indicate floor/ceiling effects. Results: We found evidence of floor/ceiling effects in the early premanifest stages of disease for most motor and function assessments (e.g., TMS, TFC) and select cognitive tasks (MMSE, Trail Making tests). Other cognitive assessments, and the HADS-SIS scales, performed well ubiquitously, with no evidence of floor/ceiling effects at any disease stage. Floor/ceiling effects were evident at every disease stage for certain assessments, including PBA-s measures. Ceiling effects were apparent for DCL from onset stages onwards, as expected. Discussion: Developing instruments sensitive to subtle differences in performance at the earlier stages of the disease spectrum, particularly in motor and function domains, is warranted.
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Affiliation(s)
- Daisy Abreu
- Associação para Investigação e Desenvolvimento da Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Jennifer Ware
- CHDI Management/CHDI Foundation, Princeton, NJ, United States
| | - Nellie Georgiou-Karistianis
- Turner Institute of Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Blair R Leavitt
- Centre for Molecular Medicine and Therapeutics, Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | | | - Raquel Lobo
- Associação para Investigação e Desenvolvimento da Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Ana Raquel Fernandes
- Associação para Investigação e Desenvolvimento da Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Olivia Handley
- School of Biosciences, Cardiff University, Cardiff, United Kingdom
| | - Karen E Anderson
- Department of Psychiatry and Department of Neurology, Georgetown University, Washington, DC, United States
| | - Julie C Stout
- Turner Institute of Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
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Lisiecka D, Kearns A, Bourke F, Lawson I, Muir C. A qualitative meta-synthesis of evidence (meta-ethnography) exploring the personal experiences of gastrostomy tube in neurodegenerative diseases: a case of motor neurone disease. Disabil Rehabil 2021; 44:4949-4965. [PMID: 34033736 DOI: 10.1080/09638288.2021.1922518] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE The lived experiences of a gastrostomy tube (GT) in adults with neurodegenerative diseases (NDDs) are not well understood. The aim of this qualitative meta-synthesis was to review and synthesise the available evidence to inform clinical practice and identify research gaps. METHODS Meta-ethnographic synthesis of qualitative studies was conducted with systematic searching of eight databases from inception to March 2021. Qualitative studies reporting personal experiences of GTs in adults with NDDs were identified. New theories were developed during translation of concepts from each study and combined as a "line-of-argument" synthesis. Patient and public involvement was incorporated as two of the authors are living with an NDD and a GT. RESULTS AND CONCLUSIONS Of 2863 unique records identified, only nine fulfilled the review criteria. All studies recruited participants with motor neurone disease (MND); no other NDDs were represented. Two main themes emerged: decision making and living with GT. Decision making was the predominant theme and data regarding living with GT were sparse. There is limited research on the lived experience of a GT in adults with NDDs. The lived experience of GT in MND is complex and individualised. Future research is indicated to inform clinical practice.Implications for rehabilitationEvidence related to the lived experiences of gastrostomy tube (GT) in neurodegenerative diseases (NDDs) is lacking especially in relation to the time after GT insertion.Decision making in relation to GT is a complex and individualised psychological process for some people, while others perceive no decisional conflict.Support from healthcare professionals is crucial during the decision-making time and should not cease after GT insertion.Support from healthcare professionals can help resolve any clinical complications and also incorporate GT into everyday routines.Healthcare professionals should be aware that their views on the benefits and problems related to GT may differ to those of individuals with a NDD.
