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Huntington's Disease

What is Huntington’s disease?

Huntington’s disease is an inherited and progressive brain disease that affects a person's cognitive, behavioural and motor abilities. The symptoms often appear between the ages of 30 to 50 years, and may include problems with thinking, memory, mood, swallowing, speech, mobility, and depression.

A characteristic symptom of HD is the presence of uncontrollable dance-like movements known as chorea, due to damage to parts of the brain that control voluntary movements.

What are the symptoms of Huntington’s disease?

Early symptoms of HD include:

difficulty concentrating
memory lapses
stumbling and clumsiness
psychiatric problems – a lack of emotions and not recognizing the needs of others
mood swings - periods of aggression, irritability, excitement, depression, anger and antisocial behaviour
apathy – a lack of interest in things

Late symptoms of HD include:

uncontrollable jerking or fidgety movements of the limbs and body, known as chorea
difficulty in communicating
slurred speech
difficulty in eating - swallowing problems, risk of choking on food and lung infections
increasingly slow or rigid movements
breathing problems
balance problems - they may be unable to walk or sit up by themselves
sexual problems - loss of interest in sex or making inappropriate sexual demands

Speak to your doctor if you have a combination of symptoms that make you think of the description above, especially if there is a history of this condition in your family.

Learn more about Huntington’s disease

What are the different types of Huntington’s disease?

HD can be of three subtypes based on the age of onset:

1. Adult-onset HD: This is the most common type of HD. Symptoms usually appear in people between the ages of 30 and 50.

2. Juvenile HD: This rare form of HD is seen in children and teenagers. The symptoms are similar to Parkinson's disease. Common signs of juvenile HD include:

a rapid worsening of school performance
changes in handwriting
slow and stiff movements
tremors
muscle twitching
fits (seizures)

3. Late-onset HD: This type of HD develops in persons above 60 years of age. Chorea is the main symptom seen in people with late-onset HD.

What causes Huntington’s disease? Who is at risk of Huntington’s disease?

HD is caused by an alteration (also known as mutation) in the Huntingtin (HTT) gene . This

gene mutation leads to the formation of a toxic, unwanted mutant protein known as mHTT.

In HD, having one copy of the altered HTT gene is sufficient to cause the disease (autosomal

dominance).

When a person with HD has a child, there is a 50% chance that they will pass the defective

gene to their child. If the child inherits the mutated gene, they will have a high

likelihood of developing HD at some point in their life.

On the other hand, if the child does not inherit the defective gene from their affected parent,

they will not develop HD and cannot pass it on to their future generations. When HD

occurs without a family history, it is known as sporadic HD.

How is Huntington’s disease diagnosed?

If your doctor thinks that you might have HD, they will ask you about your symptoms and medical history in addition to physical examination, running certain lab tests, brain scans, and genetic testing.

Physical examination: This may include assessment of reflexes, balance, movement, muscle tone, hearing, and walking ability.
Brain imaging: Your doctor may recommend imaging of the brain, such as computed tomography (CT) or magnetic resonance imaging (MRI). These scans usually reveal shrinkage of certain areas and enlargement of fluid-filled cavities within the brain called ventricles. However, there may not be any specific changes visible on the brain scan in early stages of the disease.
Genetic testing: Genetic testing helps in predicting if you will develop HD, using DNA taken from a blood sample. In persons showing signs of HD and who do not have a family history, a genetic test may rule out or confirm this disease.
Prenatal testing: If there is a family history of HD, it is possible to test for the presence of faulty HTT gene already at 11 weeks of pregnancy.

What are the stages of Huntington’s disease?

The course of HD can be divided into ‘premanifest’ and ‘manifest’ periods.

1. Premanifest period: The period before diagnosable signs and symptoms of HD appear is called ‘premanifest’. It can be further subdivided into presymptomatic and prodromal periods.

a. Presymptomatic stage: No signs or symptoms are present.

b. Prodromal stage: It is characterized by subtle motor, cognitive and behavioural changes.

2. Manifest period: It is characterized by slow progression of motor and cognitive signs and symptoms. Fine motor skills get impaired steadily. This phase can be subdivided into three broad stages.

a. Early stage: Most areas of functioning, including working or driving can be actively performed.

b. Moderate stage: Complex functions such as working, driving or shopping independently cannot be performed, but activities of daily living and simple household tasks can be taken care of.

c. Late stage: Activities of daily living cannot be performed without help.

What treatment options are available for Huntington’s disease?

At the moment, there are no treatments that can cure or slow the progression of HD. The treatments currently available are used to relieve symptoms in order to improve the quality of life. The main treatments used for HD are:

Medications: While medications can help relieve some of the symptoms caused by HD, they cannot stop or slow down the disease. They include:

Antidepressants can be used for improving mood swings and depression.
Mood stabilizers can help in easing mood swings and irritability.
Antipsychotic medications may help in managing delusions and violent outbursts, but they can cause side effects. These drugs may also suppress involuntary movements.

Always speak to your doctor about the various treatment options available and their associated side effects.

Supportive care such as assistance in performing day-to-day activities may be required.

Speech and language therapy - To improve communication skills and memory.
Dietician - To work out an appropriate diet plan to prevent weight loss and prevent choking.
Occupational therapy - To adapt your home and equipment to make life easier, such as, providing wheelchair access, installing grab rails, stairlift, using electric toothbrushes, voice-controlled devices, etc.
Physical therapy - To help with mobility and balance.

What is the outlook for a person with Huntington’s disease?

Clinical trials (which can also be called ‘research studies’) are designed to look at how safe experimental drugs are and the mechanisms involved in slowing or potentially stopping the progression of the disease. Researchers are working hard to learn more about HD, and the cellular and molecular mechanisms involved.

Several clinical trials are underway to look at potential new treatments.

If you would like to know more about Roche sponsored clinical trials or are interested in taking part in a clinical trial, speak to your doctor or visit the Roche ForPatients clinical trials page https://forpatients.roche.com/

M-XX-00015745

References

National Institute of Neurological Disorders and Stroke. Huntington’s disease. Accessed Jul 7 2023. Available from: 05.Jul.2023
National Health Service. Huntington’s disease. Accessed Jul 7 2023. Available from: 05.Jul.2023
Chaganti SS, McCusker EA, Loy CT. What do we know about Late Onset Huntington's Disease?. J Huntingtons Dis. 2017;6(2):95-103. doi:10.3233/JHD-170247
MedlinePlus. National Library of Medicine. HTT Gene. Accessed Jul 7 2023. Available from: 05.Jul.2023
Ross CA, Aylward EH, Wild EJ, et al. Huntington disease: natural history, biomarkers and prospects for therapeutics. Nat Rev Neurol. 2014;10(4):204-216. doi:10.1038/nrneurol.2014.24

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Huntington's Disease

What are the different types of Huntington’s disease?

What causes Huntington’s disease? Who is at risk of Huntington’s disease?

How is Huntington’s disease diagnosed?

What are the stages of Huntington’s disease?

What treatment options are available for Huntington’s disease?

What is the outlook for a person with Huntington’s disease?

References

Clinical Research Explained

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Huntington's Disease

What are the different types of Huntington’s disease?

What causes Huntington’s disease? Who is at risk of Huntington’s disease?

How is Huntington’s disease diagnosed?

What are the stages of Huntington’s disease?

What treatment options are available for Huntington’s disease?

What is the outlook for a person with Huntington’s disease?

Find related clinical studies

References

Clinical Research Explained