November 5, 2026

@michaelokun

When most people think of Huntington's disease, they picture chorea, the involuntary, dance-like movements that have become the hallmark of this condition. However, Huntington's is not simply a disease of too much movement. It is also a disease of too little movement, including bradykinesia (slowness), rigidity, impaired walking and difficulty initiating movements. This important new analysis from the PROOF-HD trial, published in Neurology, reminds us that suppressing chorea by reducing dopamine signaling may come at a price. Investigators examined patients in the placebo arm of the trial and found that those receiving antidopaminergic medications experienced greater worsening in functional capacity, cognition, overall motor performance and composite Huntington's disease scores compared with those not receiving these medications. Although chorea improved, other motor features, including bradykinesia, tended to worsen. Importantly, the associations were observed with both VMAT2 inhibitors, which reduce dopamine availability, and antipsychotics, which block dopamine receptors, with higher medication exposure also associated with greater decline. These findings do not prove that the drugs accelerate the underlying disease, since patients requiring treatment may already have more severe symptoms. My bottom line for clinicians is that treating Huntington's disease should never be reduced to treating chorea. The choice of medication, mechanism of dopamine suppression and dose all matter. We should use the lowest effective dose, reassess the need for treatment, and carefully monitor walking, swallowing, cognition, bradykinesia and everyday function. Our goal should not be simply to make the dancing stop. It should be to help the person with Huntington's disease function better and live better. https://www.neurology.org/doi/pdf/10.1212/WNL.0000000000218627