Fluoxetine in the treatment of Huntington's disease
Fluoxetine in the treatment of Huntington's disease
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DOI：
10.1007/s002130000575
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发表时间：
2001-01-01
影响因子：
3.4
通讯作者：
Ragone, MA
中科院分区：
文献类型：
--
作者：
De Marchi, N;Daniele, F;Ragone, MA
基本原理：最近的报告表明，选择性5-羟色胺再摄取抑制剂（SSRIs）在治疗亨廷顿氏病（HD）的特定症状（如攻击性和激动）方面可能有效。然而，尚未建立识别可能从该治疗中获益的HD受试者的预测特征。目的：来自一个具有非常高的强迫症（OCD）患病率的大型HD家系的两名个体接受了氟西汀（一种SSRI）治疗。我们的目的是测试在这个家系中这两种疾病的共同发生是否可能有一些潜在的致病相似性，也可能导致HD症状对抗强迫症药物氟西汀的良好反应。研究方法：对每例患者进行评价，开始氟西汀治疗，然后每月重新评估：（a）HD运动评定量表，以评定运动障碍，（B）简易精神状态检查，以确定认知。他们还接受了全面的精神病学和神经病学检查。结果：两例受试者对氟西汀均表现出极好的反应。一名患者表现出改善的运动和行为组成部分的障碍，而另一个改善也在认知领域的HD。最好的反应是在年轻时患有强迫症的人。这两名患者的改善分别维持了2年和6年，而HD的病程是进行性恶化。结论：无法得出解释这些结果的可靠结论。然而，这两个人对氟西汀的反应似乎支持了一个假设，即家系中强迫症的过量提示了多巴胺能系统的参与。至少在某些HD病例中，精神病学图像在选择适当治疗方面的价值值得进一步探讨。
Rationale: Recent reports suggest the possible efficacy of selective serotonin reuptake inhibitors (SSRIs) in treating particular symptoms of Huntington's disease (HD), such as aggressiveness and agitation. However, predictive features to identify HD subjects who may benefit from this treatment have not been established. Objectives: Two individuals from a large HD pedigree with a very high prevalence of obsessive-compulsive disorder (OCD) have been treated with fluoxetine, an SSRI. We aimed at testing whether the co-occurrence of the two disorders in this pedigree might have some underlying pathogenic similarities, maybe also resulting in a good response of HD symptoms to the anti-obsessional drug fluoxetine. Methods: Each patient was evaluated, started on fluoxetine treatment, and then reassessed monthly with: (a) the HD motor rating scale, to rate the impairment of movement, and (b) the mini mental state examination, for a cognitive ascertainment. They had a complete psychiatric and neurologic examination as well. Results: Both subjects showed an excellent response to fluoxetine. One patient exhibited improvement of the motor and behavioral components of the disorder, while the other improved also in the cognitive domain of HD. The best response was shown by the individual suffering from OCD in her youth. The amelioration in these two patients has been maintained for 2 and 6 years, respectively, whereas the course of HD is that of a progressive deterioration. Conclusions: Firm conclusions to explain these results cannot be drawn. However, a hypothetical involvement of the serotonergic system, suggested by the excess of OCD in the pedigree, seems supported by the response of these two individuals to fluoxetine. It may be worth further exploring the value of the psychiatric picture in selecting the appropriate treatment for at least some cases of HD.