Free Essay

Huntington's Disease

In:

Submitted By jelo
Words 1861
Pages 8
Huntington Disease
Rachelle Jelosek
Idaho State University

Jackson is a healthy twenty-seven year old male who recently presented to his doctors office inquiring about genetic testing. Jackson recently married, and his wife Alisha is anxious to start a family. Unfortunately Jackson does not share Alisha's enthusiasm because he fears that he is a carrier of a deadly genetic mutation. Just five years ago Jackson's mother was diagnosed with Huntington's Disease at the age of 43 and Jackson's grandmother succumbed to the disease at the age of 68. Jackson is an only child and although unconfirmed and heavily denied by his family Jackson is convinced that his mother discovered her ill fate shortly after he was born. Jackson's wife and father do not want him to be tested for the disorder because they fear a positive diagnosis will destroy any life he has now and in the future . Jackson has endured years of watching his loved ones suffer and does not want to pass the disorder on to his children. The purpose of this paper is to define and describe Huntington's disease (HD), explain inheritance patterns, describe the specific gene mutation seen in patients with HD, discuss reproductive issue and outline the ethical and social implications associated with genetic testing. Huntington's disease was named after Dr. George Huntington, who is credited for discovering the hereditary disorder in 1872(Huntington’s Disease Society of America, 2008). HD progressively destroys neurons in the basal ganglia of the brain. This destruction of brain cells causes deterioration of both mental and physical abilities(Huntington’s Disease Society of America, 2008, para. 2). Symptoms of the disease consist of motor, cognitive and behavioral malfunctions. Motor degeneration affects internal and external organs and develops gradually over time. Involuntary movements such as jerking of the limbs and facial muscles as well as quivering of the abdomen and shoulders is frequently seen. Many lose the ability to swallow properly causing constant choking, and aspiration pneumonia is a common cause of death (Leontini, 2006, p. 2). Speech becomes slow and slurred and cognitive decline affects short-term memory, attention span, concentration and decision making. Often affected individuals become depressed, suicidal, hallucinate and experience schizophrenia-like symptoms (Leontini, 2006). In the last stages of HD spastic movements decline and muscle rigidity sets in causing physical paralysis and eventually respiratory arrest. Onset of symptoms seen in HD usually occur after the third or fourth generation of life with the vast majority of sufferers being adults between the ages of 35 to 45 years old(Leontini, 2006). Early indications of HD are depression, irritability, and emotional outbursts. The course of HD, from observable symptoms to death, is estimated at 15 years. HD affects roughly one in 20,000 individuals worldwide and is transmitted as an autosomal dominant heterozygous trait where an affected individual carries both a normal and an altered copy of the gene. HD is one of the most common Mendelian disorders in people of European decent with a 50 percent risk of inheritance("Huntington disease: Predictive genetic testing", 2003). Located near the short arm on chromosome four is a gene that codes for a protein referred to as huntingtin. This protein carries the amino acid glutamine that is critical to the functioning of countless metabolic processes (Paulsen, 2010). The average number of repeats for a normal Huntington Gene is between 10 and 15 and the mutated form of the gene occurs when an excessive number of “C A G” repetitions occur. Individuals who have less than 32 repetitions are not considered carriers of the disease but someone who has more than 38 repetitions will most certainly develop the disease (Paulsen, 2010) . Treatment for HD is directed at symptom control and comfort care because currently there is no cure for the disorder (Huntington’s Disease Society of America, 2008, para. 8). The goal of treatment is to slow down the course of the disease and help the individual function as comfortably as possible. Various medications can be given to control the psychological effects of HD such as antipsychotics, antidepressants, tranquilizers, and mood stabilizers. Some practitioners inject botulinum toxin to help with muscle dystonia and involuntary spasms and recent evidence suggests that co-enzyme Q10 may also help slow down the course of the disease ("Huntington disease: Predictive genetic testing", 2003). Many types of genetic testing and services are available for the detection and management of HD. Predictive genetic testing by mutation analysis is an option that was made available in 1993. Predictive testing is done by a relatively inexpensive laboratory blood test because every individual affected with HD carries the same mutation on the same gene ("Huntington disease: Predictive genetic testing", 2003, p. 3). Predictive genetic testing analyzes the number of CAG repeats on the gene inherited from the individual's mother and the gene inherited from the individual's father. Only a small blood sample is required for the test and it is no longer necessary to have DNA samples from any other family members ("Huntington disease: Predictive genetic testing", 2003). Predictive testing is a viable option for Jackson who was discussed in the case study presented at the beginning of this paper. Jackson wants to know if he is a carrier of the mutated Huntington gene so that he can prepare himself for the future and avoid passing the gene on to future offspring. Although not recommended Jackson can complete the testing entirely by himself, confidentially without involving his family in the process. Genetic counseling done by a professional advisor is available for pre and post-testing consultations to ensure that at-risk individuals such as Jackson are fully informed of the issues involved with predictive testing. A minimum of two counseling sessions to prepare for the test and one follow-up session is highly recommended ("Huntington disease: Predictive genetic testing", 2003). Genetic counseling is ideal for Jackson's situation because he lacks familial support and a positive result indicating a terminal illness will be life altering even with careful preparation and decision making. A possible referral for Jackson would be the National Society of Genetic Counselors. This nation-wide referral source will work with Jackson's provider to find a genetic counselor in his geographical area who will interpret information about genetic disorders such as HD, analyze inheritance patterns and risk of recurrence and review available treatment options with Jackson (National Society of Genetic Counselors, 2009). Because HD is passed on genetically by an affected parent to their offspring with a 50 percent inheritance ratio procreating can be an emotional dilemma that must be considered. Preimplantation genetic testing (PGT) provides an approach in which antenatal diagnosis can be offered without incurring the adverse effects of predictive diagnosis ("Preimplantation and genetic testing", 2009, para. 2). PGT uses in vitro fertilization to biopsy embryos prior to implantation. Prenatal diagnoses have been accurately made by this method with no known adverse effects on the fetus (Harper & Handyside, 1994). High risk patients such as Jackson and his wife can participate in antenatal testing with or without having predictive testing done on Jackson prior to having children. Many advantages and disadvantages occur with genetic testing. It is estimated that more than half of the individuals tested for HD by predictive testing each year receive favorable results and can go on worry free for the rest of their lives ("Huntington disease: Predictive genetic testing", 2003). The remaining individuals receive unfavorable results and must come to terms with the fact that they will develop a terminal illness that will end their life. Positive HD results may increase the cost of medical and life insurance, cause the individual to become uninsurable, lead to job discrimination, and inflict severe emotional hardships on family members, relatives and friends. All of these implications must be carefully reviewed and addressed before testing is done.

