How to Treat Huntington’s Disease

Talk to Your Doctor About These Treatment Options

Huntington's disease is a progressive neurodegenerative disorder that affects movement, cognition and behavior. While there is currently no cure for Huntington's disease, various treatment options can help manage symptoms and improve quality of life for patients. This article explores the available treatments and information on how to treat Huntington's disease, focusing on medication, therapy and supportive care approaches.

Medication Options for Huntington's Disease

Austedo (Deutetrabenazine)

Austedo represents one of the most significant advances in Huntington's disease treatment in recent years. The FDA approved this medication specifically for treating chorea, the involuntary movements that commonly occur in Huntington's disease. Austedo works by regulating dopamine, a neurotransmitter involved in movement control.

Key benefits of Austedo include:

• Significant reduction in chorea symptoms.
• Once or twice daily dosing for convenience.
• Potentially fewer side effects than older medications.
• Demonstrated improvement in overall motor function.

Clinical trials have shown that Austedo can reduce chorea scores by approximately 4.4 points on the Unified Huntington's Disease Rating Scale, offering meaningful symptom relief for many patients. The medication is typically started at a low dose and gradually increased to find the optimal balance between symptom control and side effect management.

Xenazine (Tetrabenazine)

Before Austedo, Xenazine was the first medication approved specifically for Huntington's chorea. Like Austedo, it works by regulating dopamine levels but requires more frequent dosing and may have a higher risk of side effects such as depression and sedation. Xenazine remains an important option for patients who respond well to it or cannot access newer medications.

Antipsychotic Medications

Various antipsychotic medications can help manage both movement disorders and psychiatric symptoms in Huntington's disease:

• Haloperidol, fluphenazine and other typical antipsychotics can reduce chorea but may cause significant side effects.
• Atypical antipsychotics like olanzapine, risperidone and quetiapine may help with movements while simultaneously addressing irritability, agitation and psychosis.

These medications are often prescribed at lower doses than those used for primary psychiatric conditions

Mood Stabilizers and Antidepressants

Many Huntington's disease patients experience depression, anxiety and mood swings. Treatment options include:

• SSRIs such as citalopram, sertraline and fluoxetine for depression and anxiety.
• Mood stabilizers like valproate and lamotrigine for irritability and emotional volatility.
• Benzodiazepines for acute anxiety, though used cautiously due to side effects.

Non-Medication Therapies

Physical Therapy

Physical therapy plays a crucial role in maintaining mobility and independence for as long as possible. A customized physical therapy program typically includes:

• Strength-building exercises to maintain muscle function.
• Balance training to reduce fall risk.
• Gait training to improve walking ability.
• Range-of-motion exercises to maintain flexibility.
• Adaptations for daily activities as the disease progresses.

Physical therapists also help determine when assistive devices like walkers, wheelchairs or bathroom modifications become necessary for safety and independence.

Occupational Therapy

Occupational therapy focuses on maintaining daily function and independence through:

• Assessment of home safety and recommendations for modifications.
• Training in adaptive equipment use.
• Strategies to compensate for cognitive changes.
• Energy conservation techniques.
• Positioning techniques to prevent complications.

Therapists work closely with patients and families to adapt the environment and routines as needs change over time.

Speech Therapy

As Huntington's disease progresses, speech and swallowing difficulties often emerge. Speech therapists provide:

• Exercises to maintain speech clarity and volume.
• Alternative communication strategies when speech becomes difficult.
• Swallowing assessments and techniques to reduce choking risk.
• Recommendations for food textures and positioning during meals.
• Family education on communication strategies.

Early intervention with speech therapy can significantly extend a person's ability to communicate effectively.

Psychotherapy

The psychological impact of Huntington's disease affects both patients and families. Psychotherapy options include:

• Cognitive behavioral therapy for depression and anxiety.
• Family therapy to address relationship challenges.
• Support groups for patients and caregivers.
• Counseling to process grief and loss.

These interventions can significantly improve emotional well-being and quality of life throughout the disease course.

Nutritional Support

Maintaining adequate nutrition becomes increasingly challenging as Huntington's disease progresses due to:

• Increased caloric needs from constant movement.
• Swallowing difficulties.
• Cognitive problems affecting meal preparation.
• Coordination problems affecting self-feeding.

Nutritional interventions may include:

• High-calorie diets to prevent weight loss.
• Modified food textures for swallowing safety.
• Nutritional supplements when oral intake is insufficient.
• Feeding tube placement in advanced stages when appropriate.

Working with a dietitian familiar with neurodegenerative diseases is highly beneficial for developing individualized nutritional plans.

Comprehensive Care Approach

The most effective Huntington's disease management involves a multidisciplinary approach with:

• Regular neurology appointments to adjust medications and monitor progression.
• Coordination between various therapy providers.
• Social work support for resource connection.
• Palliative care integration for symptom management.
• Planning for long-term care needs.

Many medical centers offer specialized Huntington's disease clinics that provide this coordinated care under one roof.

Key Symptoms to Watch For

Recognizing the early signs of Huntington's disease can lead to earlier intervention and better quality of life. Key symptoms to monitor include:

Movement Symptoms

• Involuntary jerking or writhing movements.
• Muscle rigidity or stiffness.
• Slow or abnormal eye movements.
• Impaired gait, posture and balance.
• Difficulty with coordination.

Cognitive Symptoms

• Difficulty organizing tasks or managing time.
• Trouble with problem-solving or multitasking.
• Slowed thinking and processing.
• Difficulty learning new information.

Psychiatric Symptoms

• Depression or apathy.
• Irritability, aggression or agitation.
• Social withdrawal.
• Insomnia or sleep disturbances.
• Obsessive-compulsive behaviors.
• In some cases, psychosis with delusions or hallucinations.

Recognizing symptoms is key for getting a proper diagnosis. Then, you can speak to your doctor about how to treat Huntington's disease and find the right option for your individual needs.