This is a comprehensive review of the literature regarding the use of Deutetrabenazine in treating chorea associated with Huntington’s disease. Unfortunately, treatment has been limited for many aspects of this neurodegenerative disease. The present investigation presents the background, evidence, and indications for the use Deutetrabenazine in the setting of Huntington’s disease. Huntington’s disease is characterized by a variety of motor, psychiatric, and cognitive symptoms with chorea being one of the more notable ones. Chorea is a movement disorder present in multiple neurologic diseases that causes involuntary and irregular muscle movements theorized to be stemming from high dopamine levels. Deutetrabenazine is thought to function as an inhibitor of the VMAT2 vesicular monoamine transporter resulting in decreased monoamine release, including dopamine, in the synaptic cleft which has a therapeutic effect in management of chorea. This drug was approved by the FDA in 2017 with a specific indication for tardive dyskinesia and choreiform movement in Huntington’s disease. Currently, there is no definitive treatment for Huntington’s disease. Thus, management is primarily focused on symptom management with the use of a variety of pharmaceutical agents. Chorea is one of the many manifestations that significantly alter the quality of life of many patients. Deutetrabenazine is a promising new option for the treatment of chorea in the setting of Huntington’s disease. Although studies so far have displayed mixed results, further research, including head-to-head studies, is necessary to elucidate the true potential of this drug.

As many patients are refractory to traditional methods of treatment for chronic neuropathic pain and psychiatric illness, physicians and researchers looked to other avenues for alternative treatment possibilities. Ketamine, which has actually been around for over 50 years, is a dissociative anesthetic, used historically mostly for induction of anesthesia and functions via N-methyl-d-aspartate receptor complex inhibition. While the undesired dissociative effects have caused it to have limited, but necessary, utility as an induction agent, ketamine delivered at subanesthetic doses has shown to improve pain and depressive symptoms in patients suffering from chronic pain or depression refractory to standard treatment. Ketamine infusions are quickly becoming more popular among patients and providers as treatment alternatives for pain or depression that is not responding to the traditional method of treatment. Patients across the United States continue to be at risk of opioid abuse as the search for powerful non-opioid analgesia is still ongoing. Ketamine infusions delivered at subanesthetic doses may also be a possibility as treatment for patients suffering from opioid addiction. Currently, ketamine infusions are offered around the United States as an off-label treatment for chronic pain, post-traumatic stress disorder (PTSD), depression, and a variety of other psychiatric and neuropathic pain conditions. In this chapter, we discuss the role of ambulatory surgery centers in ketamine infusions and benefits for patients and providers.