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Huntington’s Disease or Huntington’s Chorea
: Cognitive and movement disorder.
Chorea (Greek): to dance.
Named after _______________________, an American physician in 1872.
Four (4) hallmark clinical signs:1) Involuntary movements: __________________________________
- initially can resemble normal movements (especially if afflicted
individual incorporates those involuntary movements into “normal -looking actions”).
- gives impression of restlessness.
- eventually results in facial grimacing, slurred speech, clumsy
hands, unsteady walking, and abnormal posture.
2) Rigidity : ______________________________________________
3) Bradykinesia: __________________________________________
4) Cognitive deficits and Dementia: ___________________________
- affected individuals may be describes as impulsive, erratic, difficult, uninhibited, and depressed (may increase alcohol drinking).
Unlike Parkinson’s disease, Huntington’s disease has a strong ______
- disease has been linked to a family in a southern England town
(Bures) in the early 17th century (1630).
- however, their appears to be family histories untraceable to En gland
suggesting a low but regular mutation frequency for this disease.
- ________________ that is lethal on average 17 -20 years after onset.
- usually first experienced ____________________________.
- approximately 30,000 individuals are diagnosed with Huntington’s
- some individuals express the symptoms much earlier, during
childhood, which has been linked to ____________________ of the gene; these show a faster rate of progression, with increased rigidity.
- maternal transmission of the Huntington’s gene produce a later
occuring onset with milder, slower progression.
- gene associated with Huntington’s disease discovered in 1993.
- it is an ___________________ gene disorder passed down from the
- linked to short arm of ________________.
- therefore, children of one Huntington carrying parent have a 50 %
chance of inheriting the disease (whether they are male or female).
Question. Would you prefer to know, given that one of your parent develops Huntington’s disease, whether you carry the gene or not ?
- in normal individual, a _____________________ (cytosine-adenine-
guanine), is normally found approximately 26 times as part of a normally occurring gene.
- in individuals with the Huntington’s gene, this CAG sequence is
- exact function of these extra trinucleotide repeats not clear.
- mutated gene produces an abnormal protein named _____________.
- selectively produces neural degeneration in ___________________
- it is therefore an _______________________________ disease.
Reminder: Anatomical components of Basal gangliaa. Caudate nucleusb. Putamenc. Globus pallidusd. Ventral lateral nucleus of the thalamuse. Substantia nigra
Specific defect associated with Huntington’s disease
- medium-sized spiny neurons (containing _____) degenerate in both
- these medium spiny neurons appear to contain the dopamine
receptor _____________ preferentially, so that most __ receptors in striatum of Huntington’s patients are lost (see figure on next p age).
- the mechanism of medium spiny neuron cell death is unknown but
they have been shown to be more sensitive to _________________
Question. What neurotransmitter is used by neurons projecting onto the caudate and putamen? ________________________________________________________________________________________________________________________________- increased susceptibility to glutamate toxicity might be related to
lower levels of a specific subtype of glutamate receptor on medium spiny neurons, the ________________________________________.
Treatment of Huntington’s disease
I. Pharmacological treatments
: Several classes of drugs are
employed in an attempt to reduce the symptoms associated with
1) Involuntary movements: often treated with ___________________.
- these generally involve ___________________________________
- typical antipsychotics : haloperidol (Haldol), sulpiride,
- problem with typical antipsychotics is that they produce
__________________________________________________ which can exacerbate Huntington’s symptoms, especially at more advanced stages of disease.
- atypical antipsychotics have, by definition, ___________________
__________, but still block D2 receptors.
- effective atypical antipsychotic: Olanzapine.
2) Depressive, aggressive mood: often associated with Huntington’s
disease, these mood disorders are treated, accordingly, with ______ ______________________________________________________ ___________________.
- tricyclic antidepressants (especially desipramine) and SSRIs
(serotonin -specific reuptake inhibitors) for depressive moods (valproate , fluoxetine [Prozac]).
- irritability and aggression can be treated with antipsychotics with
sedative effects (haloperidol ) or adrenergic agents (propranolol ).
Remember, pharmacological treatments _______________________ _________________________________________, but may improve quality of life as disease progresses.
II. Fetal tissue transplant in Huntington’s patients
: the results of
two fetal tissue transplant have been recently reported (2001).
- fetal tissue taken from the ________________________________
- implanted in the striatum of Huntington’s patients.
- group in University of Florida reported that 5 of 7 patients improved
by 15-20% compared to untreated patients whose disease got worse by an average of 20%/year.
- French group reported similar results in 3 out of 5 implanted
patients, showing increased activity in the striatum of implanted patients with concomitant improvement of symptoms.
So far, these studies suggest that fetal tissue transplant _____ _______ _______________________________________________________.
These studies are also very preliminary, and the average patient has had the implant for a few years only. Need to know the ________ __ ________________________________.
Meta-Analysis (or Overview) Clinical Scenario • Mrs BW 64 y.o. • Hysterectomy • Dx of osteoporosis (Spinal BMD < 2SD below Dx of osteoporosis (Spinal BMD < 2SD below • ? aminobisphosphonate (etidronate, ? aminobisphosphonate (etidronate, alendronate) • Pt concern: cost Osteoporosis • Affects 30-40% of postmenopausal women • 1.5M fracture
A collection of energisers, name games, and ways to break into small groups When using the below exercises, it is essential that you use tools that work for the group that you are working with. Be thoughtful about any mobility, hearing, sight or other impairments that Some activities can be adapted to make them inclusive for your group. For example, adapting an exercise to have the group sit