Hamilton Clayton J, Timmer Tysen K, Munjal Robert C, Cardozo-Pelaez Fernando, Mcgrane Ian R
Dr. Hamilton is with the Department of Pharmacy, Veteran's Affairs Montana Medical Center-Fort Harrison, in Helena, Montana.
Mr. Timmer is a third-year medical student at the University of Washington School of Medicine in Seattle, Washington.
Innov Clin Neurosci. 2018 Aug 1;15(7-8):27-31. eCollection 2018 Jul-Aug.
Cognitive, affective, and sleep disturbances can be found in patients with Huntington's disease (HD), and medications used to treat these HD-related sequela can also impact HD-related movement disorders. We present the case of a 52-year-old Caucasian man with previously undiagnosed HD who exhibited significant choreoathetoid movements that improved with discontinuation of fluoxetine and lisdexamfetamine upon hospital admission. Following diagnosis of HD through genetic testing, he was administered 5mg of oral melatonin on two consecutive evenings, which resulted in worsening choreoathetosis. We calculated Naranjo adverse event scores of 5, 5, and 2 for fluoxetine, lisdexamfetamine, and melatonin, respectively, based on our assessment, review of outpatient medical records, and available literature. We review the literature surrounding these possible adverse drug events and their mechanisms regarding dopaminergic modulation in early-middle stages of HD. Our report indicates that caution should be exercised when initiating psychostimulants, fluoxetine, and melatonin in patients with early-middle stage HD. Screening for HD might be warranted for patients who develop choreoathetosis after initiation of the aforementioned medications. We recommend ascertaining baseline level of chorea before initiating these medications in patients with known HD and closely monitoring for exacerbation during therapy.
亨廷顿舞蹈症（HD）患者可能会出现认知、情感和睡眠障碍，用于治疗这些与HD相关后遗症的药物也可能影响与HD相关的运动障碍。我们报告了一例52岁的白种男性病例，该患者此前未被诊断出患有HD，入院时表现出明显的舞蹈指划样动作，停用氟西汀和赖氨酸右旋苯丙胺后症状有所改善。通过基因检测确诊为HD后，连续两个晚上给他服用5毫克口服褪黑素，结果导致舞蹈指划样动作加重。根据我们的评估、对门诊病历的审查以及现有文献，我们分别计算出氟西汀、赖氨酸右旋苯丙胺和褪黑素的纳伦霍不良事件评分为5分、5分和2分。我们回顾了围绕这些可能的药物不良事件及其在HD早中期多巴胺能调节机制的文献。我们的报告表明，在早中期HD患者中开始使用精神兴奋剂、氟西汀和褪黑素时应谨慎。对于在开始使用上述药物后出现舞蹈指划样动作的患者，可能有必要进行HD筛查。我们建议在已知患有HD的患者开始使用这些药物之前确定舞蹈症的基线水平，并在治疗期间密切监测病情是否加重。
