Chorea
Chorea | |
---|---|
Specialty | Neurology |
Chorea (or choreia, occasionally) is an abnormal involuntary
The term hemichorea refers to chorea of one side of the body, such as chorea of one arm but not both (analogous to hemiballismus).
Presentation
Chorea is characterized by brief, semi-directed, irregular movements that are not repetitive or rhythmic, but appear to flow from one muscle to the next. These 'dance-like' movements of chorea often occur with
Causes
Huntington's disease
Other genetic causes
Other genetic causes of chorea are rare. They include the classical Huntington's disease 'mimic' or
Acquired causes
The most common acquired causes of chorea are cerebrovascular disease and, in the developing world, HIV infection—usually through its association with cryptococcal disease.[2]
Sydenham's chorea occurs as a complication of streptococcal infection. Twenty percent (20%) of children and adolescents with rheumatic fever develop Sydenham's chorea as a complication. It is increasingly rare, which may be partially due to penicillin, improved social conditions, and/or a natural reduction in the bacteria (Streptococcus) it has stemmed from. Psychological symptoms may precede or accompany this acquired chorea and may be relapsing and remitting. The broader spectrum of paediatric autoimmune neuropsychiatric disorders associated with streptococcal infection can cause chorea and are collectively referred to as PANDAS.[2]
Chorea gravidarum refers to choreic symptoms that occur during pregnancy. If left untreated, the disease resolves in 30% of patients before delivery but, in the other 70%, it persists. The symptoms then progressively disappear in the next few days following the delivery.[2]
Chorea may also be caused by drugs (commonly
Other acquired causes include
.Treatment
There is no standard course of treatment for chorea. Treatment depends on the type of chorea and the associated disease. Although there are many drugs that can control it, no cure has yet been identified.
Form | Treatment |
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Huntington's-related | A common treatment is dopaminergic antagonists, although treatment is largely supportive. Tetrabenazine is the only FDA approved drug for the treatment of Huntington's disease-related chorea. |
Sydenham's chorea | valproic acid. Usually involves antibiotic drugs to treat the infection, followed by drug therapy to prevent recurrence.
|
Chorea gravidarum | haloperidol,[5][6][7] chlorpromazine alone or in combination with diazepam, also pimozide can also be used. |
Wilson's disease | Reducing levels of copper in the body using D- trientine hydrochloride, tetrathiomolybdate, and other chelating agents
|
Drug-induced chorea | Adjusting medication dosages. |
Metabolic and endocrine-related choreas | Treated according to their causes. |
History
Historically, choreas like Huntington disease and Sydenham's chorea were called Saint Vitus' dance, related to a series of social phenomena of the same name.[8]
See also
Notes
- ISBN 978-0199929146.
- ^ S2CID 31059440.
- S2CID 3100453.
- PMID 15825133.
- PMID 4643046.
- PMID 472859.
- PMID 7078886.
- ISBN 9780791095867.