February 4, 2013

Guideline Title

Evidence-based guideline: pharmacologic treatment of chorea in Huntington disease: report of the Guideline Development Subcommittee of the American Academy of Neurology.

Bibliographic Source(s)

Armstrong MJ, Miyasaki JM. Evidence-based guideline: pharmacologic treatment of chorea in Huntington disease: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology 2012 Aug 7;79(6):597-603. [31 references] PubMed External Web Site Policy

Guideline Status

This is the current release of the guideline.

2012 Aug 7;79(6):597-603. doi: 10.1212/WNL.0b013e318263c443. Epub 2012 Jul 18.

Evidence-based guideline: pharmacologic treatment of chorea in Huntington disease: report of the guideline development subcommittee of the American Academy of Neurology.

Armstrong MJ, Miyasaki JM; American Academy of Neurology.

Source

Department of Neurology, University of Maryland, Baltimore, MD, USA.

Abstract

OBJECTIVE:

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

METHODS:

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

RESULTS AND RECOMMENDATIONS:

If HD chorea requires treatment, clinicians should prescribe tetrabenazine (up to 100 mg/day), amantadine (300-400 mg/day), or riluzole (200 mg/day) (Level B) for varying degrees of expected benefit. Occurrence of adverse events should be discussed and monitored, particularly depression/suicidality and parkinsonism with tetrabenazine and elevated liver enzymes with riluzole. Clinicians may also prescribe nabilone for modest decreases (1- to <2-point 100="" 3-point="" abuse="" antichoreic="" any="" b="" benefits="" but="" c="" change="" changes="" choose="" chorea="" clinicians="" concerns="" creatine="" day="" disease="" ethyl-epa="" evel="" for="" given="" goals="" hd="" huntington="" important="" improvements="" in="" information="" insufficient="" is="" long-term="" may="" mg="" minocycline="" moderate="" not="" on="" or="" particularly="" potential="" prescribe="" rating="" recommend="" riluzole="" s="" scale="" score="" short-term="" should="" the="" to="" u="" uhdrs="" unified="" use="" very="" year="">3-point UHDRS chorea change) in HD chorea. Clinicians may choose not to prescribe coenzyme Q10 (Level B) for moderate improvements in HD chorea. Data are insufficient to make recommendations regarding the use of neuroleptics or donepezil for HD chorea treatment (Level U).