Huntington's disease and minocycline

Abstract

Reference 1. Friedman JH. More on repetitive behaviors in Parkinson's disease. Mov Disord 2005;20:509. Huntington's Disease and MinocyclineWe read with interest the brief report by Thomas and colleagues 1 on their open-label study of 28 Huntington's disease (HD) patients on minocycline. The patients were rated at baseline and after 6 months using the Unified HD Rating Scale (UHDRS), the Mini-Mental State Examination, and the Abnormal Involuntarily Movement Scale. In contrast to our results in an earlier, similarly designed study, 2 they could not find a significant change in one of these scales. However, this finding might be the result of adding together the four main parts of the UHDRS, which in our view is somewhat misleading. The UHDRS 3 is divided into four components assessing motor performance, cognition, behavior, and functional capacity. The motor component consists of 31 questions rated on a 0to 4-point scale, with 4 indicating the most severe impairment. The five-item cognitive component consists of the Benton Verbal Fluency Test, 4 the Symbol Digit Modalities Test, 5 and the Stroop Test. 6 The behavioral assessment consists of 28 items assessing severity and frequency of mood, anxiety, aggression, psychosis, and other behavioral abnormalities. The functional component is composed of three subunits: first, the functional checklist, which includes 25 yes/no questions; the second is the Independence Scale 7 ; and the third is the Total Functional Capacity Scale. 8 Whereas the motor part and the behavioral assessment indicates a greater number as greater impairment, all three neuropsychological tests, the functional checklist, the independence scale, and the total functional capacity scale, do the opposite, thus indicating a lower number as greater impairment. So what exactly do the authors mean by a UHDRS mean value of 235.8 units? The maximal point count is 124 units for the UHDRS motor part, 25 units for the psychosocial function, 13 units for the functional capacity, 100 units for the independence scale, whereas cognitive parameters do not have an upper limit.We encourage the authors to share the details of this important study with the community. This is not just of academic interest, as there are data on the natural course of a variety of UHDRS subtests, which makes it possible to evaluate the value of minocycline in HD. Siesling and coworkers examined 78 patients 9 and found the motor component of the UHDRS to be deteriorated by 5.97 units per year. More data are available on the natural course of the Independence Scale: Siesling reported a decline of 3.6 units per year, the Huntington Study Group (960 patients) 10 found a declined at a rate of 4.5 units, and Myers and colleagues 7 found a 5.3 units decrease for the same period. On the other hand, the Huntington Study Group found a deterioration of functional capacity of 0.72 units over 1 year, which is equal to a variety of other natural studies. 9,11,12 Moreover, we hereby suggest clustering the motor component of the UHDRS into seven groups for...

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