olanzapine and Huntington-Disease

There are currently no effective pharmacological agents available to stop or prevent the progression of Huntington's disease (HD), a rare hereditary neurodegenerative disorder. In addition to psychiatric symptoms and cognitive impairments, HD causes progressive motor disturbances, in particular choreiform movements, which are characterized by unwanted contractions of the facial muscles, trunk and extremities. Management of choreiform movements is usually advised if chorea interferes with daily functioning, causes social isolation, gait instability, falls, or physical injury. Although drugs to reduce chorea are available, only few randomized controlled studies have assessed the efficacy of these drugs, resulting in a high variety of prescribed drugs in clinical practice. The current pharmacological treatment options to reduce chorea in HD are outlined in this review, including the latest results on deutetrabenazine, a newly developed pharmacological agent similar to tetrabenazine, but with suggested less peak dose side effects. A review of the existing literature was conducted using the PubMed, Cochrane and Medline databases. In conclusion, mainly tetrabenazine, tiapride (in European countries), olanzapine, and risperidone are the preferred first choice drugs to reduce chorea among HD experts. In the existing literature, these drugs also show a beneficial effect on motor symptom severity and improvement of psychiatric symptoms. Generally, it is recommended to start with a low dose and increase the dose with close monitoring of any adverse effects. New interesting agents, such as deutetrabenazine and pridopidine, are currently under development and more randomized controlled trials are warranted to assess the efficacy on chorea severity in HD.

Topics: Antipsychotic Agents; Benzodiazepines; Humans; Huntington Disease; Olanzapine; Risperidone; Tetrabenazine; Tiapride Hydrochloride

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Brain; Cognition Disorders; Dementia; Humans; Huntington Disease; Magnetic Resonance Imaging; Male; Memory, Short-Term; Mood Disorders; Olanzapine; Paroxetine

The few reports available on olanzapine in Huntington's disease (HD) are insufficiently documented and/or insufficiently dosed. We describe a 30-year-old woman with genetically confirmed HD who presented with severe chorea. She was not able to eat or dress without help and did not respond to haloperidol; the motor scale of the Unified HD Rating Scale (UHDRS-I) revealed 65 of a possible 124 points. After admission, we treated the patient with a high dose of olanzapine (30 mg daily). The chorea almost ceased in the next 2 days, she was able to eat and walk without assistance (UHDRS-I of 21 points), and fine motor tasks improved, as well as gait and eye movements. This effect lasted for 5 months. We conclude that high-dose olanzapine appears to be useful in grave choreatic attacks.

Topics: Activities of Daily Living; Adult; Antipsychotic Agents; Benzodiazepines; Eye Movements; Female; Gait; Humans; Huntington Disease; Neurologic Examination; Olanzapine; Pirenzepine; Psychomotor Performance

To study the effect of olanzapine (OL) in Huntington's disease (HD) patients.. Eleven HD patients (five men), aged 47.6 +/- 11.4 years and with disease duration of 11.2 +/- 3.3 years received OL. Assessment was carried out using the Clinical Global Impression of Change Scale (CGIC) and the Unified Huntington's Disease Rating Scale behavioral (UHDRS - b) and motor (UHDRS - m) at 6 month intervals.. Nine patients were treated for 9.8 +/- 5.9 months. The mean OL dose/patient was 11.4 +/- 8.5 mg/day (median 10 mg/day). Mean CGIC was 2.1 +/- 0.8. UHDRS - b improved significantly (P < 0.0001) and UHDRS - m did not change. Chorea improved in five patients and two dropped out because of drug eruption and lack of efficacy.. OL is a good alternative treatment in HD, mainly for the psychiatric symptoms and moderately effective for the motor symptoms, possibly because of its effect on chorea. We suggest OL should be used in HD patients with the adult onset form, severe chorea and/or severe psychiatric disturbances.

