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Zadegan SA, Ramirez F, Reddy KS, Sahin O, Rocha NP, Teixeira AL, Furr Stimming E. Treatment of Depression in Huntington's Disease: A Systematic Review. J Neuropsychiatry Clin Neurosci 2024:appineuropsych20230120. [PMID: 38528808 DOI: 10.1176/appi.neuropsych.20230120] [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] [Indexed: 03/27/2024]
Abstract
Depression is a common psychiatric disorder among individuals with Huntington's disease (HD). Depression in HD and major depressive disorder appear to have different pathophysiological mechanisms. Despite the unique pathophysiology, the treatment of depression in HD is based on data from the treatment of major depressive disorder in the general population. The objective of this systematic review was to conduct a comprehensive evaluation of the available evidence. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Studies on the treatment of depression in HD were identified by searching MEDLINE, Embase, and PsycInfo. The initial search yielded 2,771 records, 41 of which were ultimately included. There were 19 case reports, seven case series, three cross-sectional studies, one qualitative study, nine nonrandomized studies, and two randomized trials among the included studies. The most common assessment tools were the Hospital Anxiety and Depression Scale (N=8), the Beck Depression Inventory (N=6), and the Hamilton Depression Rating Scale (N=6). Only 59% of the included studies assessed depressive symptoms with a scoring system. The pharmacological options for the treatment of depression included antidepressants and antipsychotics. Nonpharmacological approaches were multidisciplinary rehabilitation, psychotherapy, and neurostimulation. Limited evidence on the treatment of depression in HD was available, and this literature consisted mainly of case reports and case series. This systematic review highlights the knowledge gap and the pressing need for HD-specific research to determine the efficacy of treatment approaches for depression in HD.
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Affiliation(s)
- Shayan Abdollah Zadegan
- Department of Neurology (Zadegan, Ramirez, Rocha, Furr Stimming) and Department of Psychiatry and Behavioral Sciences (Teixeira), McGovern Medical School (Reddy, Sahin), University of Texas Health Science Center at Houston; Huntington's Disease Society of America Center of Excellence at University of Texas Health Science Center at Houston (Zadegan, Ramirez, Rocha, Teixeira, Furr Stimming)
| | - Frank Ramirez
- Department of Neurology (Zadegan, Ramirez, Rocha, Furr Stimming) and Department of Psychiatry and Behavioral Sciences (Teixeira), McGovern Medical School (Reddy, Sahin), University of Texas Health Science Center at Houston; Huntington's Disease Society of America Center of Excellence at University of Texas Health Science Center at Houston (Zadegan, Ramirez, Rocha, Teixeira, Furr Stimming)
| | - Kirthan S Reddy
- Department of Neurology (Zadegan, Ramirez, Rocha, Furr Stimming) and Department of Psychiatry and Behavioral Sciences (Teixeira), McGovern Medical School (Reddy, Sahin), University of Texas Health Science Center at Houston; Huntington's Disease Society of America Center of Excellence at University of Texas Health Science Center at Houston (Zadegan, Ramirez, Rocha, Teixeira, Furr Stimming)
| | - Onur Sahin
- Department of Neurology (Zadegan, Ramirez, Rocha, Furr Stimming) and Department of Psychiatry and Behavioral Sciences (Teixeira), McGovern Medical School (Reddy, Sahin), University of Texas Health Science Center at Houston; Huntington's Disease Society of America Center of Excellence at University of Texas Health Science Center at Houston (Zadegan, Ramirez, Rocha, Teixeira, Furr Stimming)
| | - Natalia Pessoa Rocha
- Department of Neurology (Zadegan, Ramirez, Rocha, Furr Stimming) and Department of Psychiatry and Behavioral Sciences (Teixeira), McGovern Medical School (Reddy, Sahin), University of Texas Health Science Center at Houston; Huntington's Disease Society of America Center of Excellence at University of Texas Health Science Center at Houston (Zadegan, Ramirez, Rocha, Teixeira, Furr Stimming)
| | - Antonio L Teixeira
- Department of Neurology (Zadegan, Ramirez, Rocha, Furr Stimming) and Department of Psychiatry and Behavioral Sciences (Teixeira), McGovern Medical School (Reddy, Sahin), University of Texas Health Science Center at Houston; Huntington's Disease Society of America Center of Excellence at University of Texas Health Science Center at Houston (Zadegan, Ramirez, Rocha, Teixeira, Furr Stimming)
| | - Erin Furr Stimming
- Department of Neurology (Zadegan, Ramirez, Rocha, Furr Stimming) and Department of Psychiatry and Behavioral Sciences (Teixeira), McGovern Medical School (Reddy, Sahin), University of Texas Health Science Center at Houston; Huntington's Disease Society of America Center of Excellence at University of Texas Health Science Center at Houston (Zadegan, Ramirez, Rocha, Teixeira, Furr Stimming)
