Washington University School of Medicine

Huntington's Disease

HDSA Center of Excellence

About Huntington's Disease

Huntington's Disease (HD) is a hereditary degenerative brain disorder which leads to both physical and mental disabilities. Symptoms usually appear between the ages of 30 and 50, but can begin as early as 2 and as old as 80. Symptoms range from forgetfulness, personality change, and involuntary movement to difficulty swallowing, although each person is affected individually and may display different symptoms. Every child born to an affected person has a 50% chance of inheriting the gene which causes the disease. It affects woman and men as well as all races. Currently there is no cure or treatment for the disease, however symptomatic treatments are available and a great deal of research is ongoing throughout the world.

Why a Center of Excellence (CoE)?

The Huntington's Disease Society of America (HDSA) Centers of Excellence were designated to create stable regional centers which offer the best clinical care and services for those affected by HD and their families. Centers are staffed with Neurologists, Psychiatrists, Social Workers, Physical and Occupational Therapists, and other professionals; all with the commitment to caring for individuals with HD and their families.

About our Center

At Washington University, we are committed to providing comprehensive services for individuals with Huntington's disease and their families. Our Center is located within the Department of Neurology, Movement Disorders Section. We serve the Midwest area, drawing individuals from Missouri, Kansas, Iowa, Arkansas and Southern Illinois.

Services available

¨ Pre-symptomatic genetic testing
¨ Neurology
¨ Psychiatry
¨ Occupational Therapy
¨ Counseling
¨ Support groups
¨ Genetic counseling
¨ Research opportunities
¨ Information and referral
¨ Social work support
¨ General HD information
¨ In-home visits/nursing home visits (limited area)
¨ Professional education/speaker's bureau

RESEARCH

HDSA Center of Excellence staff is active in HD research. For more information, please contact our center social worker at 314-362-3471 or bartons@neuro.wustl.edu.

Meet our Center Staff

Neurologists

Joel S. Perlmutter, MD - Center Co-Director
Marc Diamond, MD - Center Co-Director
Brad A. Racette, MD
Samer Tabbal, MD
Tom Thach, MD
Paul Kotzbauer, MD, PhD
Susan Criswell, MD
Morvarid Karimi, MD
Alison Wright Willis, MD

Pediatric Neurologist
Bradley L. Schlaggar, MD, PhD

Neuropsychiatrist
Kevin Black, MD

Social Worker
Stacey K. Barton, MSW, LCSW

Neuropsychologist
Tamara Hershey, Ph.D.

Pre-symptomatic Genetic Testing

The HDSA Center of Excellence at Washington University School of Medicine has developed a protocol for pre-symptomatic genetic testing with the goal of providing adequate support and education to at-risk individuals interested in learning their HD gene status.

Pre-symptomatic, or predictive, genetic testing allows individuals who are at-risk for Huntington's Disease because of a positive family history, to learn whether or not they have inherited the HD gene prior to the onset of any symptoms. The decision of whether or not to have predictive testing is a personal one, and not to be made lightly. Because of the implications of learning prior to the onset of symptoms whether a person is at-risk of a degenerative illness are far-reaching, it is important that those seeking this testing receive adequate support, education and assessment of readiness for this information. Below is a brief summary of the testing protocol followed at Washington University School of Medicine. For more specific information, or to discuss your personal concerns related to testing, please contact our center social worker.

Prior to seeking testing, you may want to consider some important matters. In addition to considering these issues prior to beginning testing, you will discuss these with our staff prior to beginning testing and/or during the testing process. Some of these issues are cost/insurance issues, emotional implications of results, effect on the family, practical considerations for long term planning, and other concerns.

Cost
The costs associated with pre-symptomatic testing are for the genetic counseling, neurology assessment, neuropsychiatry assessment, the genetic test itself, and in some cases counseling afterwards. When you contact us about predictive testing, we will discuss your payment options with you. Please contact us for detailed information about the cost of testing.

Next Steps
An individual interested in going through pre-symptomatic genetic testing should begin by making contact with our center social worker by phone and/or email. During this call, you will discuss your family's history of HD, your motivation for testing at this time, and the schedule of our testing protocol, if it is decided that you wish to proceed. Costs of testing will be discussed prior to beginning the testing protocol. Testing involves at least three visits to our center:
The first visit is a lengthy one. You will meet with the social worker for genetic counseling and a discussion of the practical steps to take before receiving your results. You will next meet with the neurologist for a neurological exam to determine if there is any evidence of manifest HD. Next you will meet with the neuropsychiatrist for an assessment of your emotional and behavioral risks. While it is rare, it is possible that after these initial appointments the pre-symptomatic testing team may determine that it is not appropriate to move forward with testing or may recommend delaying testing until a later date. In these cases, the cost for the initial appointments is not refundable.

During the second visit you will meet with the social worker who will accompany you as your blood is drawn for the genetic test. This visit is a minimum of one month after your initial counseling appointments, as described above. Any additional questions will be answered.

The final visit occurs no less than one month from the date of the blood draw. This is where your test results will be revealed to you. Both the center social worker and the neuropsychiatrist are involved with you at this visit. At this time, regardless of results, we may recommend, or you may choose to have, ongoing counseling and support. Please discuss this with our center social worker if you have questions.

We strongly recommend that you have a support person with you for all of your visits to our center. Generally, it is best if your support person is not also an at-risk person because of the emotional risk to someone who may not be ready to learn the technical information about testing, the practical implications, or your test results. We will consider requests outside of our recommendations on a case by case basis.

It is acceptable for you to decide to forego testing at any point during the protocol. For example, if after your initial counseling appointments you decide not to have your blood drawn for testing you may tell us and we will cancel any future appointments. You may also, even after having the blood drawn, decide not to receive the results of your test. In this case, we will hold the copy of your results and if in the future you wish to receive them, this option will be available to you. In this case, we may require additional counseling visits with one or more of our team members before receiving the results. Any costs already incurred will not be refunded, but you will not be liable for any costs of services not yet provided.

Confidentiality
Confidentiality is an important feature of the predictive testing protocol. There are numerous safeguards in place to protect your confidentiality and additional concerns about unintended disclosure will be discussed during your initial visit with the social worker. At this time, anonymous testing is not available.

Important Considerations of Predictive Testing
¨ We will not test at-risk, non-symptomatic minors. There are no exceptions to this policy.
¨ We can provide counseling and referral for those who wish to consider prenatal genetic testing or receive information on preimplantation genetic testing. In some cases, this can be done without disclosure of the genetic status of the mother.
¨ In some cases, the results of one individual may disclose another person's gene status, such as in the cases of identical twins or in cases where the parent of the person seeking testing is at-risk but not symptomatic.

In all of these situations, significant counseling is required before going forth with the testing protocol.