Science has revealed a great deal about how and where the HD protein causes its damage and the effect it has on hundreds of cellular processes and components. New studies using mice have added to our knowledge about the disease ("Small changes", 2009). Research in mice has shown that the disease can be modified by drugs, supplements and interventions that hopefully will be ready for human use within the next five years ("Small changes", 2009). Knowing where the mutation occurs on the specific gene allows researchers to find and alter existing drugs that affect the mutation and also to develop new drugs for potential treatments. The decision to have genetic testing is controversial at best. Jackson and his provider must consider every aspect before proceeding with the test and family support is highly recommended. In conclusion the support of a knowledgeable genetic counselor will help Jackson find an acceptable solution to his difficult situation.
References
Huntington disease: Predictive genetic testing. (2003). Encyclopedia of the Human Genome. Retrieved from http://www.credoreference.com/entry/wileyhg/huntington_disease_predictive_genetic_ testing_
Huntington’s Disease Society of America. (2008). http://www.hdsa.org
Leontini, R. (2006, June). Looking forward, looking back: the narrative of testing positive to Huntington’s disease. Health Sociology Review, 15(2), 144-158. Retrieved from http://find.galegroup.com.ezproxy.apollolibrary.com/gps/infomark.do?&contentSet=IAC-Documents&type=retrieve&tabID=T002&prodId=IPS&docId=A158525938&source=gale&srcprod=AONE&userGroupName=uphoenix&version=1.0
National Center for Biotechnology Information. (2008). http://www.ncbi.nlm.nih.gov
National Society of Genetic Counselors. (2009). http://www.nsgc.org
PDRhealth.com. (2009). www.PDRhealth.com
Paulsen, J. S. (2010, Jan). Early detection of Huntington’s disease. Future Neurology, 5(1), 85-105. Retrieved from http://find.galegroup.com.ezproxy.apollolibrary.com/gps/infomark.do?&contentSet=IAC-Documents&type=retrieve&tabID=T002&prodId=IPS&docId=A217432461&source=gale&srcprod=AONE&userGroupName=uphoenix&version=1.0
Porth, C. M. (2009). Alterations in the cardiovascular system. In Advanced Pathophysiology (pp. 322-325). Philadelphia, PA: Lippincott, Williams,& Wilkins.
Preimplantation and genetic testing. (2009). Retrieved from http://www.givf.com/library/pgdhuntington.cfm
Schwartz, R. R. (2010, June). Ripples from a stone skipping across the lake: a narrative approach to the meaning of Huntington’s disease. Journal of Neuroscience Nursing, 42(3), 157-169. Retrieved from http://find.galegroup.com.ezproxy.apollolibrary.com/gps/start.do?prodId=IPS&userGroupName=uphoenix
Small changes in protein chemistry play large role in Huntington disease. (2009, December 24). National Institutes of Health: News and Events. Retrieved from http://www.nih.gov/news/health/dec2009/ninds-24.htm
Southwell, A. L., & Ko, L. (2009). Intrabody gene therapy ameliorates motor, cognitive, and neuropathological symptoms in multiple mouse models of Huntington’s disease. Journal of Neuroscience, 29(43). Retrieved from http://find.galegroup.com.ezproxy.apollolibrary.com/gps/infomark.do?&contentSet=IAC-Documents&type=retrieve&tabID=T002&prodId=IPS&docId=A224881845&source=gale&srcprod=AONE&userGroupName=uphoenix&version=1.0
Williams, J., Schutte, D., Evers, C., & Forcucci, C. (1999). Adults seeking presymptomatic gene testing for Huntington disease. Journal of Nursing Scholarship, 31(2), 109-114. Retrieved from http://find.galegroup.com.ezproxy.apollolibrary.com/gps/infomark.do?&contentSet=IAC-Documents&type=retrieve&tabID=T002&prodId=IPS&docId=A148859775&source=gale&srcprod=ITOF&userGroupName=uphoenix&version=1.0