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Saft C, Burgunder JM, Dose M, Jung HH, Katzenschlager R, Priller J, Nguyen HP, Reetz K, Reilmann R, Seppi K, Landwehrmeyer GB. Symptomatic treatment options for Huntington's disease (guidelines of the German Neurological Society). Neurol Res Pract 2023; 5:61. [PMID: 37968732 PMCID: PMC10652593 DOI: 10.1186/s42466-023-00285-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 11/17/2023] Open
Abstract
INTRODUCTION Ameliorating symptoms and signs of Huntington's disease (HD) is essential to care but can be challenging and hard to achieve. The pharmacological treatment of motor signs (e.g. chorea) may favorably or unfavorably impact other facets of the disease phenotype (such as mood and cognition). Similarly, pharmacotherapy for behavioral issues may modify the motor phenotype. Sometimes synergistic effects can be achieved. In patients undergoing pragmatic polypharmacological therapy, emerging complaints may stem from the employed medications' side effects, a possibility that needs to be considered. It is recommended to clearly and precisely delineate the targeted signs and symptoms (e.g., chorea, myoclonus, bradykinesia, Parkinsonism, or dystonia). Evidence from randomized controlled trials (RCTs) is limited. Therefore, the guidelines prepared for the German Neurological Society (DGN) for German-speaking countries intentionally extend beyond evidence from RCTs and aim to synthesize evidence from RCTs and recommendations of experienced clinicians. RECOMMENDATIONS First-line treatment for chorea is critically discussed, and a preference in prescription practice for using tiapride instead of tetrabenazine is noted. In severe chorea, combining two antidopaminergic drugs with a postsynaptic (e.g., tiapride) and presynaptic mode of action (e.g., tetrabenazine) is discussed as a potentially helpful strategy. Sedative side effects of both classes of compounds can be used to improve sleep if the highest dosage of the day is given at night. Risperidone, in some cases, may ameliorate irritability but also chorea and sleep disorders. Olanzapine can be helpful in the treatment of weight loss and chorea, and quetiapine as a mood stabilizer with an antidepressant effect. CONCLUSIONS Since most HD patients simultaneously suffer from distinct motor signs and distinct psychiatric/behavioral symptoms, treatment should be individually adapted.
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Affiliation(s)
- Carsten Saft
- Department of Neurology, Huntington-Zentrum NRW, St. Josef-Hospital, Ruhr-Universität Bochum, Bochum, Germany.
| | - Jean-Marc Burgunder
- Department of Neurology, Schweizerisches Huntington-Zentrum, Bern University, Bern, Switzerland
| | - Matthias Dose
- Kbo-Isar-Amper-Klinikum, Taufkirchen/München-Ost, Germany
| | | | - Regina Katzenschlager
- Department of Neurology and Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders, Klinik Donaustadt, Vienna, Austria
| | - Josef Priller
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- Neuropsychiatry, Charité-Universitätsmedizin, Berlin, Germany
| | - Huu Phuc Nguyen
- Huntington-Zentrum NRW, Department of Human Genetics, Ruhr-Universität Bochum, Bochum, Germany
| | - Kathrin Reetz
- Department of Neurology, Euregional Huntington Centre Aachen, RWTH Aachen University Hospital, Aachen, Germany
| | - Ralf Reilmann
- George-Huntington-Institute, Muenster, Germany
- Department of Radiology, Universitaetsklinikum Muenster (UKM), Westfaelische Wilhelms-University, Muenster, Germany
- Department of Neurodegenerative Diseases and Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Owen NE, Barker RA, Voysey ZJ. Sleep Dysfunction in Huntington's Disease: Impacts of Current Medications and Prospects for Treatment. J Huntingtons Dis 2023; 12:149-161. [PMID: 37248911 PMCID: PMC10473096 DOI: 10.3233/jhd-230567] [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: 05/06/2023] [Indexed: 05/31/2023]
Abstract
Sleep dysfunction is highly prevalent in Huntington's disease (HD). Increasing evidence suggests that such dysfunction not only impairs quality of life and exacerbates symptoms but may even accelerate the underlying disease process. Despite this, current HD treatment approaches neither consider the impact of commonly used medications on sleep, nor directly tackle sleep dysfunction. In this review, we discuss approaches to these two areas, evaluating not only literature from clinical studies in HD, but also that from parallel neurodegenerative conditions and preclinical models of HD. We conclude by summarizing a hierarchical framework of current medications with regard to their impact on sleep, and by outlining key emerging sleep therapies.