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Affiliation(s)
- Dominika Lisiecka
- Department of Nursing and Healthcare Sciences, School of Health and Social Sciences, Munster Technological University, Kerry Campus, Tralee, Ireland
| | - Aine Kearns
- Department of Speech & Language Therapy, School of Allied Health, University of Limerick, Limerick, Ireland
| | - Fiona Bourke
- Department of Speech & Language Therapy, School of Allied Health, University of Limerick, Limerick, Ireland
| | - Ian Lawson
- North Yorkshire Disability Forum, Whitby, UK
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Shah R, Lee SC, Strasser RB, Grossman C. An Australian Neuro-Palliative perspective on Huntington's disease: a case report. BMC Palliat Care 2021; 20:53. [PMID: 33794853 PMCID: PMC8017854 DOI: 10.1186/s12904-021-00744-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Huntington's Disease (HD) is an incurable, progressive neuro-degenerative disease. For patients with HD access to palliative care services is limited, with dedicated Neuro-Palliative Care Services rare in Australia. We discuss the experiences of and benefits to a patient with late-stage HD admitted to our Neuro-Palliative Care service. CASE PRESENTATION We present the case of a patient with a 16-year history of HD from time of initial genetic testing to admission to our Neuro-Palliative Care service with late-stage disease. CONCLUSIONS Given the prolonged, fluctuating and heterogenous HD trajectory, measures need to be implemented to improve earlier access to multi-specialty integrative palliative care services. Given the good outcomes of our case, we strongly advocate for the role of specialised Neuro-Palliative Care services to bridge the gap between clinical need and accessibility.
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Affiliation(s)
- Rajvi Shah
- Calvary Health Care Bethlehem, Melbourne, Australia.
| | - Sarah Cm Lee
- Calvary Health Care Bethlehem, Melbourne, Australia
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Vicente E, Ruiz de Sabando A, García F, Gastón I, Ardanaz E, Ramos-Arroyo MA. Validation of diagnostic codes and epidemiologic trends of Huntington disease: a population-based study in Navarre, Spain. Orphanet J Rare Dis 2021; 16:77. [PMID: 33568143 PMCID: PMC7877055 DOI: 10.1186/s13023-021-01699-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 01/19/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND There is great heterogeneity on geographic and temporary Huntington disease (HD) epidemiological estimates. Most research studies of rare diseases, including HD, use health information systems (HIS) as data sources. This study investigates the validity and accuracy of national and international diagnostic codes for HD in multiple HIS and analyses the epidemiologic trends of HD in the Autonomous Community of Navarre (Spain). METHODS HD cases were ascertained by the Rare Diseases Registry and the reference Medical Genetics Centre of Navarre. Positive predictive values (PPV) and sensitivity with 95% confidence intervals (95% CI) were estimated. Overall and 9-year periods (1991-2017) HD prevalence, incidence and mortality rates were calculated, and trends were assessed by Joinpoint regression. RESULTS Overall PPV and sensitivity of combined HIS were 71.8% (95% CI: 59.7, 81.6) and 82.2% (95% CI: 70.1, 90.4), respectively. Primary care data was a more valuable resource for HD ascertainment than hospital discharge records, with 66% versus 50% sensitivity, respectively. It also had the highest number of "unique to source" cases. Thirty-five per cent of HD patients were identified by a single database and only 4% by all explored sources. Point prevalence was 4.94 (95% CI: 3.23, 6.65) per 100,000 in December 2017, and showed an annual 6.1% increase from 1991 to 1999. Incidence and mortality trends remained stable since 1995-96, with mean annual rates per 100,000 of 0.36 (95% CI: 0.27, 0.47) and 0.23 (95% CI: 0.16, 0.32), respectively. Late-onset HD patients (23.1%), mean age at onset (49.6 years), age at death (66.6 years) and duration of disease (16.7 years) were slightly higher than previously reported. CONCLUSION HD did not experience true temporary variations in prevalence, incidence or mortality over 23 years of post-molecular testing in our population. Ascertainment bias may largely explain the worldwide heterogeneity in results of HD epidemiological estimates. Population-based rare diseases registries are valuable instruments for epidemiological studies on low prevalence genetic diseases, like HD, as long as they include validated data from multiple HIS and genetic/family information.
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Affiliation(s)
- Esther Vicente
- Community Health Observatory Section, Instituto de Salud Pública y Laboral de Navarra, IdiSNA (Navarre Institute for Health Research), Pamplona, Spain.
