by LaVonne Veatch Goodman, MD

Huntington's scientists are finding many chemicals that suggest neuroprotective benefit in various animal models. It has not been proven whether benefit in animal modes will predict response in people.

My recommendation is to use those treatments that are safe, and have some early evidence for benefit in people. The experts also believe that ultimately successful treatment will require combinations.  Cost and convenience must be figured in. Don’t go bankrupt, or spend too much of your day taking powders and pills. And as much as possible, incorporate them into a healthy diet and exercise.  At present there is no drug or supplement that has shown more benefit than exercise and social stimulation.

If you start these agents you must understand that there is no proof that they will be helpful. Medications that work in the mouse may not help people.

Rationale for each is found in separate treatment descriptions.

Dr. Goodman's preferred agents for neuroprotective potential

• creatine?
• Coenzyme Q-10?
  
• SSRI antidepressants?
• trehalose?

Both creatine and coenzyme Q-10 are alleged to work at the same part of the disease (energy disruption). Based on mouse studies there is preliminary evidence that combining creatine and coenzyme-Q may slightly better than either agent used alone [Yang 2009].  Creatine is much less expensive; but Coenzyme Q-10 has a trend toward human benefit (at 600 mg dosage) in clinical trial.  Antidepressants are helpful for many symptoms of Huntington's, and have some mouse model data suggesting neuroprotective benefit.  Trehalose has both rat and mouse model benefit -- and it's safe and cheap.

Preferred medications (by class) for symptoms: There are no recommended treatment guidelines for doctors who treat Huntington's patients. So each doctor prescribes based on his or her own experience (or the experience of a mentor). As found in surveys from the experts: the following are drugs prescribed most frequently:

Preferred antidepressants

• sertraline (Zoloft®)
• citalopram (Celexa®)

Preferred antipsychotic

• olanzapine (Zyprexa®)
• risperidone (Risperdal®)

Preferred mood stabilizer

• valproate (Depakote®)
• carbamazepine (Tegretol®)
  

Lifestyle recommendations: Healthy lifestyle is vitally important. Lifestyle includes diet, exercise (for body and mind), and stress reduction.

Food recommendations (based solely on mouse studies)

• antioxidants (brightly colored fruits and vegetables)
• high omega 3's (salt water fish)
• low calorie
• low protein
• low iron content (avoid iron supplements and red meats)
• green tea

Exercise recommendations

• physical: the more the better, but go easy on the marathons
• social and intellectual: the more the better
• stress reduction

References

Yang L, Calingasan NY, Wille EJ, Cormier K, Smith K, Ferrante RJ, Beal MF. Combination therapy with coenzyme Q10 and creatine produces additive neuroprotective effects in models of Parkinson's and Huntington's diseases. J Neurochem 2009 Jun;109(5):1427-39. PubMed abstract