Agitation is a recognised and challenging complication across the stages of Huntington's disease. Identifying the underlying cause — whether an environmental trigger, a somatic factor, or a concurrent neuropsychiatric condition — is the essential first step before any pharmacological intervention, particularly when communication with the patient is impaired.
Management depends on the nature and severity of the agitation. When agitation occurs alongside features of an anxiety disorder, a specific class of agent is considered on an as-needed basis to minimise the risk of dependence. For cases of more extreme agitation with associated behavioural or personality disturbance, a different pharmacological category is indicated.
Full regimen details, selection criteria, and sequencing are available via the structured protocol below.
In case of agitation, priority should be given to identifying environmental or somatic triggers (bladder distension, fecal impaction, pain, etc.) in order to treat the underlying cause, especially in the advanced stages of the disease when communication difficulties exist.
When agitation is associated with an anxiety disorder, a benzodiazepine should be prescribed as needed to reduce the risk of dependence and falls (Professional agreement).
Some benzodiazepines (e.g., midazolam) may be useful in emergency situations.
In the case of extreme agitation, and if there are associated behavioral and personality disorders, it is advised to prescribe a neuroleptic (Grade C).
DOI: 10.3389/fneur.2019.00710
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