Pharmacological Treatment of Chorea in Huntington’s Disease– Good Clinical Practice versus Evidence-based Guideline

In May, 2012, the Amercian Academy of Neurology (AAN) published "evidence-based guidelines" for the pharmacologicl treatment of chorea in HD.

HDSA posted a position on our website when the AAN guidelines were published with special note to the fact that AAN invited HDSA to review the draft and when we provided meaningful comment, they sent back a curt letter disagreeing with our assessment and that they didn't have a process to include our feedback anyway. (To review these reports click here.)

Certainly, we're disappointed in AAN's perspective and definition of what consitutes evidence-based, and continue to monitor this closely.

This week, Dr. Ralf Reilman, one of the world's leading experts on chorea in HD, published his own response to the AAN guidelines: Pharmacological Treatment of Chorea in Huntington’s Disease–
Good Clinical Practice versus Evidence-based Guideline in the recent edition of the Journal of Movement Disorders.

 

Pharmacological Treatment of Chorea in Huntington’s Disease–
Good Clinical Practice versus Evidence-based Guideline

Ralf Reilmann, MD, PhD

Huntington Group, Department of Neurology, University Clinic Muenster, Westfaelische Wilhelms University of Muenster,
Muenster, Germa

ABSTRACT: Recently, the American Academy of Neurology published an evidence-based guideline for the pharmacological treatment of chorea in Huntington’s disease. Although the progress in medical care because of the implementation of criteria of evidence-based medicine is undisputed, the guideline classifies the level of evidence for drugs to reduce chorea based on anchors in the Unified Huntington’s Disease Rating Scale-Total Motor Score chorea sum score, which were chosen arbitrarily and do not reflect validated or generally accepted levels of clinical relevance. Thus, the guideline faces several serious limitations and delivers clinical recommendations that do not represent current clinical practice; these are reviewed in detail, and arguments are presented why these recommendations should not be followed. To remedy the lack of evidence- based recommendations and provide guidance to a pragmatic symptomatic therapy of chorea in HD, a flow-chart pathway that follows currently established clinical standards based on expert opinion is presented.
Copyright 2013 Movement Disorder Society

To download the complete article (fee required) click here.