Similar Documents

Free Essay

Huntington's Disease

...Cellular Pathophysiology Huntington’s disease causes many changes in the immune system and the inflammatory response. According to Ellrich, Reick, Saft and Linker (2013), “increased inflammation in HD might be the response to neuronal death induced by mhtt toxicity” (para. 10). The immune system initiates the inflammatory response that is seen in Huntington’s disease. The exact impact of the innate and adaptive immune system is unknown in Huntington’s disease (Ellrichmann, Reick, Saft and Linker, 2013). It has been proven that the immune system, inflammatory response and stress provide more harm to the body than good. Eventually those diagnosed with Huntington’s disease end up succumbing to an illness that is contracted from a failing immune system (Mayo Clinic, 2014). Huntington’s disease is an autosomal dominant inherited disease that causes cell loss (Revilla, 2014). According to Raymond et al. (2011), cell loss occurs in the striatum, cortex, globus pallidus, thalamus, hypothalamus, subthalamic nucleus, substantia nigra, and the cerebellum. The exact mechanism of cellular death is still unknown in Huntington’s disease. According to Revilla (2014), “Several mechanisms of neuronal cell death have been proposed for HD, including excitotoxicity, oxidative stress, impaired energy metabolism, and apoptosis”. Systemic Dysfunction Huntington’s disease not only affects the brain but the entire human body. According to Zielonka et al. (2014), “patients experience a wide array...

