Treatment of the symptoms of Huntington's disease: Preliminary results comparing aripiprazole and tetrabenazine

Abstract

Aripiprazole (AP), a dopamine (DA) D(2) receptor partial agonist, has recently been used to reduce schizophrenic symptoms, while tetrabenazine (TBZ), a DA depletor, has been used to treat hyperkinesias in Huntington's disease (HD). The aim of this study is to define the role of AP on chorea, motor performance, and functional disability, and to compare the effects of AP vs. TBZ in a small study of six patients with HD. Both AP and TBZ increased the Unified Huntington's Disease Rating Scale (UHDRS) chorea score in a similar way. However, AP caused less sedation and sleepiness than TBZ and was better tolerated by the patients on the trial. Moreover, AP showed a slight but not significant improvement of depression in the patients as compared to TBZ. A larger group of patients and a longer period of observation are an important prerequisite for further evaluations of AP's therapeutic use.

Tetrabenazine

“…Aripiprazole (AP) is a D 2 receptor partial agonist used in the treatment of psychosis but, in our experience, it is often effective in the management of tics and chorea. Recently, in a single-blinded trial, AP and TBZ have been compared: both were equally able to improve chorea but TBZ treatment induced drowsiness more frequently than AP [75]. However, it has to be kept in mind that especially in the long-term use either olanzapine or AP may worsen Parkinsonism and even cause TD [76,77].…”

Treatment of Huntington's Disease

“…Clozapine was studied in patients with HD up to a dose of 150 mg/day for up to 31 days without benefit and significant adverse events, including drowsiness, fatigue, anticholinergic symptoms, and walking difficulties [91]. The newer atypical agent with multiple mechanisms of action, aripiprazole, has been found to be beneficial in a few small trials with a reduction in chorea equivalent to that with TBZ [92][93][94]. Although aripiprazole may have fewer adverse effects on mood than TBZ, it may be associated with akathisia and tardive dyskinesia, similar to other typical and atypical neuroleptics.…”

Gastrodia elata prevents huntingtin aggregations through activation of the adenosine A2A receptor and ubiquitin proteasome system

“…Finally, death results from complications such as choking, infection, and heart failure. Currently, therapeutic strategies for treating HD patients are mostly for symptom relief, and some treatments have unfavorable side effects (Brusa et al, 2009). Therefore, developing therapeutic drugs to treat HD is necessary.…”