Sydenham chorea

Answer 1

Definition

Sydenham chorea is a movement disorder that occurs with rheumatic fever.

Alternative Names

St. Vitus dance

Causes, incidence, and risk factors

Sydenham chorea is one of the major signs of acute rheumatic fever. It is discussed here separately because it may be the only sign of rheumatic fever in some patients.

Sydenham chorea occurs most often in girls before puberty, but may be seen in boys.

Symptoms

• Changes in handwriting
• Jerky, uncontrollable, and purposeless movements in different muscle groups (looks like twitching)
• Loss of fine motor control, especially of the fingers and hands
• Loss of emotional control, with bouts of inappropriate crying or laughing
• Symptoms of rheumatic fever (see acute rheumatic fever)

Signs and tests

There may be a history of sore throat for several weeks before Sydenham chorea.

Blood tests that may show signs of rheumatic fever include erythrocyte sedimentation rate (ESR).

Different blood tests may be done to identify whether the child may have a strep infection.

Treatment

Antibiotics are given against streptococci, the bacteria that cause rheumatic fever. The health care provider may prescribe preventive antibiotics (antibiotic prophylaxis).

Supportive care is given as necessary to control symptoms of Sydenham chorea, especially the constant movements. Sedation may be advised in severe cases.

Expectations (prognosis)

Sydenham chorea usually clears up in a few months. In rare cases, an unusual form of Sydenham chorea may begin later in life.

Complications

No complications are expected.

Calling your health care provider

Call your health care provider if your child develops uncontrollable or jerky movements, especially if the child has recently had a sore throat.

Prevention

Pay careful attention to children's complaints of sore throats and get early treatment to prevent acute rheumatic fever. If there is a strong family history of rheumatic fever, be especially watchful, because your children may be more likely to develop this infection.

References

Gerber MA. Group A streptococcus. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 182.

Answer 2

Definition

Sydenham chorea is a movement disorder that occurs with rheumatic fever.

Alternative Names

St. Vitus dance

Causes, incidence, and risk factors

Sydenham chorea is a major sign of acute rheumatic fever. The person may currently or recently have had the disease. Sydenham chorea may be the only sign of rheumatic fever in some patients.

Sydenham chorea occurs most often in girls before puberty, but may be seen in boys.

Symptoms

• Changes in handwriting
• Jerky, uncontrollable, and purposeless movements that look like twitches; the abnormal movements disappear during sleep
• Loss of fine motor control, especially of the fingers and hands
• Loss of emotional control, with bouts of inappropriate crying or laughing
• Symptoms of rheumatic fever (See: Acute rheumatic fever)

Signs and tests

There may be a history of sore throat for several weeks before Sydenham chorea.

Blood tests that may show signs of rheumatic fever include erythrocyte sedimentation rate (ESR).

Different blood tests may be done to identify whether the child may have a strep infection.

Treatment

Antibiotics used to kill the bacteria that cause rheumatic fever. The doctor may also prescribe antibiotics to prevent future rhematic fever infections. This is called preventive antibiotics, or antibiotic prophylaxis.

Symptoms will be treated as appropriate. Sedation may be needed in severe cases.

Expectations (prognosis)

Sydenham chorea usually clears up in a few months. In rare cases, an unusual form of Sydenham chorea may begin later in life.

Complications

No complications are expected.

Calling your health care provider

Call your health care provider if your child develops uncontrollable or jerky movements, especially if the child has recently had a sore throat.

Prevention

Pay careful attention to children's complaints of sore throats and get early treatment to prevent acute rheumatic fever. If there is a strong family history of rheumatic fever, be especially watchful, because your children may be more likely to develop this infection.

References

Bisno AL. Rheumatic fever. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 313.

Lang A. Other movement disorders. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 434.

Reviewed By

Review Date: 09/28/2010

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Daniel B. Hoch, PhD, MD, Assistant Professor of Neurology, Harvard Medical School, Department of Neurology, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.