Treatment for Huntington's Disease
There is no cure for Huntington's disease. Treatment focuses on reducing symptoms, preventing complications, and providing support and assistance to the patient and those close to him or her.
Medication and Huntington's Disease
Physicians often prescribe various medications to help control emotional and movement problems.
- Antipsychotics (hallucinations, delusions, violent outbursts): haloperidol, chlorpromazine, olanzapine (contraindicated if patient has dystonia)
- Antidepressants (depression, obsessive-compulsive behavior): fluoxetine, sertraline hydrochloride, nortriptyline
- Tranquilizers (anxiety, chorea): benzodiazepines, paroxetine, venlafaxin, beta-blockers
- Mood-stabilizers (mania, bipolar disorder): lithium, valproate, carbamazepine
- Botulinum toxin (dystonia, jaw clenching)
Tetrabenazine (Xenazine) is approved by the U.S. Food and Drug Administration (FDA) to treat chorea associated with Huntington's disease. This drug usually is administered once per day to start, and the dosage may be gradually increased to up to three times a day. Side effects include excessive sleepiness (somnolence), fatigue, nausea, and restlessness. Tetrabenazine also may increase the risk for depression and suicidal thoughts or behavior (suicidality).
Because most drugs used to treat the symptoms of HD can produce undesirable side effects, ranging from fatigue to restlessness and hyperexcitability, physicians often prescribe the lowest possible dose.
Nutrition & Eating and Huntington's Disease
Some Huntington's disease patients need a lot of time for meals because the loss of coordinated movement can make it difficult for them to swallow or feed themselves. These difficulties put them at risk for choking.
Food can be cut into small pieces, softened, or pureed to make swallowing easier. Swallowing therapy can help if started before there is serious difficulty. Dairy products should be avoided because they tend to increase the secretion of mucus, which can increase the risk for choking.
It is important for the patient to consume enough calories to maintain adequate body weight. The number of daily meals may have to be increased and vitamins and nutritional supplements may be recommended. If eating and dietary problems become severe, families and caregivers may need to consider the use of a feeding tube.
HD patients require large quantities of fluids, especially during hot weather, to avoid dehydration. Bendable straws can make drinking easier. In cases where the patient's muscular capability is severely weakened, water may have to be thickened with additives to the consistency of syrup before drinking is possible.
Complications such as constipation and incontinence can develop as a result of diet and lack of physical activity. A physician can provide dietary advice and information about how to cope with these problems.
Physical Activity and Huntington's Disease
It is important for Huntington's disease patients to be as physically fit as their condition permits. Daily exercise promotes physical and mental well-being. Patients should walk as much as possible, even if assistance is necessary.
Because falls are always a risk, caregivers should keep the patient's surroundings free of hard, sharp objects. Wearing special padding during walks can help protect against injury from falls. Small weights worn around the ankles and sturdy, well-fitting shoes that slip on and off easily can help improve a patient's stability.
Social Activity and Huntington's Disease
Unless and until the disease's progression prohibits it, people with HD should participate in outside activities, socialize, and pursue hobbies and interests. These activities also give family members and caregivers valuable time for themselves.
Huntington's Disease Prognosis
Huntington's disease usually runs its full terminal course in 10 to 30 years. It has been observed that the earlier in life the symptoms of HD appear, the faster the disease progresses. The bedridden patient in the final stages of Huntington's disease often dies from complications such as heart failure or pneumonia.
Juvenile Huntington's disease runs it course comparatively fast, with death typically occurring in about 10 years.