Huntington’s disease in Bangladesh
The Lancet has published a very interesting article about HD in Bangladesh that we want to share with you! You can either read the article below or here
Huntington’s disease is an autosomal dominant neurodegenerative disorder characterised by chorea, dystonia, incoordination, cognitive decline, and behavioural difficulties.1 Genetic testing is needed to confirm the clinical diagnosis, but it is not widely available in low-income and middle-income countries.In 2012, a meta-analysis2 reported hospital-based prevalence of 2·71 per 100 000 (95% CI 1·55–4·72), which was comparable with the prevalence of Guillain-Barré syndrome. In 2016, a systematic review3 described a population-based pooled prevalence of Huntington’s disease of 5·5 per 100 000, denoting a rise in prevalence over the years with increased availability of diagnostic testing. However, most data included in these studies were from high-income countries.A study in Bangladesh4 reported that eight members of a family had Huntington’s disease with atypical clinical presentation. All patients had mild jerky movement of the fingers, four (50%) had chorea, and none showed any cognitive or psychiatric disturbance. Another study in a tertiary hospital of Bangladesh5 reported that seven patients with suspected Parkinson’s disease carried the huntingtin (HTT) mutation. Such atypical presentations might also lead to underdiagnosis and under-reporting.Expanding genetic testing into under-resourced health-care settings can benefit ongoing research on Huntington’s disease. Accurately characterising the prevalence of this condition is essential to allocate resources for health and social care provision, research funding, and counselling. Clinicians in these settings should be trained to screen patients with neurological diseases with overlapping symptoms (such as Parkinson’s disease or Alzheimer’s disease) and a family history of neurodegenerative disease. We call for the research community and funding agencies to come forward with a view to implementing better facilities for the diagnosis of Huntington’s disease in low and middle-income settings.