De Marchi N, Daniele F, Ragone M A
Institute of Psychiatry, Second University of Naples, Italy.
Psychopharmacology (Berl). 2001 Jan 1;153(2):264-6. doi: 10.1007/s002130000575.
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.
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.
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.
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.
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.
最近的报告表明，选择性5-羟色胺再摄取抑制剂（SSRI）在治疗亨廷顿舞蹈病（HD）的特定症状，如攻击性和激越方面可能有效。然而，尚未确定可识别可能从该治疗中获益的HD患者的预测特征。
来自一个强迫症（OCD）患病率非常高的大型HD家系的两名个体接受了SSRI氟西汀治疗。我们旨在测试该家系中这两种疾病的共病是否可能存在一些潜在的致病相似性，或许还会导致HD症状对抗强迫药物氟西汀产生良好反应。
对每位患者进行评估，开始氟西汀治疗，然后每月重新评估：（a）HD运动评定量表，用于评定运动障碍，以及（b）简易精神状态检查，用于认知判定。他们还进行了全面的精神和神经检查。
两名患者对氟西汀均表现出良好反应。一名患者的运动和行为症状有所改善，而另一名患者在HD的认知方面也有改善。年轻时患有OCD的个体反应最佳。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。
无法得出解释这些结果的确切结论。然而，家系中OCD过多提示的5-羟色胺能系统的假设性参与，似乎得到了这两名个体对氟西汀反应的支持。对于至少部分HD病例，在选择合适治疗方法时进一步探索精神症状表现的价值可能是值得的。