Topics: Adult; Aged; Antipsychotic Agents; Benzodiazepines; Female; Humans; Huntington Disease; Male; Middle Aged; Olanzapine; Pirenzepine; Treatment Outcome

Topics: Antipsychotic Agents; Brain; Diagnosis, Differential; Female; Humans; Huntington Disease; Middle Aged; Olanzapine; Psychotic Disorders

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Delusions; Humans; Huntington Disease; Male; Neuroleptic Malignant Syndrome; Olanzapine

We report about a woman of 60 years who received psychiatric inpatient treatment for an affective disorder with psychotic symptoms on several occasions. As time elapsed symptoms of dementia became more and more obvious. Despite a comprehensive workup with neuroimaging methods (SPECT, PET) the correct diagnosis of Huntington's Chorea was not attained until the characteristic movements appeared. Up till then pathologic movements had hardly occurred and there were no known cases of Huntington's Chorea in the family. This case is remarkable as the patient was not only treated with different antidepressants and antipsychotics but with a course of ECT too. Beyond this it shows the enormous stress this illness imposes on patients and their caregivers.

Topics: Antidepressive Agents; Antipsychotic Agents; Benzodiazepines; Brain; Combined Modality Therapy; Dementia; Depressive Disorder, Major; Diagnosis, Differential; Disease Progression; Electroconvulsive Therapy; Female; Humans; Huntington Disease; Middle Aged; Olanzapine; Positron-Emission Tomography; Psychotic Disorders; Suicidal Ideation; Tomography, Emission-Computed, Single-Photon; Treatment Failure

We report the case of a 30-year-old woman with a rare presentation of early adulthood Huntington's disease (HD) with hypersexuality. It is not known if sexual dysfunction in HD patients is due to a specific brain lesion or adverse psychosocial factors associated with HD. Although there are no evidence-based treatment guidelines for hypersexuality in HD, our patient exhibited significant improvement with olanzapine and haloperidol.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Female; Haloperidol; Humans; Huntington Disease; Olanzapine; Sexual Behavior; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological; Treatment Outcome

Huntington's disease (HD) is a neurodegenerative, autosomal dominant disease that manifests with a triad of symptom clusters including movement disorder, cognitive impairment and psychiatric symptoms. We present a patient with HD who, prior to developing neurological signs and symptoms, had been exposed to war trauma and had developed posttraumatic stress disorder. Fifteen years later he manifested with dysarthria, difficulties with swallowing and involuntary movement. What brought him to psychiatrist was a heteroanamnestically noticed change in personality with irritable mood, impulsivity, aggressive outbursts in behavior and delusional ideation. Therapy was stared with haloperidol, but patient developed severe extrapiramidal side effects. Subsequent treatment with olanzapine, diazepam and omega 3 fatty acids lead to mood stabilization and better impulse control with even some improvement in motoric symptoms. To our knowledge, this is the first case report on combat related PTSD as psychiatric disorder manifested prior to HD. We discuss a possible influence of psychological stress disorder on severity of psychiatric symptoms in the HD. The importance of personalized approach in both psychopharmacological and psychotherapeutical treatment of patients with HD is emphasized. If the influence of environmental stress on the psychiatric phenotype of the disease should be confirmed by clinical trials and further studies, both screening methods and interventions aimed to reduce psychological stress in carriers of Huntington gene could be considered.

Topics: Alleles; Antipsychotic Agents; Atrophy; Benzodiazepines; Cerebral Cortex; Chromosomes, Human, Pair 4; Combat Disorders; Combined Modality Therapy; Comorbidity; Diagnosis, Differential; Diazepam; Fatty Acids, Omega-3; Genetic Testing; Humans; Huntington Disease; Magnetic Resonance Imaging; Male; Medulla Oblongata; Middle Aged; Neurologic Examination; Olanzapine; Patient Care Team; Psychotherapy; Risk Factors; Social Environment; Stress Disorders, Post-Traumatic; Trinucleotide Repeats

Topics: Antipsychotic Agents; Aripiprazole; Benzodiazepines; Humans; Huntington Disease; Male; Middle Aged; Olanzapine; Piperazines; Psychiatric Status Rating Scales; Psychotic Disorders; Quinolones; Treatment Outcome

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Humans; Huntington Disease; Male; Mental Disorders; Olanzapine

Previous reports on the use of olanzapine in Huntington's disease (HD) used doses ranging from 10-30 mg. We report a case of HD with marked delusions and behavioral impairment assessed by the Unified Huntington's Disease Rating Scale at baseline and four months later treated with a low dose of olanzapine. The patient improved in motor, psychiatric and activity of daily living symptoms after four months of treatment. The response to a low dose of olanzapine in HD may be an indicator of efficacy in similar cases. Further randomized controlled trials can properly assess these findings.