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Affiliation(s)
- Natalia E. Owen
- Department of Clinical Neurosciences, John van Geest Centre for Brain Repair, University of Cambridge, Cambridge, UK
| | - Roger A. Barker
- Department of Clinical Neurosciences, John van Geest Centre for Brain Repair, University of Cambridge, Cambridge, UK
- Wellcome Trust-MRC Cambridge Stem Cell Institute, University of Cambridge, Cambridge, UK
| | - Zanna J. Voysey
- Department of Clinical Neurosciences, John van Geest Centre for Brain Repair, University of Cambridge, Cambridge, UK
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Sáenz-Farret M, Tijssen MAJ, Eliashiv D, Fisher RS, Sethi K, Fasano A. Antiseizure Drugs and Movement Disorders. CNS Drugs 2022; 36:859-876. [PMID: 35861924 DOI: 10.1007/s40263-022-00937-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 11/03/2022]
Abstract
The relationship between antiseizure drugs and movement disorders is complex and not adequately reviewed so far. Antiseizure drugs as a treatment for tremor and other entities such as myoclonus and restless leg syndrome is the most common scenario, although the scientific evidence supporting their use is variable. However, antiseizure drugs also represent a potential cause of iatrogenic movement disorders, with parkinsonism and tremor the most common disorders. Many other antiseizure drug-induced movement disorders are possible and not always correctly identified. This review was conducted by searching for all the possible combinations between 15 movement disorders (excluding ataxia) and 24 antiseizure drugs. The main objective was to describe the movement disorders treated and worsened or induced by antiseizure drugs. We also summarized the proposed mechanisms and risk factors involved in the complex interaction between antiseizure drugs and movement disorders. Antiseizure drugs mainly used to treat movement disorders are clonazepam, gabapentin, lacosamide, levetiracetam, oxcarbazepine, perampanel, phenobarbital, pregabalin, primidone, topiramate, and zonisamide. Antiseizure drugs that worsen or induce movement disorders are cenobamate, ethosuximide, felbamate, lamotrigine, phenytoin, tiagabine, and vigabatrin. Antiseizure drugs with a variable effect on movement disorders are carbamazepine and valproate while no effect on movement disorders has been reported for brivaracetam, eslicarbazepine, lacosamide, and stiripentol. Although little information is available on the adverse effects or benefits on movement disorders of newer antiseizure drugs (such as brivaracetam, cenobamate, eslicarbazepine, lacosamide, and rufinamide), the evidence collected in this review should guide the choice of antiseizure drugs in patients with concomitant epilepsy and movement disorders. Finally, these notions can lead to a better understanding of the mechanisms involved in the pathophysiology and treatments of movement disorders.
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Affiliation(s)
- Michel Sáenz-Farret
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Division of Neurology, University of Toronto, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada
| | - Marina A J Tijssen
- Department of Neurology, University of Groningen, Groningen, The Netherlands.,Expertise Center Movement Disorders Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Dawn Eliashiv
- UCLA Seizure Disorder Center, Department of Neurology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Robert S Fisher
- Departments of Neurology and Neurological Sciences and Neurosurgery, Stanford University, Stanford, CA, USA
| | - Kapil Sethi
- Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Division of Neurology, University of Toronto, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada. .,Krembil Brain Institute, Toronto, ON, Canada. .,Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, Canada.
