From the Guidelines
Chorea is a movement disorder that can be caused by various factors, including medications, and its management should prioritize reducing morbidity, mortality, and improving quality of life. The most common medications that cause chorea include dopamine-blocking agents (antipsychotics like haloperidol), dopamine-enhancing drugs (levodopa used for Parkinson's disease), anticonvulsants (particularly phenytoin and valproic acid), oral contraceptives, and some stimulants 1. If you experience chorea as a medication side effect, you should contact your healthcare provider immediately rather than stopping the medication abruptly. Management typically involves reducing the dose or discontinuing the offending medication under medical supervision. In some cases, medications like tetrabenazine (12.5-25 mg twice daily) or deutetrabenazine (6-12 mg twice daily) may be prescribed to control the movements. Chorea occurs because these medications affect the balance of neurotransmitters in the basal ganglia, particularly dopamine, which controls smooth, coordinated movements. The symptoms usually improve once the medication is adjusted or discontinued, though recovery may take weeks to months in some cases. Some key points to consider in managing chorea include:
- Identifying and addressing the underlying cause of chorea, whether it be a medication side effect or an underlying condition such as Huntington's disease or systemic lupus erythematosus 1.
- Using symptomatic therapy with dopamine antagonists or other medications as needed to control symptoms.
- Considering brain imaging or other diagnostic tests to rule out secondary causes of chorea or to assess for any underlying conditions that may be contributing to the symptoms 1.
- Providing patients with guidance on how to manage their symptoms and improve their quality of life, including reducing the risk of falls or other accidents that may be associated with chorea. It's also important to note that some medications, such as atypical antipsychotics, can have significant side effects, including extrapyramidal symptoms, and require careful monitoring and management 1. Overall, the goal of managing chorea should be to reduce symptoms, improve quality of life, and minimize the risk of morbidity and mortality.
From the FDA Drug Label
14.1 Chorea Associated with Huntington’s Disease The FDA drug label does not answer the question.
From the Research
Chorea Side Effect
- Chorea is a hyperkinetic movement disorder that can have deleterious effects on patients' quality of life 2
- Deutetrabenazine, a vesicular monoamine transporter 2 (VMAT2) inhibitor, is approved for the treatment of Huntington's disease (HD)-associated chorea and tardive dyskinesia (TD) 2, 3
- Valbenazine, another VMAT2 inhibitor, has been evaluated for the treatment of chorea associated with HD and has shown improvement in chorea compared to placebo 4
- The safety profile of deutetrabenazine and valbenazine in clinical trials is similar to that of placebo, with somnolence being the most commonly reported treatment-emergent adverse event 2, 4, 3
- Treatment options for chorea also include dopamine receptor blockers, anti-epileptics, and anti-glutamatargics, as well as deep brain stimulation for patients with disabling chorea despite optimal medical therapy 5, 6
Treatment Options
- Deutetrabenazine and valbenazine are considered the treatment of choice for patients with chorea due to their ability to cause striatal dopamine depletion 6
- Tetrabenazine, another VMAT2 inhibitor, is also used to treat chorea, but has a less favorable adverse effect profile compared to deutetrabenazine 3
- Dopamine stabilizers, such as pridopidine, and other experimental drugs are currently being investigated in the treatment of chorea 6
Clinical Trials
- The First-HD and ARC-HD clinical trials demonstrated the efficacy and safety of deutetrabenazine in treating HD-associated chorea 2, 3
- The KINECT-HD clinical trial evaluated the safety and efficacy of valbenazine for the treatment of chorea associated with HD and showed significant improvement in chorea compared to placebo 4