The treatment of Huntington’s disease focuses on managing symptoms and improving quality of life. While there is no cure, a combination of medication, therapy, and supportive care can help individuals maintain independence for as long as possible.
Because the disease progresses gradually, treatment must adapt over time. A multidisciplinary approach — involving neurologists, psychiatrists, physiotherapists, speech therapists, and dietitians — is considered the gold standard.
Medications for Motor Symptoms
Chorea, the involuntary jerking movements, is one of the main symptoms of Huntington’s disease. Treatment options include:
- Tetrabenazine – The first FDA-approved drug for chorea; reduces dopamine activity but may increase depression risk.
- Deutetrabenazine – A modified version with fewer side effects and longer action.
Antipsychotics (e.g., haloperidol, olanzapine, risperidone) can help control chorea when behavioural symptoms coexist. However, these drugs must be used carefully to avoid worsening rigidity.
For stiffness and muscle spasms, medications like baclofen, benzodiazepines, or amantadine may provide relief.
Managing Emotional and Psychiatric Symptoms
Psychological symptoms are common and require prompt attention. Treatment may include:
- Antidepressants (SSRIs like fluoxetine or sertraline) for depression and anxiety.
- Mood stabilisers (valproic acid, carbamazepine) for aggression or mood swings.
- Antipsychotics for psychosis or severe behavioural issues.
Therapies such as Cognitive Behavioural Therapy (CBT), counselling, and support groups help individuals and families cope with emotional challenges.
Physical and Occupational Therapy
Physiotherapy helps maintain mobility, balance, and strength, reducing fall risk. Occupational therapists assist with:
- Home modifications (grab bars, stair rails).
- Adaptive devices for daily tasks.
Speech therapy supports communication and swallowing, introducing assistive tools when speech declines.
Nutritional Support
Weight loss is common due to increased energy use and swallowing problems. Strategies include:
- High-calorie, nutrient-rich diets.
- Texture-modified foods for safe swallowing.
- Feeding tubes (PEG) in advanced stages to prevent malnutrition and aspiration pneumonia.
Regular monitoring by a dietitian is essential throughout the disease.
Emerging and Experimental Treatments
Research offers hope for slowing or stopping disease progression. Key areas include:
- Gene-silencing therapies (e.g., antisense oligonucleotides) to reduce mutant huntingtin protein.
- CRISPR gene editing to repair the faulty gene (still experimental).
- Stem cell therapy to replace damaged neurons.
- Neuroprotective drugs to protect brain cells.
These treatments are still in clinical trials, but progress is promising.
Long-Term and Palliative Care
Advanced stages require full-time care. Planning should cover:
- Living arrangements and home adaptations.
- Legal matters, including power of attorney and advance directives.
- Palliative care, focusing on comfort, pain relief, and dignity in late stages.
Hospice services may be needed when swallowing difficulties, severe cognitive decline, or recurrent infections develop.
The Role of Support Networks
Emotional and practical support is as vital as medical care. Families benefit from:
- Respite care to reduce caregiver burnout.
- Support groups and advocacy organisations, such as the Huntington’s Disease Society of America and local associations.
- Educational resources for better disease management.
Summary
The treatment of Huntington’s disease aims to control symptoms, maintain independence, and support emotional wellbeing. Although no cure exists yet, ongoing research brings hope for therapies that may slow or even halt the disease in the future.