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Network medicine for disease module identification and drug repurposing with the NeDRex platform. Nat Commun 2021; 12:6848. [PMID: 34824199 PMCID: PMC8617287 DOI: 10.1038/s41467-021-27138-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 11/04/2021] [Indexed: 12/17/2022] Open
Abstract
Traditional drug discovery faces a severe efficacy crisis. Repurposing of registered drugs provides an alternative with lower costs and faster drug development timelines. However, the data necessary for the identification of disease modules, i.e. pathways and sub-networks describing the mechanisms of complex diseases which contain potential drug targets, are scattered across independent databases. Moreover, existing studies are limited to predictions for specific diseases or non-translational algorithmic approaches. There is an unmet need for adaptable tools allowing biomedical researchers to employ network-based drug repurposing approaches for their individual use cases. We close this gap with NeDRex, an integrative and interactive platform for network-based drug repurposing and disease module discovery. NeDRex integrates ten different data sources covering genes, drugs, drug targets, disease annotations, and their relationships. NeDRex allows for constructing heterogeneous biological networks, mining them for disease modules, prioritizing drugs targeting disease mechanisms, and statistical validation. We demonstrate the utility of NeDRex in five specific use-cases.
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Rissardo JP, Fornari Caprara AL. Lamotrigine-Associated Movement Disorder: A Literature Review. Neurol India 2021; 69:1524-1538. [PMID: 34979637 DOI: 10.4103/0028-3886.333440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Lamotrigine (LMT) is a phenyltriazine derivative that was originally described as an antiepileptic drug. OBJECTIVE This literature review aims to evaluate the clinical epidemiological profile, pathological mechanisms, and management of lamotrigine-associated movement disorders. METHODS Relevant reports in six databases were identified and assessed by two reviewers without language restriction. Reports that the individuals only developed tremor or ataxia after LMT use were not included. RESULTS In total 48 reports of 108 cases from 19 countries were assessed. The movement disorders associated with LMT found were 29 tics, 21 dyskinesias, 14 myoclonus, 13 parkinsonism, 10 dystonia, and 1 stuttering. The not clearly defined cases included 10 akathisia, 4 myoclonus, 4 cerebellar syndromes, 1 hypertonia, 1 dyskinesia, and an unknown number of dystonia cases. The mean reported age was 33.34 years (range: 1.574 years). The male was the predominant sex and the most common LMT indication was epilepsy. The mean LMT-dose at the movement disorder onset was 228 mg. The time from LMT start to the onset of movement disorder was within 6 months in 81%. The time from LMT withdrawal to complete recovery was within 1 month in 83%. The most common management was LMT withdrawal. CONCLUSIONS In the literature, the majority of the cases did not give a clear picture of the individual, and the times of movement disorder onset and recovery are not described. We believe that before withdrawal LMT, a dose adjustment based on the benefits and adverse events with careful evaluation case-by-case can be done.
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Affiliation(s)
- Jamir Pitton Rissardo
- Department of Neurology; Departments of Medicine, Federal University of Santa Maria, Santa Maria, Rio Grande do Sul, Brasil
| | - Ana L Fornari Caprara
- Department of Neurology; Departments of Medicine, Federal University of Santa Maria, Santa Maria, Rio Grande do Sul, Brasil
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Kumar A, Kumar V, Singh K, Kumar S, Kim YS, Lee YM, Kim JJ. Therapeutic Advances for Huntington's Disease. Brain Sci 2020; 10:brainsci10010043. [PMID: 31940909 PMCID: PMC7016861 DOI: 10.3390/brainsci10010043] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/09/2020] [Accepted: 01/10/2020] [Indexed: 02/07/2023] Open
Abstract
Huntington’s disease (HD) is a progressive neurological disease that is inherited in an autosomal fashion. The cause of disease pathology is an expansion of cytosine-adenine-guanine (CAG) repeats within the huntingtin gene (HTT) on chromosome 4 (4p16.3), which codes the huntingtin protein (mHTT). The common symptoms of HD include motor and cognitive impairment of psychiatric functions. Patients exhibit a representative phenotype of involuntary movement (chorea) of limbs, impaired cognition, and severe psychiatric disturbances (mood swings, depression, and personality changes). A variety of symptomatic treatments (which target glutamate and dopamine pathways, caspases, inhibition of aggregation, mitochondrial dysfunction, transcriptional dysregulation, and fetal neural transplants, etc.) are available and some are in the pipeline. Advancement in novel therapeutic approaches include targeting the mutant huntingtin (mHTT) protein and the HTT gene. New gene editing techniques will reduce the CAG repeats. More appropriate and readily tractable treatment goals, coupled with advances in analytical tools will help to assess the clinical outcomes of HD treatments. This will not only improve the quality of life and life span of HD patients, but it will also provide a beneficial role in other inherited and neurological disorders. In this review, we aim to discuss current therapeutic research approaches and their possible uses for HD.
