Affiliation:
1. Department of Paediatric Neurology Hospital Sant Joan de Déu Barcelona Spain
2. Health Technology Assessment Area‐AETSA Andalusian Public Foundation for Progress and Health (“Fundación Progreso y Salud”‐“FPS”) Seville Spain
3. Research Group HUM604: Lifestyle Development in the Life Cycle and Health Promotion University of Huelva Huelva Spain
4. Assistance Publique‐Hôpitaux de Paris, Henri Mondor Hospital National Center of Reference for Huntington's Disease Créteil France
5. Département d'Etudes Cognitives, École Normale Supérieure PSL University Paris France
6. European Reference Network for Rare Neurological Diseases (ERN‐RND) Tübingen Germany
7. Department of Pediatric Neuroscience Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy
8. Movement Disorders Clinic, Department of Neurosciences Bambino Gesù Children's Hospital Rome Italy
9. U‐703 Centre for Biomedical Research on Rare Diseases (CIBER‐ER) Instituto de Salud Carlos III Barcelona Spain
Abstract
AbstractBackgroundThe NKX2‐1‐related disorders (NKX2‐1‐RD) is a rare disorder characterized by choreiform movements along with respiratory and endocrine abnormalities. The European Reference Network of Rare Neurological Disorders funded by the European Commission conducted a systematic review to assess drug treatment of chorea in NKX2‐1‐RD, aiming to provide clinical recommendations for its management.MethodsA systematic pairwise review using various databases, including MEDLINE, Embase, Cochrane, CINAHL, and PsycInfo, was conducted. The review included patients diagnosed with chorea and NKX2‐1‐RD genetic diagnosis, drug therapy as intervention, no comparator, and outcomes of chorea improvement and adverse events. The methodological quality of the studies was assessed, and the study protocol was registered in PROSPERO.ResultsOf the 1417 studies examined, 28 studies met the selection criteria, consisting of 68 patients. The studies reported 22 different treatments for chorea, including carbidopa/levodopa, tetrabenazine, clonazepam, methylphenidate, carbamazepine, topiramate, trihexyphenidyl, haloperidol, propranolol, risperidone, and valproate. No clinical improvements were observed with carbidopa/levodopa, tetrabenazine, or clonazepam, and various adverse effects were reported. However, most patients treated with methylphenidate experienced improvements in chorea and reported only a few negative effects. The quality of evidence was determined to be low.ConclusionsThe management of chorea in individuals with NKX2‐1‐RD presents significant heterogeneity and lack of clarity. While the available evidence suggests that methylphenidate may be effective in improving chorea symptoms, the findings should be interpreted with caution due to the limitations of the studies reviewed. Nonetheless, more rigorous and comprehensive studies are necessary to provide sufficient evidence for clinical recommendations.
Subject
Neurology (clinical),Neurology