Tetrabenazine Treatment in Movement Disorders

Abstract

Tetrabenazine (TBZ) is a catecholamine depletor used for the treatment of a variety of movement disorders. The purpose of this study was to assess the efficacy of TBZ in a retrospective chart review in 3 tertiary care movement disorders centers over long-term treatment. Of 150 patients to whom TBZ was prescribed, 118 were followed up and assessed using the Clinical Global Impression of Change (CGIC), (-3 to +3), a composite grade from a patient and caregiver scale over variable periods. The patients had a variety of hyperkinetic movement disorders including dystonia (generalized and focal: axial, Meige syndrome, torticollis, blepharospasm, bruxism), Huntington disease (HD) or other choreas, tardive dyskinesia (TD) or akathisia, and Tourette syndrome. Mean patient age was 48.8 +/- 18.7 years; 48 were men (40.7%) with a mean disease duration of 93 months. The mean follow-up time was 22 months and the mean TBZ dose was 76.2 +/- 22.5 mg/d (median 75 mg, range 25-175 mg/d). The mean CGIC score was +1 (mild improvement). The group of patients who scored +3 on the CGIC (very good improvement) represented 18.6% (n = 22) of all patients. They had HD or other types of chorea 7.6% (n = 9), facial dystonia/dyskinesia (n = 7, 5.9%), 1 with TD, 2 with trunk dystonia, 2 with Tourette syndrome, and 1 with tardive akathisia. This group had the longest treatment duration and received a mean TBZ dose of 70.5 mg/d (median 75 mg/d) for a mean of 25.4 +/- 21.3 months. The report concludes that TBZ is a moderately effective treatment of a large variety of hyperkinetic movement disorders, with excellent effects in a subgroup with chorea and facial dystonia/dyskinesias.

Treatment of tardive dyskinesia with tetrabenazine or valbenazine: a systematic review

“…Because this open-label study was only presented orally in a platform session at the 2016 American Academy of Neurology (AAN) Annual Meeting, information about the methods and results were limited. Nine studies were identified for tetrabenazine: one double-blind, crossover study [31]; and eight open-label studies, which included two case series [32,33], three long-term studies [34][35][36] and three retrospective chart reviews [37][38][39]. Full-text review resulted in the exclusion of one open-label case series [32] because only four of the 14 TD patients were treated with tetrabenazine.…”

“…The tetrabenazine studies also included retrospective chart reviews by Paleacu et al [37] and Miguel et al [39]. Both studies examined the effects of tetrabenazine on TD and other movement disorders in patients who did not respond to other medications.…”

Symptomatic Treatment of Huntington Disease

“…12,13 Since then, numerous case reports and clinical trials, most of them open-label, retrospective or using a small number of subjects, have provided evidence for the benefits of TBZ in the treatment of chorea associated with HD or other causes. [14][15][16][17][18] Tetrabenazine causes depletion of brain dopamine, norepinephrine, and serotonin by binding to the central, presynaptic, intravesicular portion of the vesicular monoamine transporter VMAT2. Striatal dopamine is the most sensitive to the effects of TBZ.…”

Untitled

“…In clinical studies of valbenazine, tetrabenazine and deutetrabenazine, the most common side effects were sedation, and akathisia [11][12][13][14]. Warnings and precautions for VMAT2 inhibitors include somnolence, QTc prolongation, and akathisia ( …”

“…The most reported side effects include sedation, weakness, lack of interest, depression, parkinsonism, agitation and restlessness. Tetrabenazine is a safe and effective option for those with hyperkinetic movement disorders such as TD [13].…”