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Affiliation(s)
- Ashok Kumar
- Department of Genetics, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow 226014, UP, India;
| | - Vijay Kumar
- Department of Biotechnology, Yeungnam University, Gyeongsan, Gyeongbuk 38541, Korea; (Y.-S.K.); (Y.-M.L.)
- Correspondence: (V.K.); (J.-J.K.)
| | - Kritanjali Singh
- Central Research Station, Subharti Medical College, Swami Vivekanand Subharti University, Meerut 250002, India;
| | - Sukesh Kumar
- PG Department of Botany, Nalanda College, Bihar Sharif, Magadh University, Bihar 824234, India;
| | - You-Sam Kim
- Department of Biotechnology, Yeungnam University, Gyeongsan, Gyeongbuk 38541, Korea; (Y.-S.K.); (Y.-M.L.)
| | - Yun-Mi Lee
- Department of Biotechnology, Yeungnam University, Gyeongsan, Gyeongbuk 38541, Korea; (Y.-S.K.); (Y.-M.L.)
| | - Jong-Joo Kim
- Department of Biotechnology, Yeungnam University, Gyeongsan, Gyeongbuk 38541, Korea; (Y.-S.K.); (Y.-M.L.)
- Correspondence: (V.K.); (J.-J.K.)
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Bachoud-Lévi AC, Ferreira J, Massart R, Youssov K, Rosser A, Busse M, Craufurd D, Reilmann R, De Michele G, Rae D, Squitieri F, Seppi K, Perrine C, Scherer-Gagou C, Audrey O, Verny C, Burgunder JM. International Guidelines for the Treatment of Huntington's Disease. Front Neurol 2019; 10:710. [PMID: 31333565 PMCID: PMC6618900 DOI: 10.3389/fneur.2019.00710] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 06/17/2019] [Indexed: 12/11/2022] Open
Abstract
The European Huntington's Disease Network (EHDN) commissioned an international task force to provide global evidence-based recommendations for everyday clinical practice for treatment of Huntington's disease (HD). The objectives of such guidelines are to standardize pharmacological, surgical and non-pharmacological treatment regimen and improve care and quality of life of patients. A formalized consensus method, adapted from the French Health Authority recommendations was used. First, national committees (French and English Experts) reviewed all studies published between 1965 and 2015 included dealing with HD symptoms classified in motor, cognitive, psychiatric, and somatic categories. Quality grades were attributed to these studies based on levels of scientific evidence. Provisional recommendations were formulated based on the strength and the accumulation of scientific evidence available. When evidence was not available, recommendations were framed based on professional agreement. A European Steering committee supervised the writing of the final recommendations through a consensus process involving two rounds of online questionnaire completion with international multidisciplinary HD health professionals. Patients' associations were invited to review the guidelines including the HD symptoms. Two hundred and nineteen statements were retained in the final guidelines. We suggest to use this adapted method associating evidence base-medicine and expert consensus to other rare diseases.