- Department of Health Sciences, Universidad Pública de Navarra, IdiSNA, Pamplona, Spain.
| | - Ainara Ruiz de Sabando
- Department of Health Sciences, Universidad Pública de Navarra, IdiSNA, Pamplona, Spain
- Department of Medical Genetics, Complejo Hospitalario de Navarra, IdiSNA, Pamplona, Spain
- Fundación Miguel Servet-Navarrabiomed, IdiSNA, Pamplona, Spain
| | - Fermín García
- Department of Medical Genetics, Complejo Hospitalario de Navarra, IdiSNA, Pamplona, Spain
| | - Itziar Gastón
- Department of Neurology, Complejo Hospitalario de Navarra, IdiSNA, Pamplona, Spain
| | - Eva Ardanaz
- Community Health Observatory Section, Instituto de Salud Pública y Laboral de Navarra, IdiSNA (Navarre Institute for Health Research), Pamplona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - María A Ramos-Arroyo
- Department of Health Sciences, Universidad Pública de Navarra, IdiSNA, Pamplona, Spain
- Department of Medical Genetics, Complejo Hospitalario de Navarra, IdiSNA, Pamplona, Spain
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Ou ZYA, Byrne LM, Rodrigues FB, Tortelli R, Johnson EB, Foiani MS, Arridge M, De Vita E, Scahill RI, Heslegrave A, Zetterberg H, Wild EJ. Brain-derived neurotrophic factor in cerebrospinal fluid and plasma is not a biomarker for Huntington's disease. Sci Rep 2021; 11:3481. [PMID: 33568689 PMCID: PMC7876124 DOI: 10.1038/s41598-021-83000-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/18/2021] [Indexed: 11/08/2022] Open
Abstract
Brain-derived neurotrophic factor (BDNF) is implicated in the survival of striatal neurons. BDNF function is reduced in Huntington's disease (HD), possibly because mutant huntingtin impairs its cortico-striatal transport, contributing to striatal neurodegeneration. The BDNF trophic pathway is a therapeutic target, and blood BDNF has been suggested as a potential biomarker for HD, but BDNF has not been quantified in cerebrospinal fluid (CSF) in HD. We quantified BDNF in CSF and plasma in the HD-CSF cohort (20 pre-manifest and 40 manifest HD mutation carriers and 20 age and gender-matched controls) using conventional ELISAs and an ultra-sensitive immunoassay. BDNF concentration was below the limit of detection of the conventional ELISAs, raising doubt about previous CSF reports in neurodegeneration. Using the ultra-sensitive method, BDNF concentration was quantifiable in all samples but did not differ between controls and HD mutation carriers in CSF or plasma, was not associated with clinical scores or MRI brain volumetric measures, and had poor ability to discriminate controls from HD mutation carriers, and premanifest from manifest HD. We conclude that BDNF in CSF and plasma is unlikely to be a biomarker of HD progression and urge caution in interpreting studies where conventional ELISA was used to quantify CSF BDNF.
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Affiliation(s)
- Zhen-Yi Andy Ou
- UCL Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, WC1N 3BG, UK
| | - Lauren M Byrne
- UCL Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, WC1N 3BG, UK
| | - Filipe B Rodrigues
- UCL Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, WC1N 3BG, UK
| | - Rosanna Tortelli
- UCL Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, WC1N 3BG, UK
| | - Eileanoir B Johnson
- UCL Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, WC1N 3BG, UK
| | - Martha S Foiani
- UK Dementia Research Institute at UCL, London, WC1E 6BT, UK
- Department of Neurodegenerative Disease, UCL Institute of Neurology, London, WC1N 3BG, UK
| | - Marzena Arridge
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, WC1N 3BG, UK
| | - Enrico De Vita
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, WC1N 3BG, UK
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Rachael I Scahill
- UCL Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, WC1N 3BG, UK
| | - Amanda Heslegrave
- UK Dementia Research Institute at UCL, London, WC1E 6BT, UK
- Department of Neurodegenerative Disease, UCL Institute of Neurology, London, WC1N 3BG, UK
| | - Henrik Zetterberg
- UK Dementia Research Institute at UCL, London, WC1E 6BT, UK
- Department of Neurodegenerative Disease, UCL Institute of Neurology, London, WC1N 3BG, UK
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, 431 80, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, 431 80, Mölndal, Sweden
| | - Edward J Wild
- UCL Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, WC1N 3BG, UK.