Words: 752 - Pages: 4

Premium Essay

The Huntington's Disease

...The Huntington’s disease Author’s name University Affiliation Nancy Wexler is an American geneticist at Columbia University as the Higgins Professor of Neuropsychology. She is known for discovering the location of the gene causing Huntington’s disease. She works in the field of genetics despite earning a Ph.D. in clinical psychology. Currently, she works as the president of the Hereditary Disease Foundation clinic initiated by her father. The personal situation that motivated her to take up the study was the prevalence of Huntington’s disease in her family (Quarrell, 2008). Her grandfather, mother and three uncles died of the disease. She got prepared professionally for this task from the bright background as her father was a psychoanalyst while the mother was a geneticist. She also made up her mind to go for the gene testing hence added to her credibility. Additionally, the doctoral thesis she wrote on the emotional features of people at risk for Huntington’s disease also helped her. She contributed to the effort to produce a chromosomal test to identify carriers of the disease. Hungitin protein encoded by the Huntington’s gene plays a significant role in the neurons of the brain for development before birth. In cells, this protein is involved in transporting materials, chemical signaling, binding to proteins, and protects the cells from self-destruction. The coding area of the gene contains the DNA sequence repeated many times. People infected with Huntington disease...

Words: 348 - Pages: 2

Premium Essay

What Is The Genetic Basis For Huntington's Disease

...Describe the genetic basis and inheritance pattern of Huntington’s disease, and discuss the ethical considerations of genetic testing for the disease. Huntington’s Disease is a disease that affects the brain and can involve the damage of brain cells. It is an inherited disease and the damage in brain cells could cause the deterioration or gradual loss of functions in some areas of the brain. This disease affects movement, behaviour and factors that contribute to cognition within some areas of the brain. Some early symptoms can be observed when the patient is between 35 and 55 years old, and these symptoms include changes in personality and mood. Huntington’s disease can also cause psychiatric problems, some people may develop to have obsessive behaviours and in rare cases schizophrenia. The disease is strongly associated with movement problems, in the early stages, the victim may start to show uncontrollable movements of the face and body. As Huntington’s progresses, the uncontrollable movements become more extreme and occur more frequently. Due to the loss of co-ordination, some patients struggle with eating, as it may be difficult to control their muscles that are in charge with swallowing and chocking on food and water is a risk factor....

Words: 445 - Pages: 2

Premium Essay

Huntington's Disease Analysis

...Huntington’s disease is an autosomal dominant neurodegenerative condition that is currently untreatable and inevitably fatal. Associated signs and symptoms include involuntary and impaired movement (chorea and dystonia), compromised cognitive abilities and psychiatric disorders such as depression, obsessive compulsive disorder, mania and bipolar disorder (Mayo Clinic Staff, 2014). Although symptoms usually appear between the ages of 35 and 55, they can begin at any age and usually cause death within 10 to 20 years. (Nordqvist, 2014) The source of Huntington’s disease was first traced to chromosome 4 with Southern blotting techniques and then focused more precisely between 4p16.1 and 4p16.3, on the short arm, using in-situ hybridization (Wang...

Words: 1178 - Pages: 5

Premium Essay

Juvenile Huntington's Disease

...for this disease? Chorea is an appropriate name for this disease due to the symptoms the disease causes. People with Huntington’s chorea usually show symptoms of quick, abnormal and erratic movements especially of the arms, legs and face along with other parts. These symptoms relate to the diseases name because chorea means “dance” in the Greek Language. Therefore, chorea is in relation to the abnormal movements displayed by people who suffer from the disease. Question 2: What are the primary manifestations of juvenile Huntington’s disease? Juvenile Huntington’s disease can have a number of manifestations or symptoms that drastically impede the person’s body from functioning normally. There are...

