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Asphyxiation, Bulimia, and Insulin Levels in Huntington Disease (Chorea)

John R. Whittier, MD
JAMA. 1976;235(14):1423-1424. doi:10.1001/jama.1976.03260400011003.
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To the Editor.—  It is well known that patients with Huntington disease (hereditary chorea) frequently die because of asphyxiation or bronchopneumonia following aspiration of food at mealtime. This is usually due to dysphagia resulting from chorea and from pseudobulbar paresis that interferes with chewing and swallowing, breathing, and the coordination of these functions, which may be compounded by hasty spoon-feeding, even of pureed diet, during short mealtimes.Unfortunately, in some cases, but not all, bulimia is a striking symptom among those affected by Huntington disease. Voracious appetite is then added to the feeding handicaps. The symptom has usually been thought to be an obvious result of an increased need for additional energy arising from chorea, but bulimia is often present with obesity and very little chorea.There are recent conflicting data, the resolution of which might add to our knowledge of the symptom of bulimia.Podolsky et al1 reported


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