In Huntington disease with severe chorea, use dopamine-blocking or depleting agents as first-line and select atypical antipsychotics over older agents to improve tolerability, but monitor elderly patients for stroke risk. When evaluating a young patient with a wing-beating tremor, Wilson disease must be included in the differential and confirmed or excluded before attributing the syndrome to any other cause.

Dopamine receptor blockers or dopamine-depleting agents are standard first-line chorea therapy; Clinicians have also utilized riluzole, which works as a glutamate release inhibitor, and remacemide, which is an NMDA receptor antagonist; Additionally, coenzyme Q-ten has been tried and may offer some behavioral benefits; Divalproex can be very helpful for mitigating both the chorea and underlying psychiatric issues, such as severe aggression and irritability; For managing aggressive outbursts or irritability, lithium and propranolol are solid options, and selective serotonin reuptake inhibitors are highly useful for the associated mood disorders