Correspondence

Improvement of Huntington's Disease with Olanzapine and Valproate

N Engl J Med 2000; 343:973-974September 28, 2000

Article

To the Editor:

Huntington's disease is an inherited, progressive, mentally and physically disabling disorder characterized by choreoathetoid movements, dementia, and occasionally psychosis.1 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 of olanzapine 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 eating, bathing, and social activities, and their psychotic behavior and choreoathetoid 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 μg 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 olanzapine was chosen to reduce the required dose of an antipsychotic drug and thus help prevent adverse effects that could lead to the rejection of medication.2 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.3,4

Vernon Eugene Grove, Jr., M.D.
Jaime Quintanilla, M.D.
George T. DeVaney, M.D.
Kerrville State Hospital, Kerrville, TX 78029

4 References

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   Wendy Phillips, Kathleen M. Shannon, Roger A. Barker. (2008) The current clinical management of Huntington's disease. Movement Disorders 23:11, 1491-1504
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   Raphael M Bonelli, Peter Hofmann. (2007) A systematic review of the treatment studies in Huntington’s disease since 1990. Expert Opinion on Pharmacotherapy 8:2, 141-153
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