Words: 742 - Pages: 3

Premium Essay

Causes Of Huntington's Disease

...Huntington’s disease is fatal genetic disorder that causes the gradual breakdown of nerve tissue in the brain. Day be day, a persons physical and mental brain state slowly deteriorate until they are unable to do essential body functions such as swallow and breathe. During this process, patients loose the ability to walk properly, speak and comprehend, and even eat. After symptoms of Huntington’s disease begin to take over a patients body, their life as they knew it changes significantly, as they loose their independency. Unfortunately, there is no definite cure of Huntington’s disease. It is a genetic neurological degenerative disease, meaning that it is an inherited disease that slowly dismantles the brains ability to function properly. A patient who contains the Huntington's gene has the 50% likelihood of passing it onto their offspring, therefore there are approximately 30,000 US citizens are currently suffering from the disease....

Words: 497 - Pages: 2

Premium Essay

Huntington's Disease Research Paper

...Huntington’s disease is a hereditary disorder that progresses throughout life and eventually causes mobility deficits, behavioral symptoms, and dementia. Huntington’s disease can begin at birth, but it mostly begins in midlife. People with this disease have a parent or both parents that are affected by this disease. A child with an affected parent has a fifty percent chance of becoming affected with Huntington’s disease. People that have Huntington’s disease that occurs before the age of twenty is called the juvenile form of Huntington’s disease. If transmission of this disease is equal from both parents, then the onset of the disease can occur at adulthood. Unfortunately, there is no cure for Huntington’s disease, but there are studies in...

Words: 777 - Pages: 4

Premium Essay

Huntington's Disease Research Paper

...Huntington's disease is an adult onset progressive brain disorder that causes uncontrolled movement, emotional problems, and the loss of thinking abilities.The disease usually appears in a person’s early thirties or forties.Early signs include depression, poor coordination, irritability, and trouble learning new information. As the disease matures affected people may have trouble swallowing, speaking and walking people also experience changes in personality and reasoning people who have the adult onset form of the disease usually live for fifteen to twenty years after showing signs. The gene that is related to the disease is a mutation that occurs in the HTT gene. The HTT gene provides instructions for making the protein huntingtin which plays...

Words: 355 - Pages: 2

Premium Essay

Huntington's Disease Research Paper

...According to The Huntington's Disease Society of America Huntington's disease is an inherited disorder that results in the progressive loss of both mental facilities and physical control. The symptoms of Huntington's disease can range anywhere from behavioral issues such as mood swings or a total change of personality to loss of coordination or even trouble swallowing. “Huntington's disease is caused by inheriting a mutation in The HTT gene” (Genetics Home Reference). At this point in time there is no cure for Huntington's but there has been some progress in slowing down the disease. “People who are diagnosed with Huntington's disease don’t usually have any signs or symptoms until they are between the ages of thirty to fifty” (HDSA.org). In some very rare cases the symptoms can start in childhood. This type of the disease progresses much faster and the teenager or child who gets it usually only lives ten to fifteen years after being diagnosed. “In the early stages of Huntington's the most common symptoms are poor memory, depression, lack of coordination, and...

Words: 731 - Pages: 3

Premium Essay

Huntington's Disease Research Paper

...Huntington’s disease is an inherited disease that causes a breakdown of certain neurons in the brain. Huntington’s disease is a neurodegenerative disorder which causes involuntary movements, emotional disturbance, and cognitive impairment. “Huntington’s disease (HD) is caused by an autosomal dominant pathogenic mutation, resulting in an expanded stretch of 36 or more glutamine residues in the N terminus of the huntingtin (HTT) protein (1)” (Weiss et al., 2012, p.1 ). People who have Huntington’s disease are born with the faulty gene; however, symptoms typically don’t appear until the person reaches middle age. Although in most cases people with HD don’t start to experience symptoms until middle age, some people may start to experience them...

