Off label use of lithium in the treatment of Huntington's disease: A case series
Mr. B, a 58-year-old male, presented in 2001 with a history of abnormal movements. These movements had started at the age of 35 years and were slowly progressive. A clinical diagnosis of Huntington's disease was made. At the time of presentation, the movements were disabling, irregular, would worsen with anxiety and disappear during sleep. Patient had a significant family history of HD; involving both parents and 7 out of 9 siblings, totally 9 affected first-degree relatives. On examination, patient was noted to have severe generalized chorea involving the hands, legs, trunk and the neck. CT scan showed atrophy of caudate. A genetic analysis showed a pathological CAG repeat expansion in Huntington's gene. The movements continued with a variable course over the next 8 years.\nPatient was admitted in 2009 with a worsening of movements over the previous 6 months and weight loss of about 6 kg. Patient was evaluated for medical causes of weight loss. All investigations including prostate specific antigen and chest X-ray were normal and the weight loss was attributed to nutritional causes. Patient was prescribed dietary modifications to prevent further weight loss. Patient was started on Carbamazepine 200 mg twice a day for control of movements. Patient was also started on Lithium 150 mg at night. Patient reported a decrease in severity of the movements which continued following discharge. Family members reported that the patient was able to eat well and had no behavioral symptoms. However, he still needs support for some activities of daily living. The patient has been on follow up for the last three years and maintains status quo.