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Affiliation(s)
- Anne-Catherine Bachoud-Lévi
- National Centre of Reference for Huntington's Disease, Henri Mondor Hospital, AP-HP, Creteil & NeurATRIS, Créteil, France
| | - Joaquim Ferreira
- Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal
| | - Renaud Massart
- National Centre of Reference for Huntington's Disease, Henri Mondor Hospital, AP-HP, Creteil & NeurATRIS, Créteil, France
| | - Katia Youssov
- National Centre of Reference for Huntington's Disease, Henri Mondor Hospital, AP-HP, Creteil & NeurATRIS, Créteil, France
| | - Anne Rosser
- IPMCN, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Monica Busse
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - David Craufurd
- Division of Evolution and Genomic Sciences, Faculty of Biology, Medicine and Health, Manchester Centre for Genomic Medicine, School of Biological Sciences, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Ralf Reilmann
- Department of Radiology, George-Huntington-Institute, Universitaetsklinikum Muenster, Münster, Germany
- Department of Neurodegenerative Diseases and Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | | | - Daniela Rae
- Department of Clinical Genetics, NHS Grampian, Aberdeen, United Kingdom
| | - Ferdinando Squitieri
- Huntington and Rare Diseases Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Klaus Seppi
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Charles Perrine
- Genetic Department, National Center of reference for Huntington's Disease, Salpêtrière Hospital, Paris, France
| | | | - Olivier Audrey
- Neurology Department, Angers University Hospital, Angers, France
| | - Christophe Verny
- Neurology Department and UMR CNRS 6214 INSERM U1083, National Centre of Reference for Neurodegenerative Diseases, Angers University Hospital, Angers, France
| | - Jean-Marc Burgunder
- NeuroZentrumSiloah and Department of Neurology, Swiss HD Center, University of Bern, Bern, Switzerland
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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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Potkin KT, Potkin SG. New directions in therapeutics for Huntington disease. FUTURE NEUROLOGY 2018; 13:101-121. [PMID: 30800004 DOI: 10.2217/fnl-2017-0035] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 03/06/2018] [Indexed: 11/21/2022]
Abstract
Huntington disease (HD) is an autosomal dominantly inherited neurodegenerative disease that affects motor, cognitive and psychiatric functions, and ultimately leads to death. The pathology of the disease is based on an expansion of CAG repeats in exon 1 of the huntingtin gene on chromosome 4, which produces a mutant huntingtin protein (mHtt). This protein is involved in neurotoxicity and brain atrophy, and can form β-sheets and abnormal mHtt aggregates. Currently, there are no approved effective treatments for HD, although tetrabenazine (Xenazine™) and deutetrabenazine (AUSTEDO™) have been approved for treatment of the motor symptom chorea in HD. This literature review aims to address the latest research on promising therapeutics based on influencing the hypothesized pathological mechanisms.
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Affiliation(s)
- Katya T Potkin
- Stony Brook School of Medicine, 101 Nicolls Rd, Stony Brook, NY 11794, USA.,Stony Brook School of Medicine, 101 Nicolls Rd, Stony Brook, NY 11794, USA
| | - Steven G Potkin
- Professor Emeritus, Department of Psychiatry & Human Behavior, University of California, Irvine, CA 92697, USA.,Professor Emeritus, Department of Psychiatry & Human Behavior, University of California, Irvine, CA 92697, USA
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Dickey AS, La Spada AR. Therapy development in Huntington disease: From current strategies to emerging opportunities. Am J Med Genet A 2017; 176:842-861. [PMID: 29218782 DOI: 10.1002/ajmg.a.38494] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 09/08/2017] [Indexed: 12/13/2022]
Abstract
Huntington disease (HD) is a progressive autosomal dominant neurodegenerative disorder in which patients typically present with uncontrolled involuntary movements and subsequent cognitive decline. In 1993, a CAG trinucleotide repeat expansion in the coding region of the huntingtin (HTT) gene was identified as the cause of this disorder. This extended CAG repeat results in production of HTT protein with an expanded polyglutamine tract, leading to pathogenic HTT protein conformers that are resistant to protein turnover, culminating in cellular toxicity and neurodegeneration. Research into the mechanistic basis of HD has highlighted a role for bioenergetics abnormalities stemming from mitochondrial dysfunction, and for synaptic defects, including impaired neurotransmission and excitotoxicity. Interference with transcription regulation may underlie the mitochondrial dysfunction. Current therapies for HD are directed at treating symptoms, as there are no disease-modifying therapies. Commonly prescribed drugs for involuntary movement control include tetrabenazine, a potent and selective inhibitor of vesicular monoamine transporter 2 that depletes synaptic monoamines, and olanzapine, an atypical neuroleptic that blocks the dopamine D2 receptor. Various drugs are used to treat non-motor features. The HD therapeutic pipeline is robust, as numerous efforts are underway to identify disease-modifying treatments, with some small compounds and biological agents moving into clinical trials. Especially encouraging are dosage reduction strategies, including antisense oligonucleotides, and molecules directed at transcription dysregulation. Given the depth and breadth of current HD drug development efforts, there is reason to believe that disease-modifying therapies for HD will emerge, and this achievement will have profound implications for the entire neurotherapeutics field.
