Poster 24: Expert Treatment Preferences for the Motor, Mood, and Behavioral Symptoms of Huntington's Disease

Objective To determine treatment preferences for Huntington disease symptoms among a small group of objectively chosen Huntington Study Group expert physicians from North America. This study is a follow-up to 2007 survey information obtained from a broader cohort of HSG clinicians. Background Though many drugs are available for the treatment of Huntington symptoms, there are inadequate data from controlled studies to guide physicians in choosing, sequencing, or combining agents. The present study is modeled on the Expert Consensus Guideline Series in Psychiatry, which utilizes similar survey information as an aid in the development of suggested treatment guidelines. Methods We developed a Web-based survey containing 21 questions and 645 options that included symptoms of chorea, depression, anxiety, irritability, agitation, insomnia, apathy, dystonia, and psychosis. The survey was sent to 30 objectively chosen experts; 21 (70%) responded. Responses were rated on a 3-point scale indicating the appropriateness of decision making, with choices ranging from first-line (preferred), second-line (alternate), and third-line (usually inappropriate). Results Most notably, 90% of respondents did not specify a first choice treatment for the majority of symptoms. This may reflect true lack of preference, or dependence on presence of other symptoms. Majority agreement: • Preference for of tetrabenazine for chorea (86%) and limiting co-administration of antidepressants only after onset of depression (86%). • Preference for SSRIs (82%) (Luvox in particular) and inappropriateness for mood stabilizers (>70%) for OCP. • Lack of consensus on preferred drugs for irritability, agitation, insomnia, and psychosis. Conclusions Among this select group, these results show a notable lack of consensus in treatment preference for many Huntington symptoms. This highlights the need, as has been done in other disease communities, to empower a panel of experts who can generate expert guideline suggestions that can guide other clinicians on the appropriate use of drugs in Huntington's.