Words: 2171 - Pages: 9

Premium Essay

Huntington's Disease Research Paper

...Huntington's Disease Huntington’s Disease is an inherited disease that breaks down the nerves of the brain. This disease can affect the individuals functional abilities. Most people with this disease start getting symptoms in their 30s or 40s. When this disease affects people before the age 30 it is called “ juvenile Huntington’s disease”. The causes of Huntington’s is due to a inherited defect in a single gene. Cystic Fibrosis Cystic Fibrosis is a genetic disease that causes lung infections and makes it difficult for the individual to breathe. This disease causes sticky build up of mucus in lungs, pancreas, and other organs. Cystic Fibrosis is a genetic disease, the individuals have 2 copies of defective CF gene Down's Syndrome...

Words: 802 - Pages: 4

Premium Essay

Huntington's Disease Research Paper

...Huntington's Disease Essay: By Jasmine Mongeon Huntington's disease is an inherited disease characterized by the degeneration of the central nervous system, which ultimately results in abnormal movements and mental deterioration. The genetic abnormality consists of expansion in the trinucleotide repeat CAG in the HD gene on chromosome 4, which codes for the normal protein huntingtin. The HD gene is an autosomal dominant condition which means that only one parent must have the gene in order for a child to inherit HD. Huntington's disease results in abnormal movements and mental deterioration. Each child of an Huntington's disease parent has a 50% chance of getting the Huntington's disease. If the child does not inherit the Huntington's disease...

Words: 971 - Pages: 4

Premium Essay

Huntington's Disease Research Paper

...Huntington’s disease is an autosomal dominant, progressive neurodegenerative disorder illness, causing problems such as hindered or jerky limb movement, loss of cognitive function (which can lead to early onset dementia) and emotional problems such as depression (Jones L., Hughes A., 2011). There are a variety of symptoms that are associated with Huntington's disease of which start off with behavioral disturbances such as moodiness, restlessness, paranoia or psychosis before progressing onto more physical changes like head turning limited to only shifting eye position, sporadic and sometimes wild jerking movements of the arms, legs, face, and other body parts as well as slow, uncontrolled movements. Over the years, the sick individual will...

Words: 1347 - Pages: 6

Premium Essay

Huntington's Disease Research Paper

...TITLE: Perspective: The Therapeutic Potential of Deep Brain Stimulation in Huntington's Disease AUTHORS: Sean J. Nagel, Andre G. Machado, John Gale, Darlene A. Lobel, Mayur Pandya ABSTRACT Huntington’s Disease (HD) is an incurable neurodegenerative disease characterized by the triad of chorea, cognitive dysfunction and psychiatric disturbances. Since the discovery of the HD gene in 1993, the pathogenesis has been outlined, but to date a cure has not been found. Disease modifying therapies are needed desperately to improve function, alleviate suffering, and provide hope for symptomatic patients. Deep brain stimulation (DBS), a proven therapy for managing the symptoms of some neurodegenerative movement disorders, including Parkinson’s...

Words: 3175 - Pages: 13

Premium Essay

Diagnosing Huntington's Disease

...out of every ten thousand people have Huntington’s disease, and two hundred thousand are at-risk of inheriting the disease. Huntington’s disease is a genetic disease that can effects all races, both sexes, and even juveniles. It is an autosomal dominant disorder, meaning you only need one defective gene to develop the disorder, so if one of your parents have the disease there is a fifty percent chance that you have it. Unfortunately there is currently no cure for Huntington’s disease but there are many symptoms to lead you to consider genetic testing to get a through diagnosis as well as a few treatments to help manage those symptoms. Huntington’s disease usually causes disorders with movement, cognitive, and psychiatric...

Words: 1140 - Pages: 5