Practical recommendations for the treatment of chorea associated with Huntington's disease: An expert consensus

Huntington's disease (HD) is a rare, autosomal dominant neurodegenerative disorder caused by a pathogenic CAG expansion in the huntingtin gene, classically characterized by a triad of cognitive, psychiatric, and motor symptoms. Involuntary movements known as chorea are the most notable feature of HD. Despite the negative impact chorea can have on many aspects of day-to-day life, pharmacologic treatment remains underutilized in clinical practice. Barriers include anosognosia, a complex treatment landscape, limited evidence-based guidelines, and variable access to care. In February 2025, 11 North American HD specialists and members of the Huntington Study Group (HSG) Motor Treatment Task Force, who collectively care for ∼1500 people with HD (PwHD) convened to discuss current practices and challenges in the pharmacologic treatment of chorea. Insights were supplemented by responses to a long-form questionnaire distributed via email. Attendees and respondents described practical approaches to assessing chorea, engaging care partners, and setting goal-oriented treatment plans. This review draws on collective experience to highlight practical, real-world strategies for the evaluation and treatment of HD chorea. The two most common medication classes used to suppress chorea are vesicular monoamine transporter 2 (VMAT2) inhibitors and antipsychotics. Individualized titration, regular patient and care partner feedback, and functional, rather than purely motor-based, assessments are key to optimizing therapy. By integrating pharmacologic therapy with multidisciplinary care and holistic, goal-oriented communication about the impact of chorea, clinicians can meaningfully improve safety, independence, and quality of life for individuals and families affected by HD.