Antipsychotic drugs in Huntington's disease

Area of Science:

• Pharmacology and Neurology
• Neurodegenerative Diseases

Background:

• Huntington's disease (HD) presents complex motor and psychiatric symptoms.
• Effective pharmacological management for HD symptoms remains a clinical challenge.
• Limited randomized controlled trials (RCTs) exist for neuroleptic use in HD.

Purpose of the Study:

• To review the pharmacological characteristics of neuroleptics used in treating Huntington's disease.
• To evaluate current treatment guidelines and identify unmet clinical needs in HD management.

Main Methods:

• Systematic literature search of PubMed using terms 'Huntington's disease', 'Antipsychotic drugs', 'Neuroleptic drugs', and specific drug names.
• Evaluation of existing clinical guidelines and identification of unmet needs in HD treatment.

Main Results:

• Antipsychotics are frequently used as a first-line treatment for chorea in HD, especially with psychiatric symptoms or when tetrabenazine poses risks.
• Second-generation antipsychotics are preferred to minimize extrapyramidal side effects but may increase metabolic risks.
• Current evidence relies heavily on case reports, with a scarcity of RCTs and drug comparison studies.

Conclusions:

• Antipsychotics are a valid strategy for managing HD symptoms, with second-generation agents offering a potentially better side-effect profile.
• The development of 'dopamine stabilizers' like pridopidine may offer future alternatives by modulating dopamine transmission.
• Further high-quality research, including RCTs, is needed to establish optimal neuroleptic use in Huntington's disease.