Background There is a wide range of therapeutic interventions proposed for the symptomatic treatment of Huntington's disease (HD). However, the majority of therapeutic decisions are supported by a low level of evidence.

Aims To characterise the patterns of prescription and therapeutic indications in a HD population across European countries.

Methods Monitored data of the REGISTRY study from 2004 to 2007 were selected. Demographic, clinical phenotype, number of CAG repeats and medication were analysed. The global and national frequencies of standardised therapeutic indications and of the corresponding pharmacological agents were estimated. The project was approved by the Scientific and Bioethics Advisory Committee of the EHDN.

Results 1569 participants from 13 European countries were included. Women: 53.7%; mean age±SD 49.6±12.1; mean age of disease onset±SD 42.3±11.6. Antipsychotics and antidepressant drugs were the most frequent prescribed drugs (n=1182). Depression (734 or 46.7% of patients) and chorea/dyskinesia (675 or 43.0% of patients) were the most frequent therapeutic indications in 12/13 countries and the two most frequent indications in 9/13 countries. Overall, the most frequently used drugs for depression were escitalopram/citalopram (n=236, 32.2%) and paroxetine (n=159, 21.7%). For chorea/dyskinesia the most frequent options were tiapride (n=197, 21.9%) and tetrabenazine (n=163, 18.1%). In each indication, the frequency of each of these drugs varied across countries.

Conclusions Depression and chorea/dyskinesia were the most frequent therapeutic indications in HD but with different treatment strategies across Europe. Treatment of clinical relevant symptoms of HD like apathy, irritability and cognitive impairment are not being prioritised by clinicians.