Off label use of lithium in the treatment of Huntington's disease: A case series
Mrs. C, a 51-year-old lady presented in 2002 with history of psychiatric symptoms for the previous 8 years. Onset was sudden with symptoms of being anxious, accusing the family members of neglect, and being violent toward family members. Patient also had history of non-rhythmic quasi-purposive movements of hands which she attributed to anxiety. Family history revealed that her mother had movement disorder and an early death. On examination, patient C had choreic movements of the limbs, anxiety and depressive symptoms. A diagnosis of HD was made which was confirmed by genetic analysis, which showed expanded CAG repeats in the Huntingtin's locus. Patient was initially started on Carbamazepine 400 mg and Clonazepam 4 mg/day. Over the next one year, patient developed psychotic symptoms like delusions of reference and persecution toward her family members and was also started on Quetiapine up to 300 mg. Two years later, patient had sudden deterioration in symptoms with worsening of chorea and onset of cognitive decline–memory disturbances and apraxia, which made her completely dependent for all activities of daily living. During this time, she also developed significant mood swings. She was started on Lithium 300 mg. For the last 3 years, patient has been on a combination of Lithium 300 mg, Carbamazepine 800 mg, Quetiapine 300 mg and Clonazepam 2 mg/day. Patient's husband reported no further deterioration over 3 years in cognition or movements in the patient. However, she continued to be dependent on husband for activities of daily living and eventually died due to cardiac arrest.