Risperidone long-acting injection and Huntington's disease: case series with significant psychiatric and behavioural symptoms

There is currently no known disease-altering treatment for Huntington's disease (HD). Successful symptomatic treatment often involves antipsychotic medication, including risperidone, yet the evidence base is limited to case reports. Although noncompliance to oral antipsychotic drugs can be a practical problem, especially when significant psychiatric manifestations of HD are present, the effect of depot antipsychotic medication in HD remains largely unknown. A period of nondrug compliance to oral risperidone in five patients with HD, and significant psychiatric and behavioural symptoms, after appearing to show symptomatic improvement, suggested a possible role for risperidone long-acting injection. The patients gave informed consent before receiving a fortnightly injection at a dose of 25 mg. At the end of 2-15 months (mean 1 year) they appeared to show an unexpected sustained symptomatic improvement (chorea, functioning and insight). In conclusion, this case series suggests risperidone long-acting injection may be a viable symptomatic treatment strategy in similar HD patients. If replicated, these findings have the potential to offer an effective strategy to manage some of the most difficult patients with HD to achieve symptomatic relief.