Topics: Antipsychotic Agents; Benzodiazepines; Cognition; Female; Humans; Huntington Disease; Middle Aged; Motor Activity; Olanzapine

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Female; Humans; Huntington Disease; Olanzapine; Pirenzepine; Seizures

Topics: Antipsychotic Agents; Benzodiazepines; Dyskinesia, Drug-Induced; Humans; Huntington Disease; Male; Middle Aged; Olanzapine; Pirenzepine

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Female; Humans; Huntington Disease; Male; Neuroprotective Agents; Olanzapine; Pirenzepine; Riluzole

We report a patient with genetically confirmed Huntington's disease (HD) presenting apraxia of eyelid closure (AEC). She was unable to close her eyes at command but was able to blink. Chorea and AEC ameliorated significantly during treatment with olanzapine and riluzole, an inhibitor of glutamate release. AEC is reported in progressive supranuclear palsy, Creutzfeldt-Jakob's disease, amyotrophic lateral sclerosis, and as post-stroke AEC. No report on HD is available so far, although oculomotor disturbances are quite common in this disease.

Topics: Apraxias; Benzodiazepines; Drug Therapy, Combination; Eyelid Diseases; Female; Humans; Huntington Disease; Middle Aged; Neuroprotective Agents; Olanzapine; Pirenzepine; Riluzole; Selective Serotonin Reuptake Inhibitors

The aim was to describe the short-term (6 months) effects of olanzapine on behavioral and motor clinical manifestations in a group of 11 patients with Huntington disease.. An open-pilot study of olanzapine (5 mg) in patients with clinical and genetic diagnosis of Huntington disease was used. The Unified Huntington Disease Rating Scale for clinical assessment and the Total Functional Capacity score for the disease-stage evaluation were used. A statistical analysis was performed to compare the effects of olanzapine on the Unified Huntington Disease Rating Scale scores at time 0 (baseline) and at time 1 (6 months). Comparisons of motor scores, of single behavioral items, and of TFC scores were performed within the group.. The behavioral assessment score of items regarding depression, anxiety, irritability, and obsessions showed a significant improvement (range of p, 0.0134-0.048). Given the total behavioral scores (sum of all the items investigated), five patients significantly improved their behavioral score after a 6-month treatment (range of p, 0.013-0.047). Choreic movements improved, although not significantly (0.05 < or = p < or = 1).. Olanzapine is a potentially useful antipsychotic drug, with significant short-term effects on behavioral changes, mainly in patients with severe psychiatric symptoms at the onset. It might be considered as a possible therapeutic choice for treatment of Huntington disease.

Topics: Administration, Oral; Adult; Aged; Antipsychotic Agents; Anxiety; Benzodiazepines; Depression; Female; Humans; Huntington Disease; Male; Middle Aged; Obsessive-Compulsive Disorder; Olanzapine; Pirenzepine; Severity of Illness Index; Treatment Outcome

Topics: Activities of Daily Living; Antipsychotic Agents; Benzodiazepines; Humans; Huntington Disease; Male; Middle Aged; Olanzapine; Pirenzepine

Topics: Adult; Antimanic Agents; Antipsychotic Agents; Benzodiazepines; Drug Therapy, Combination; Female; Humans; Huntington Disease; Male; Middle Aged; Olanzapine; Pirenzepine; Valproic Acid

Topics: Antipsychotic Agents; Benzodiazepines; Humans; Huntington Disease; Male; Middle Aged; Olanzapine; Pirenzepine

Olanzapine, an atypical antipsychotic drug, was administered to a patient with Huntington's disease (HD) with marked choreiform movements. Brain SPECT with 99mTc-HMPAO was performed before and after treatment. Brain SPECT imaging has been performed in patients with HD in order to determine the status of basal ganglia perfusion. The use of brain SPECT with 99mTc-HMPAO before and after treatment in patients with HD has not been yet reported. The marked hypoperfusion of the basal ganglia on brain SPECT performed before therapy with olanzapine improved significantly after treatment.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Brain; Female; Humans; Huntington Disease; Olanzapine; Pirenzepine; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon