Tiapride versus placebo: a double-blind comparative study in the management of Huntington's chorea

Abstract

A double-blind, placebo-controlled, crossover trial was carried out in 29 patients with Huntington's chorea to evaluate the effectiveness and tolerance of high doses of tiapride in the management of neurological symptoms. Patients were allocated at random into 3 groups to receive 3 g tiapride daily for two periods of 3 weeks either preceded, interrupted or followed by a 3-week period on placebo. Patients were assessed on entry and at the end of each treatment period using a battery of tests designed to measure choreatic movements, motor skills, recognition and reaction times, and mental state. Twenty-three patients completed the trial; only 2 of the 6 drop-outs withdrew because of drug-related side-effects (sedation and extrapyramidal signs). The results showed that tiapride treatment significantly improved choreatic movements and motor skills and these findings were supported by the objective psychometric measurements. Overall evaluation of effectiveness by the physician and patients indicated the significant superiority of tiapride over placebo. Treatment was generally well tolerated and although there were significantly more reports of sedation and extrapyramidal signs whilst patients were receiving tiapride, these effects were rated as mild in most cases and did not interfere with treatment.

Evidence-based guideline: Pharmacologic treatment of chorea in Huntington disease [RETIRED]

“…28 Other than the clozapine study, only 2 studies of neuroleptic treatment for HD chorea had sufficient sample size for consideration. Both examined tiapride, an atypical neuroleptic unavailable in North America, 29,30 but neither used validated outcome measures. Neuroleptic agents may be reasonable options given behavioral concerns in HD and historical suggestion of antichoreic benefit, but formal guidelines cannot be provided.…”

Treatment of Huntington's Disease

“…Dopamine antagonists (neuroleptics) are perhaps the most commonly considered agents in the management of chorea and psychosis in patients with HD, but few double-blind, placebo-controlled studies evaluating the efficacy and safety of these agents have been published [75][76][77]. None of the typical neuroleptics have been found to be effective in reducing chorea in placebo-controlled trials.…”

Symptomatic Treatment of Huntington Disease

“…31 Tiapride was superior to placebo in improving choreic movements and motor skills in a double-blind, placebo-controlled, crossover trial of 29 patients. 32 The treatment was generally well tolerated, although mild sedation and extrapyramidal signs occurred more frequently in the active treatment group. However, in another 2-week, double-blind, placebo-controlled cross-over study of 22 HD patients, tiapride failed to significantly reduce the involuntary movements.…”