Posted to HDLighthouse: 26-Sept-2000 HDL Update: Effects of Haldol Reversed

Improvement of Huntington's Disease with Olanzapine and Valproate

To the Editor:
Huntington's disease is an inherited, progressive, mentally and physically disabling disorder characterized by chorcoathetoid movements, dementia, and occasionally psychosis. Rejection of assistance by many patients makes this an especially emotionally painful condition for family members and caregivers.

A 39-year-old man and a 52-year-old woman with Huntington's disease of 8 and 13 years' duration, respectively, were hospitalized because of agitation, aggression, and delusions that had begun 2 to 3 years earlier. In the year before admission, their uncontrollable movements had become so severe that they could not walk or assist in their own care. Both had received haloperidol in doses of up to 20 mg per day with little benefit, and this medication was discontinued in both patients the week before admission because of increased agitation.

After admission, both patients were treated with olanzapine at a dose of 10 mg daily and valproate at a dose of 125 mg twice daily. Subsequently, the dose ofolanzapine was reduced to 5 mg daily and that of valproate raised to 500 mg three times daily. After seven to eight weeks, both patients could walk with assistance and were more cooperative with caring, bathing, and social activities, and their psychotic behavior and chorcoathetoid movements decreased. The man's behavior ceased being aggressive, and in the woman the frequency of episodes of aggressive behavior decreased from 10 to 12 per week to 1 or 2 mild episodes per week. Plasma valproate concentrations ranged from 60 to 80 ug per milliliter in both patients, a value within the therapeutic range; plasma olanzapine was not measured. Both patients were discharged and are functioning well in nursing homes.

The combination of valproate, given as a mood stabilizer, with olanzapinc was chosen to reduce the required dose of an anripsychotic drug and thus help prevent adverse effects that could lead to the rejection of medication. We conclude that valproate and olanzapine, given at the lowest effective doses, may be helpful for relieving both psychosis and movement disorders in patients with Huntington's disease or a similar condition as well as for relieving agitation and aggression.

VERNON EUGKNE GROVE, Jr., M.D.
JAIME QUINTANILLA, MD
Kerrville State Hospital
Kerrville, TX 78029

Source: Adapted from The New England Journal of Medicine, 09/27/00, Vol 343 No.13, p 973

	Read the HDAC/HDLighthouse Forum. Post your comments