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Affiliation(s)
- Audrey S Dickey
- Departments of Neurology, Neurobiology, and Cell Biology, Duke Center for Neurodegeneration & Neurotherapeutics, Duke University Medical Center, Durham, North Carolina
| | - Albert R La Spada
- Departments of Neurology, Neurobiology, and Cell Biology, Duke Center for Neurodegeneration & Neurotherapeutics, Duke University Medical Center, Durham, North Carolina
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van Duijn E. Medical treatment of behavioral manifestations of Huntington disease. HANDBOOK OF CLINICAL NEUROLOGY 2017; 144:129-139. [DOI: 10.1016/b978-0-12-801893-4.00011-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Guidelines for clinical pharmacological practices in Huntington's disease. Rev Neurol (Paris) 2016; 172:423-432. [PMID: 27561440 DOI: 10.1016/j.neurol.2016.07.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 07/02/2016] [Accepted: 07/25/2016] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Evidence-based medicine is a difficult goal to achieve in rare diseases where randomized controlled trials are lacking. This report provides guidelines that capitalize on both the literature and expertise of the French National Huntington Disease Reference Centre to optimalize pharmacological therapeutic interventions for Huntington's disease (HD). MATERIAL AND METHODS HD experts conducted a systematic analysis of the literature from 1965 to 2013, using a scoring procedure established by the French National Authority for Health. These experts offered their views when evidence was missing to set up provisional guidelines for care in HD. These guidelines were then scored and amended through two subsequent online questionnaires (using SurveyMonkey® scoring), and one face-to-face meeting with an external multidisciplinary working group as a step towards validation. RESULTS Except for the beneficial effects of tetrabenazine in chorea, none of the published recommendations were grounded on established scientific evidence. Second-generation antipsychotics are nevertheless the first choice for patients with psychiatric manifestations (low level of evidence). All other guidelines are based on low-level evidence and little professional agreement. CONCLUSION Patients' care has greatly improved over the last few years despite the lack of high-level evidence standards. Guidelines are based on the expertise of trained specialists from the French National Plan for Rare Diseases. This strategy should now be extended internationally to promote future studies and to harmonize worldwide care of HD.
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Hubers AA, Hamming A, Giltay EJ, von Faber M, Roos RA, van der Mast RC, van Duijn E. Suicidality in Huntington’s Disease: A Qualitative Study on Coping Styles and Support Strategies. J Huntingtons Dis 2016; 5:185-98. [DOI: 10.3233/jhd-160188] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Anna A.M. Hubers
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Annette Hamming
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Erik J. Giltay
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Margaret von Faber
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Raymund A.C. Roos
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Rose C. van der Mast
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine, University of Antwerp, Antwerp, Belgium
| | - Erik van Duijn
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
- Center for Mental Health Care Delfland, Delft, The Netherlands
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Mason SL, Barker RA. Advancing pharmacotherapy for treating Huntington's disease: a review of the existing literature. Expert Opin Pharmacother 2015; 17:41-52. [PMID: 26536068 DOI: 10.1517/14656566.2016.1109630] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Huntington's disease (HD) is an incurable chronic neurodegenerative disorder that typically presents in mid-life with a range of motor, cognitive and affective problems. Patients are currently managed using a combination of drug treatments and non-pharmacological therapies but at present there is no "gold standard" treatment for any aspect of the disease. AREAS COVERED In this review the empirical evidence supporting the use of drugs commonly used to treat HD was discussed. In particular, we focus on therapeutics that have either reached phase 3 clinical trials or are already in clinical use. EXPERT OPINION The results confirmed that there is a striking lack of evidence to support the efficacy of the drugs currently used in the management of HD. In fact, many drugs are prescribed on the basis of case reports, open label studies, small double blind placebo control trials of limited duration, or personal clinical experience. However of late, the establishment of large international databases, capturing all patients and their clinical details regardless of stage or geographical location has led to an increase in the number of clinical trials conducted on new therapies. Unfortunately, the same is not true for the existing therapies which look set to remain untested for the foreseeable future.
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Affiliation(s)
- Sarah L Mason
- a John Van Geest Centre for Brain Repair , University of Cambridge , Cambridge CB2 0PY , UK
| | - Roger A Barker
- a John Van Geest Centre for Brain Repair , University of Cambridge , Cambridge CB2 0PY , UK.,b Department of Clinical Neuroscience , University of Cambridge , Cambridge CB2 0PY , UK
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Killoran A, Biglan KM. Current therapeutic options for Huntington's disease: good clinical practice versus evidence-based approaches? Mov Disord 2014; 29:1404-13. [PMID: 25164707 DOI: 10.1002/mds.26014] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 07/18/2014] [Accepted: 08/06/2014] [Indexed: 01/17/2023] Open
Abstract
Therapeutic decision-making in Huntington's disease (HD) is often guided by clinical experience, because of the limited empirical evidence available. The only medication for HD that has met the regulatory hurdle for approval is tetrabenazine, indicated for the treatment of chorea. However, its use has limitations, and in the setting of specific contraindications or comorbidities the treatment of choice for chorea is still the multipurpose antipsychotics. For the management of psychiatric disturbances, selective serotonin reuptake inhibitors (SSRIs) and mood stabilizers are often used, although empirical evidence is lacking. Finally, no known effective treatment is available for cognitive dysfunction in HD. We discuss the limited evidence available and current expert opinion on medical treatment of the dominant motor, psychiatric, and cognitive features of HD. This follows a brief introduction on the general principles of HD management and on evidence-based medicine in relation to clinical practice.
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Affiliation(s)
- Annie Killoran
- West Virginia University, Morgantown, West Virginia, USA
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Abstract
Irritability is a common neuropsychiatric feature of Huntington's disease (HD), with prevalences varying from 38% to 73%. Similar prevalences of irritability are reported in other neurodegenerative disorders and traumatic brain injury, especially when the frontal lobe is involved. Before therapeutic interventions are initiated, the clinician should analyze the severity and frequency of the irritable behavior. By examining irritability in a broader spectrum, a tailor-made treatment can be provided.In general, I recommend as a first step a selective serotonin reuptake inhibitor (SSRI), such as sertraline, or the mood stabilizer valproate; they both have a mild side effect profile. Next, if the result is insufficient, I advise a switch between these two medications. As an alternative, I recommend a switch to a low dose of an atypical antipsychotic, preferably twice daily. Buspirone may be another alternative. Both antipsychotics and buspirone are also used as an add-on. Other mood stabilizers and beta-adrenergic receptor antagonists should only be used when earlier treatments are ineffective. The use of acetylcholinesterase inhibitors for the treatment of irritability is discouraged, as results are unclear. Synthetic cannabinoids are an interesting new therapeutic option, though their "illicit" compound and side effect profile make them not a first-line option.It is important to identify possible comorbid psychiatric disorders, because irritability may be secondary to a psychiatric condition, and the choice of medication partly depends on the co-occurrence of a specific psychiatric disorder. For example, antipsychotic medication would be the treatment of choice in delusional HD patients with excessive irritability, instead of an SSRI or valproate.Besides psychiatric comorbidity, the choice of medication also depends on the general medical condition, the side effect profile, and drug-drug interactions with other medications in concomitant use. Patients with advanced disease are particularly likely to be using various other types of medications.In addition to pharmacotherapy, behavioral therapy or other psychotherapeutic interventions may be helpful to reduce levels of stress and should be considered.
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Affiliation(s)
- Erik van Duijn
- GGZ Delfland, PO Box 5016, 2600 GA Delft, The Netherlands
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Pathophysiology of Huntington's disease: from huntingtin functions to potential treatments. Curr Opin Neurol 2008; 21:497-503. [PMID: 18607213 DOI: 10.1097/wco.0b013e328304b692] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Drugs used to treat Huntington's disease act on the symptoms but do not slow the disease process itself. This review focuses on recent pathogenetic findings and on emerging therapeutic approaches. RECENT FINDINGS Basic research is providing novel insights into the complex molecular pathways involved in the pathogenesis of Huntington's disease. Several mechanisms have been identified that mediate neuronal dysfunction and death; these include neuronal aggregation of the mutated protein, transcriptional dysregulation, excitotoxicity, altered energy metabolism, impaired axonal transport, and altered synaptic transmission. Recent experimental works have identified potential new therapeutic targets. In particular, they emphasize the role of altered histone modifications in transcriptional dysregulation, the synergistic action of glutamatergic and dopaminergic pathways in inducing excitotoxicity, the neuroprotective effect of brain-derived neurotrophic factor expression and transport restoration, and the possibility of reducing the expression of the mutant protein huntingtin and its deleterious effects by using short interfering mRNAs. SUMMARY Successful neuroprotective therapy for Huntington's disease patients is likely to involve a combined approach targeting both cellular and molecular mediators that account for the toxicity of mutated huntingtin.
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