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Estevez-Fraga C, Scahill RI, Durr A, Leavitt BR, Roos RAC, Langbehn DR, Rees G, Gregory S, Tabrizi SJ. Composite UHDRS Correlates With Progression of Imaging Biomarkers in Huntington's Disease. Mov Disord 2021; 36:1259-1264. [PMID: 33471951 DOI: 10.1002/mds.28489] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 11/10/2020] [Accepted: 12/07/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The composite Unified Huntington's Disease Rating Scale (cUHDRS) is a multidimensional measure of progression in Huntington's disease (HD) being used as a primary outcome in clinical trials investigating potentially disease-modifying huntingtin-lowering therapies. OBJECTIVE Evaluating volumetric and structural connectivity correlates of the cUHDRS. METHODS One hundred and nineteen premanifest and 119 early-HD participants were included. Gray and white matter (WM) volumes were correlated with cUHDRS cross-sectionally and longitudinally using voxel-based morphometry. Correlations between baseline fractional anisotropy (FA); mean, radial, and axial diffusivity; and baseline cUHDRS were examined using tract-based spatial statistics. RESULTS Worse performance in the cUHDRS over time correlated with longitudinal volume decreases in the occipito-parietal cortex and centrum semiovale, whereas lower baseline scores correlated with decreased volume in the basal ganglia and surrounding WM. Lower cUHDRS scores were also associated with reduced FA and increased diffusivity at baseline. CONCLUSION The cUHDRS correlates with imaging biomarkers and tracks atrophy progression in HD supporting its biological relevance. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Carlos Estevez-Fraga
- Huntington's Disease Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Rachael I Scahill
- Huntington's Disease Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Alexandra Durr
- Sorbonne Université, Paris Brain Institute (ICM), AP-HP, Inserm, CNRS, Pitié-Salpêtrière University Hospital, Paris, France
| | - Blair R Leavitt
- Centre for Molecular Medicine and Therapeutics, Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Raymund A C Roos
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Geraint Rees
- Wellcome Centre for Neuroimaging, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Sarah Gregory
- Huntington's Disease Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Sarah J Tabrizi
- Huntington's Disease Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
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Karadag YS, Cavdarli BE, Yuksel RN. Huntington's disease in Turkey: genetic counseling, clinical features, and outcome. Neurol Res 2020; 43:381-386. [PMID: 33377823 DOI: 10.1080/01616412.2020.1866355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: This study aims to report the data of genetic counseling and to identify the clinical features of Turkish Huntington's disease (HD) patients and to investigate its possible relationship with genetic data.Method: A regular weekly outpatient clinic has been held routinely since January 2018. Patients and their referred relatives have been evaluated regarding clinical features and genetic counseling. The database of our collaborative team was used for the study.Results: Total 141 individuals have been evaluated. Among 84 subjects genetic counseling was given, diagnosis of HD was confirmed genetically in 34 (42.0%) of individuals (25 were symptomatic-HD, 9 were presymptomatic-HD). Fifty-seven patients were previously diagnosed with HD. The mean age of onset was 42.4 (11.9) years. Chorea was mostly reported initial symptom. The mean CAG repeat number of the expanded allele was 44.1 (5.1) and correlated inversely with the age of onset (p < 0.001). During a 4.8 (3.1) year follow-up, 10% of the patients were deceased. At the last visit, over half of patients had all of the movement, behavioral and cognitive problems, and 41.6% of them had required 24-hr supervision appropriate (UHDRS-independence score 64.6 (24.4)). Paternal inheritance was related to higher CAG repeats, younger age of disease onset, and higher UHDRS-motor scores.Conclusion: HD in Turkey is a severe disabling disease affecting a younger adult population. Over half of patients had all of the movement, behavioral and cognitive problems. Genetic counseling gives the opportunity to diagnose subjects at the pre-symptomatic phase. A collaborative approach is rational in the management of HD.
