Thursday, March 11, 2010

Huntington's disease

Huntington's disease - Chronic
Rahul Soman, M. Pharm


 

Definition  

A progressive, autosomal dominant neurodegenerative disorder characterized by movement abnormalities, psychiatric manifestations, and cognitive impairment


 

Presymptomatic genetic testing for individuals at risk for Huntington disease  

* Huntington disease gene mutation carrier detection test


 

Medical History  

* Family history of Huntington's disease


 

Findings  

* Chorea

* Dystonia

* Abnormal saccadic eye movement

* Poor muscle tone

* Hyperreflexia

* Bradykinesia

* Muscle rigidity

* Impaired cognition

* Depression - Chronic

* Irritability

* Personality change

* Dementia

* Weight loss

* Cachexia

* Dysphagia - Chronic

* Abnormal gait

* Indifference

* Psychotic disorder

* Dysarthria

* Agitation

* Dysphoric mood

* Anxiety

* Urinary incontinence - Chronic

* Obsessive-compulsive disorder - Chronic


 

Tests  


 

Suspected Huntington disease  

* Huntington disease gene mutation carrier detection test: In DNA testing for Huntington disease (HD), a cytosine-adenine-guanine (CAG) repeat length of equal to or less than 26 excludes the diagnosis of HD .


 

Suspected and known Huntington disease  

* Magnetic resonance imaging of brain and brain stem: Striatal volume loss may be a useful marker for progression of Huntington disease and may provide an outcome measure for therapeutic trials .


 

Suspected and known Huntington disease  

* Computerized axial tomography of brain


 

Differential Diagnosis  

* Tardive dyskinesia

* Rheumatic chorea

* Choreoacanthocytosis

* Wilson's disease - Chronic

* Systemic lupus erythematosus - Chronic

* Neurosyphilis

* Hyperthyroidism - Chronic

* Drug-induced chorea

* Polycythemia vera

* Progressive non-hereditary chorea, chronic

* Infarction of basal ganglia

* Malignant neoplasm of basal ganglia

* Benign hereditary chorea

* Fahr's syndrome

* Jakob-Creutzfeldt disease - Chronic

* Spinocerebellar ataxia

* Neuronal ceroid lipofuscinosis

* Dentatorubropallidoluysian degeneration

* Late onset Huntington's disease

* Juvenile onset Huntington's disease

* Somatization disorder


 

Treatment  


 

Drug Therapy  


 

Chorea  


 

TETRABENAZINE

Adults: initial, 12.5 mg orally once daily in the morning; after 1 week, increase to 12.5 mg orally twice daily, if necessary; titrate by 12.5 mg at weekly intervals to a dose of 37.5 to 50 mg/day orally in divided doses 3 times a day (maximum single dose, 25 mg; maximum daily dose, 100 mg); genotype patients for CYP2D6 if a dose greater than 50 mg/day is required


 

HALOPERIDOL

Adults: 0.5 to 30 mg orally daily in divided doses


 

RESERPINE  

Adults: 0.1 to 0.3 mg orally daily in divided doses


 

CLONAZEPAM  

Adults: 0.5 to 4 mg orally daily


 

DIAZEPAM  

Adults: 1.25 to 20 mg orally daily


 

Depression  


 

SERTRALINE HYDROCHLORIDE  

Adults: 25 to 200 mg orally daily


 

FLUOXETINE HYDROCHLORIDE  

Adults: 10 to 80 mg orally daily


 

PAROXETINE HYDROCHLORIDE  

Adults: 10 to 60 mg orally daily


 


 

Bradykinesia and rigidity  


 

CARBIDOPA/LEVODOPA  

Adults: (25/100 tablet) 1 tablet orally once to three times daily


 

BROMOCRIPTINE MESYLATE  

Adults: 1.25 mg orally twice daily; increase as tolerated


 


 

Psychosis  


 

RISPERIDONE

Adults: 0.5 to 6 mg orally daily


 

OLANZAPINE

Adults: 2.5 to 20 mg orally daily


 

QUETIAPINE FUMARATE  

Adults: 25 to 750 mg orally daily in divided doses


 

Procedural Therapy  


 

Inadequate nutritional intake in patients with Huntington disease  

* Enteral feeding

1 comment:

  1. I''m Charlotte Johnson,65  years old, Here in Edmonton, Canada. With the new herbal mix medicine I purchased from Dr James herbal mix medicine West Africa  was my only way to get rid of my Alzheimer's, the herbal  mix medicine effectively reversed my condition and alleviate all symptoms.  I was initially very hesitant to discuss my Alzheimer but I just hope it can still help someone. I feel this will be very important information for all Alzheimer patients, because the most violent element in society today is ignorance. Be it any condition, a healthy diet and natural herbs and roots medicine from Dr. James is the road to fast recovery. I had suffered Alzheimer for many years, I fought for proper medical recommendation, care  and all form of humane treatment with little improvement I went through many sleepless nights and periods of intense grief, as do most families. I was recommended by a friend to use Dr. James herbal mix medicine for my Alzheimer with high hope and assurance. I never doubted my friend but to contact Dr. James. And purchased His herbal mix medicine which was effective and I finally feel my Alzheimer is gone with no more symptoms. He also told me that he cures diseases such as  Lungs diseases, kidney diseases, Warts, Bipolar disorder, Shingles,  HPV, ALS, CANCER, NEPHROTIC SYNDROME, HIV / AIDS, Herpes virus, Ovarian Cancer, Pancreatic cancers, bladder cancer, prostate cancer, Glaucoma., Cataracts, Macular degeneration, Cardiovascular disease, Autism. Enlarged prostate, Osteoporosis. Alzheimer's disease, psoriasis, Tach Diseases, Lupus, Backache, dementia, skin cancer,.testicular Cancer, Leukemia, HEPATITIS A, B, C, Contact  the great one on his email    greatcureman@gmail.com
    Info @ drjamesherbalmix@gmail.com

    ReplyDelete

SYSTEM BASED CLASSIFICATION OF DISEASES

SYSTEM BASED CLASSIFICATION OF DISEASES

Bone and Joint Diseases

  1. Gout and Hyperurecemia
  2. Osteoarthritis
  3. Rheumatoid Arthritis
  4. Acute coronary Syndroms

Cardiovascular Diseases

  1. Arrhymias
  2. Cardiopulmanary Resuscitation
  3. Heart Failure
  4. Hypertension
  5. Hyperlipidemia
  6. Ischemic Heart Diseases
  7. Shock
  8. Stroke
  9. Venous Thromboembolism

Dermatrologic Diseases

  1. Acne
  2. Psoriasis
  3. Skin Disorders and Cutaneous Drug Eruptions

Endocrine Diseases

  1. Cirrhosis
  2. Portal Hypertension

Gastrointestinal Diseases

  1. Irritable Bowel Syndrome
  2. Constipation
  3. Diarrhea
  4. Gastroesophagal Reflux Disease
  5. Hepatitis, Viral
    1. Hepatitis A
    2. Hepatitis B
    3. Hepatitis C
  6. Nausea and Vomiting
  7. Pancreatitis
  8. Peptic Ulcer disease

Gynecologic and Obstetric Diseases

  1. Contraception
  2. Hormone therapy

Hematologic Diseases

  1. Anemia
    1. Megaloblastic Anemia

i. Megaloblastic Anemia due to Folate Deficiency

ii. Megaloblastic Anemia due to Vitamine B12 Deficiency

    1. Sickle Cell anemia
    2. Hemolytic Anemia
    3. Iron Deficiency Anemia
    4. Aplastic Anemia
    5. Iron Deficiency Anemia

Infectious Diseases

  1. Central Nervous System infections
  2. Endocarditis
  3. Fungal infections, Invasive
  4. Gastrointestinal Infection
  5. HIV / AIDS
  6. Intra-Abdominal Infection
  7. Respiratory Tract infections, Lower
  8. Respiratory Tract infections, Upper
  9. Sepsis and Septic Shock
  10. Sexually transmited Diseases (STD)
  11. Skin and soft tissue infection
  12. Tuberculosis
  13. Urinary tract infection and prostatitis

Neurologic Diseases

  1. Epilepsy
  2. Headache
    1. Migraine
    2. Cluster Headache
  3. Pain management
  4. Parkinson’s Diseases
  5. Status epilepticus

Nutritional Diseases

  1. Enteral Nutrition
  2. Obesity
  3. Parentaral Nutrition

Onchologic Diseases

  1. Breast cancer
  2. Colorectal Cancer
  3. Lung cancer
  4. Lymphomas
  5. Prostate cancer
  6. Cervical Cancer
  7. Esophageal Cancer
  8. Gastric Cancer
  9. Head and Neck Cancer
  10. Lung Cancer
  11. Ovarian Cancer
  12. Pancreatic Cancer
  13. Primary bone Cancer
  14. Primary Brain cancer
  15. Testicular Cancer
  16. Thyroid Gland Cancer
  17. Urinar Bladder cancer
  18. Uterine Cancer

Ophtalmic Diseases

  1. Glaucoma

Psychiatric Diseases

  1. Alzhimer’s Diseases
  2. Anxiety Disease
  3. Bipolar Diseases
  4. Depressive diseases
  5. Schizophrenia
  6. Sleep Diseases
  7. Substance-Related Diseases

Renal Diseases

  1. Acid base Diseases
  2. Acute renal Failure
  3. Chronic Renal Failure
  4. Drug Dosing in renal insufficiency
  5. Electrolyte Homeostasis

Respiratory Diseases

  1. Allergic Rhinitis
  2. Asthma
  3. Chronic Obstructive Pulmonary Diseases

Urologic Diseases

  1. Benign Prostatic, Hyperplasia
  2. Erectile Dysfunction
  3. Urinary Incontinence