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Affiliation(s)
- Yesim Sucullu Karadag
- University of Health Sciences (Turkey) Ankara City Hospital Huntington's Disease Multidisciplinary Team (MDT), Ankara, Turkey.,Ankara City Hospital Neurology Clinic, University of Health Sciences, Ankara, Turkey
| | - Busranur Erozan Cavdarli
- University of Health Sciences (Turkey) Ankara City Hospital Huntington's Disease Multidisciplinary Team (MDT), Ankara, Turkey.,University of Health Sciences (Turkey) Ankara City Hospital Medical Genetics Clinic, Ankara, Turkey
| | - Rabia Nazik Yuksel
- University of Health Sciences (Turkey) Ankara City Hospital Huntington's Disease Multidisciplinary Team (MDT), Ankara, Turkey.,University of Health Sciences (Turkey) Ankara City Hospital Psychiatry Clinic, Ankara, Turkey
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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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Ratna N, Kamble NL, Venkatesh SD, Purushottam M, Pal PK, Jain S. Psychiatric morbidity and poor follow-up underlie suboptimal functional and survival outcomes in Huntington's disease. BMC Neurol 2020; 20:87. [PMID: 32164608 PMCID: PMC7068943 DOI: 10.1186/s12883-020-01671-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 03/02/2020] [Indexed: 01/25/2023] Open
Abstract
Background Huntington’s disease (HD), an inherited, often late-onset, neurodegenerative disorder, is considered to be a rare, orphan disease. Research into its genetic correlates and services for those affected are inadequate in most low-middle income countries, including India. The apparent ‘incurability’ often deters symptomatic and rehabilitative care, resulting in poor quality of life and sub-optimal outcomes. There are no studies assessing disease burden and outcomes from India. Methods We attempted to evaluate individuals diagnosed to have HD at our tertiary-care center between 2013 and 2016 for clinical symptoms, functionality, mortality, follow up status through a structured interview, clinical data from medical records and UHDRS-TFC scoring. Results Of the 144 patients, 25% were untraceable, and another 17 (11.8%) had already died. Mean age at death and duration of illness at the time of death, were 53 years and 7 years respectively, perhaps due to suicides and other comorbidities at an early age. The patients who could be contacted (n = 81) were assessed for morbidity and total functional capacity (TFC). Mean CAG repeat length and TFC score were 44.2 and 7.5 respectively. Most individuals (66%) were in TFC stage I and II and could perhaps benefit from several interventions. The TFC score correlated inversely with duration of illness (p < 0.0001). The majority were being taken care of at home, irrespective of the physical and mental disability. There was a high prevalence of psychiatric morbidity (91%) including suicidal tendency (22%). Three of the 17 who died had committed suicide, and several other families reported suicidal history in other family members. Only about half the patients (57%) maintained a regular clinical follow-up. Conclusions This study demonstrates the poor follow-up rates, significant suicidality and other psychiatric symptoms, sub-optimal survival durations and functional outcomes highlighting the need for holistic care for the majority who appear to be amenable to interventions.
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Affiliation(s)
- Nikhil Ratna
- Department of Clinical Neuro Sciences, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India.
| | - Nitish L Kamble
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Sowmya D Venkatesh
- Molecular Genetics Laboratory, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Meera Purushottam
- Molecular Genetics Laboratory, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Pramod K Pal
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Sanjeev Jain
- Molecular Genetics Laboratory, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
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Rodrigues FB, Ferreira JJ. The risks of converting post-hoc findings into primary outcomes in subsequent trials. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S337. [PMID: 32016055 PMCID: PMC6976501 DOI: 10.21037/atm.2019.09.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 09/18/2019] [Indexed: 03/29/2024]
Affiliation(s)
- Filipe B. Rodrigues
- UCL Huntington’s Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Instituto de Medicina Molecular, Lisbon, Portugal
| | - Joaquim J. Ferreira
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Instituto de Medicina Molecular, Lisbon, Portugal
- CNS—Campus Neurológico Sénior, Torres Vedras, Portugal
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41
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Burnip E, Wallace E, Gozdzikowska K, Huckabee ML. A Systematic Review of Rehabilitation for Corticobulbar Symptoms in Adults with Huntington's Disease. J Huntingtons Dis 2019; 9:1-12. [PMID: 31744013 PMCID: PMC7081106 DOI: 10.3233/jhd-190384] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background: Corticobulbar symptoms have been reported in all stages of Huntington’s disease (HD); aspiration pneumonia associated with swallowing impairment has been identified as the most common cause of death. Whilst recent research has described positive effects of corticobulbar rehabilitation in other neurodegenerative conditions, it is unclear if this is similarly effective in HD. Preliminary evidence in corticospinal rehabilitation has revealed physical therapy and exercise could be beneficial for individuals with HD. Objective: This systematic review will explore the literature relative to rehabilitation of corticobulbar symptoms in adults with HD. Methods: Two investigators independently searched relevant electronic databases for literature related to corticobulbar rehabilitation in HD, published in English until October 2019. Included studies were critically appraised using the Oxford Centre for Evidence-based Medicine Levels of Evidence, Cochrane Risk of Bias Tool and Scottish Intercollegiate Guidelines Network checklists. Study outcomes included measurements of function, quality of life or neuromuscular physiology. Results: Seventy-seven publications were screened with eight studies meeting the inclusion criteria – two randomised control trials and six intervention studies. Validated and objective outcome measures of corticobulbar symptoms were infrequently used. There was a high risk of bias identified in 7/8 studies. The data suggested positive clinical outcomes, no adverse effects and no deterioration observed across longitudinal studies. Conclusions: This systematic review documented a lack of high-quality evidence to support the use of rehabilitation to treat corticobulbar symptoms in HD. However, the suggestion of potential positive effects based on available, albeit limited, studies provides justification for further research in this area.
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Affiliation(s)
- Emma Burnip
- Rose Centre for Stroke Recovery and Research, School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Emma Wallace
- Rose Centre for Stroke Recovery and Research, School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Kristin Gozdzikowska
- Rose Centre for Stroke Recovery and Research, School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand.,Laura Fergusson Trust, Christchurch, New Zealand
| | - Maggie-Lee Huckabee
- Rose Centre for Stroke Recovery and Research, School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
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Kachian ZR, Cohen-Zimerman S, Bega D, Gordon B, Grafman J. Suicidal ideation and behavior in Huntington's disease: Systematic review and recommendations. J Affect Disord 2019; 250:319-329. [PMID: 30875675 DOI: 10.1016/j.jad.2019.03.043] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/21/2019] [Accepted: 03/04/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND An increased risk of suicide in Huntington's disease (HD) patients is well documented, with rates significantly higher than those of the general population as well as other neurodegenerative diseases. However, despite its prevalence, the magnitude of this phenomenon as well as its predictors and etiology are still poorly understood. METHODS We performed the first systematic review of all the studies published between March 1993 and December 2018 which investigated HD patients and gene carriers that reported suicidal ideation, suicide attempt, or suicide as an outcome. RESULTS This review reveals that some aspects of suicidality in HD are more clearly understood than others. We confirm an increased risk of suicidal ideation, suicide attempt, and suicide for HD patients. We found that suicidal ideation is elevated throughout the course of the disease, and that psychiatric comorbidities are common risk factors with depression being the most prominent. LIMITATIONS Important data are still largely missing, specifically regarding cognitive and neuroanatomical mechanisms and potential effective interventions. Moreover, inconsistencies in terminology, assessment tools, and outcome measures limit the comparability of the research and the conclusions that can be drawn. CONCLUSIONS Incidence of suicidal ideation, suicide attempt, and suicide are higher among those with HD relative to the non-HD population. It is therefore important that suicidal thoughts and behaviors are closely monitored in HD clinics and that clinical trials use standardized scales. Future research should focus on better understanding the etiology of this high suicide risk and on testing the efficacy of potential interventions.
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Affiliation(s)
- Zachary R Kachian
- Cognitive Neuroscience Laboratory, Think+Speak lab, Shirley Ryan AbilityLab, 355 E Erie St., Chicago, IL 60611, USA
| | - Shira Cohen-Zimerman
- Cognitive Neuroscience Laboratory, Think+Speak lab, Shirley Ryan AbilityLab, 355 E Erie St., Chicago, IL 60611, USA.
| | - Danny Bega
- Department of Neurology, Division of Movement Disorders, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Barry Gordon
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Cognitive Science Department, Johns Hopkins University, Baltimore, MD, USA
| | - Jordan Grafman
- Cognitive Neuroscience Laboratory, Think+Speak lab, Shirley Ryan AbilityLab, 355 E Erie St., Chicago, IL 60611, USA; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Rodrigues FB, Byrne LM, De Vita E, Johnson EB, Hobbs NZ, Thornton JS, Scahill RI, Wild EJ. Cerebrospinal fluid flow dynamics in Huntington's disease evaluated by phase contrast MRI. Eur J Neurosci 2019; 49:1632-1639. [PMID: 30687961 PMCID: PMC6618296 DOI: 10.1111/ejn.14356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/11/2019] [Accepted: 01/22/2019] [Indexed: 11/27/2022]
Abstract
Multiple targeted therapeutics for Huntington's disease are now in clinical trials, including intrathecally delivered compounds. Previous research suggests that CSF dynamics may be altered in Huntington's disease, which could be of paramount relevance to intrathecal drug delivery to the brain. To test this hypothesis, we conducted a prospective cross-sectional study comparing people with early stage Huntington's disease with age- and gender-matched healthy controls. CSF peak velocity, mean velocity and mean flow at the level of the cerebral aqueduct, and sub-arachnoid space in the upper and lower spine, were quantified using phase contrast MRI. We calculated Spearman's rank correlations, and tested inter-group differences with Wilcoxon rank-sum test. Ten people with early Huntington's disease, and 10 controls were included. None of the quantified measures was associated with potential modifiers of CSF dynamics (demographics, osmolality, and brain volumes), or by known modifiers of Huntington's disease (age and HTTCAG repeat length); and no significant differences were found between the two studied groups. While external validation is required, the attained results are sufficient to conclude tentatively that a clinically relevant alteration of CSF dynamics - that is, one that would justify dose-adjustments of intrathecal drugs - is unlikely to exist in Huntington's disease.
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Affiliation(s)
- Filipe B Rodrigues
- UCL Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Lauren M Byrne
- UCL Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Enrico De Vita
- Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, University College London, London, UK.,Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Eileanoir B Johnson
- UCL Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | | | - John S Thornton
- Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Rachael I Scahill
- UCL Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Edward J Wild
- UCL Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
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Rodrigues FB, Ferreira JJ, Wild EJ. Physician perception versus true efficacy of tetrabenazine for Huntington's disease. Curr Med Res Opin 2018; 34:1537-1538. [PMID: 29920125 DOI: 10.1080/03007995.2018.1490703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Filipe B Rodrigues
- a Huntington's Disease Centre , University College London , London , UK
- b Laboratory of Clinical Pharmacology and Therapeutics , Faculdade de Medicina, Universidade de Lisboa , Portugal
- c Instituto de Medicina Molecular , Lisbon , Portugal
| | - Joaquim J Ferreira
- b Laboratory of Clinical Pharmacology and Therapeutics , Faculdade de Medicina, Universidade de Lisboa , Portugal
- c Instituto de Medicina Molecular , Lisbon , Portugal
- d CNS - Campus Neurológico Sénior , Torres Vedras , Portugal
| | - Edward J Wild
- a Huntington's Disease Centre , University College London , London , UK
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Honrath P, Dogan I, Wudarczyk O, Görlich KS, Votinov M, Werner CJ, Schumann B, Overbeck RT, Schulz JB, Landwehrmeyer BG, Gur RE, Habel U, Reetz K. Risk factors of suicidal ideation in Huntington’s disease: literature review and data from Enroll-HD. J Neurol 2018; 265:2548-2561. [DOI: 10.1007/s00415-018-9013-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 08/10/2018] [Accepted: 08/12/2018] [Indexed: 10/28/2022]
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Cankar K, Melik Z, Kobal J, Starc V. Evidence of cardiac electrical remodeling in patients with Huntington disease. Brain Behav 2018; 8:e01077. [PMID: 30028085 PMCID: PMC6085913 DOI: 10.1002/brb3.1077] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 06/29/2018] [Accepted: 07/01/2018] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Although Huntington's disease (HD) is a disease of the central nervous system, HD mortality surveys indicate heart disease as a major cause of death. Cardiac dysfunction in HD might be a primary consequence of peripherally expressed mutant huntingtin or secondary to either a general decline in health or the onset of neurological dysfunction. The aim of the study was to clarify the heart muscle involvement. MATERIALS AND METHODS We measured conventional and advanced resting ECG indices. Thirty-one subjects with a confirmed huntingtin gene mutation and 31 age- and gender-matched controls were included. The HD subjects were divided into four groups based on their Unified Huntington Disease Rating Scale (UHDRS) motor score. RESULTS We detected changes in advanced ECG variables connected with electrical ventricular remodeling (t test, p < 0.01). The increase in the unexplained part of both QT variability and the standard deviation of normal-to-normal QT intervals, presumably reflecting beat-to-beat changes in repolarization, was most pronounced. Further, both variables correlated with the product of the cytosine-adenine-guanine (CAG) triplets' repeat length and the subjects' age (CAP), the former R = 0.423 (p = 0.018) and the latter R = 0.499 (p = 0.004). There was no correlation between the CAP score and any of variables representing autonomic nervous system activity. CONCLUSIONS Both autonomic nervous system dysfunction and cardiac electrical remodeling are present in patients with HD. The changes in advanced ECG variables observed in the study evolve with HD progression. The increased values of QT unexplained variability may be a marker of temporal inhomogeneity in ventricular repolarization associated with malignant ventricular arrhythmias.
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Affiliation(s)
- Ksenija Cankar
- Faculty of medicineInstitute of PhysiologyUniversity of LjubljanaLjubljanaSlovenia
| | - Ziva Melik
- Faculty of medicineInstitute of PhysiologyUniversity of LjubljanaLjubljanaSlovenia
| | - Jan Kobal
- Division of NeurologyUniversity Medical Centre LjubljanaLjubljanaSlovenia
| | - Vito Starc
- Faculty of medicineInstitute of PhysiologyUniversity of LjubljanaLjubljanaSlovenia
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Travessa AM, Rodrigues FB, Mestre TA, Ferreira JJ. Fifteen Years of Clinical Trials in Huntington's Disease: A Very Low Clinical Drug Development Success Rate. J Huntingtons Dis 2018; 6:157-163. [PMID: 28671135 DOI: 10.3233/jhd-170245] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Drug development in Huntington's disease (HD) is particularly challenging, and only two compounds are approved by the FDA. It is therefore essential to appraise drug development programs in order to understand the reasons for their failure during the early stages of development. OBJECTIVES To describe the landscape of HD therapeutic development and critically explore the causes of compound attrition in the different stages of drug development, from phase 1 to phase 4. METHODS All HD clinical trials registered in the WHO International Clinical Trials Search Portal, from inception to May 2017, were analyzed. Two independent authors selected and extracted data. Success rate in a trial phase was calculated as the number of compounds that progressed to the next trial phase divided by the number of compounds in that phase. The overall success rate was calculated as the ratio between the number of compounds that receive regulatory approval and the total number of compounds. RESULTS Ninety-nine trials assessing 41 compounds and eleven non-pharmacological interventions (devices and cell therapies) were identified. Twenty-four (24.2%) were phase 1 trials, 46 (46.5%) phase 2, 20 (20.2%) phase 3, and two (2.0%) phase 4. Sixty trials (60.6%) received industry sponsorship. The most frequently studied compounds were creatine, latrepirdine and pridopidine. The mean number of participants enrolled was 92.0 and the length of treatment was 262.9 days, and both increased from phase 1 to phase 3 trials. The success rate was 25.0% from phase 1 to phase 2, 19.4% from phase 2 to phase 3, and 14.3% from phase 3 to approval. The overall success rate was 3.5%. CONCLUSIONS Although HD is a rare condition, 99 HD trials were identified in a comprehensive clinical trial registry. We found a low success rate at earlier phases of drug-development and a very low trial success rate at later phases. There is a significant gap between drug discovery and development success rates that warrants careful appraisal and improvement.
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Affiliation(s)
- André M Travessa
- Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Filipe B Rodrigues
- Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.,Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal.,Huntington's Disease Centre, Institute of Neurology, University College London, United Kingdom
| | - Tiago A Mestre
- Parkinson's disease and Movement Disorders Center, Division of Neurology, Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Joaquim J Ferreira
- Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.,Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal.,CNS - Campus Neurológico Sénior, Torres Vedras, Portugal
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