Summary about Disease
Chorea is a neurological disorder characterized by involuntary, jerky, and unpredictable movements. These movements can affect various parts of the body, including the face, limbs, and trunk. Chorea is not a disease itself, but rather a symptom of an underlying condition.
Symptoms
Involuntary, rapid, jerky movements of the face, limbs, and trunk.
These movements are often described as dance-like or fidgety.
Uncoordinated movements.
Difficulty with voluntary movements (e.g., walking, writing, speaking).
Grimacing or facial tics.
Slurred speech.
Difficulty swallowing.
Restlessness and irritability.
In some cases, cognitive and psychiatric symptoms may also be present.
Causes
Chorea can be caused by a variety of underlying conditions, including:
Huntington's disease: A genetic disorder that causes progressive degeneration of nerve cells in the brain.
Sydenham's chorea: An autoimmune reaction following a streptococcal infection (e.g., strep throat, scarlet fever).
Drug-induced chorea: Certain medications, such as antipsychotics or antiemetics, can cause chorea as a side effect.
Metabolic disorders: Conditions like Wilson's disease or hyperthyroidism.
Stroke or brain injury: Damage to the basal ganglia, a part of the brain involved in movement control.
Autoimmune disorders: Such as lupus.
Pregnancy: Chorea gravidarum (rare).
Other neurological conditions: Such as neuroacanthocytosis.
Medicine Used
Treatment focuses on managing the symptoms of chorea and addressing the underlying cause. Medications that may be used include:
Tetrabenazine: A dopamine-depleting agent used to reduce involuntary movements.
Deutetrabenazine: Similar to tetrabenazine, but with a slightly different chemical structure.
Antipsychotics: Medications like haloperidol, risperidone, or olanzapine can help control choreatic movements, but they have potential side effects.
Botulinum toxin (Botox): Injections can be used to treat focal chorea (chorea affecting a specific area of the body).
Other medications: Depending on the underlying cause, other medications may be used to treat the condition (e.g., antibiotics for Sydenham's chorea, medications to manage metabolic disorders).
Supportive therapies: Physical therapy, occupational therapy, and speech therapy can help improve motor function, coordination, and communication.
Is Communicable
Chorea itself is not communicable or contagious. However, Sydenham's chorea is related to a strep infection, which is contagious. The chorea manifests as a delayed autoimmune response. Huntington's disease is a genetic condition, not communicable.
Precautions
Precautions depend on the underlying cause:
Sydenham's chorea: Prompt treatment of streptococcal infections can help prevent Sydenham's chorea.
Drug-induced chorea: Monitoring for and adjusting medications that can cause chorea.
Huntington's disease: Genetic counseling for families with a history of Huntington's disease.
General:
Creating a safe environment to minimize the risk of injury due to involuntary movements.
Adaptive strategies for performing daily activities (e.g., using assistive devices for eating or dressing).
Support groups and counseling for patients and their families to cope with the emotional and psychological challenges of chorea.
How long does an outbreak last?
The duration of chorea depends on the underlying cause:
Sydenham's chorea: Typically resolves within a few months to a year, although some individuals may experience persistent symptoms.
Drug-induced chorea: Usually resolves after discontinuing the offending medication.
Huntington's disease: Chorea is a progressive symptom that worsens over time.
Other causes: The duration varies depending on the underlying condition and its treatment.
How is it diagnosed?
Diagnosis involves:
Medical history and physical examination: Assessing the patient's symptoms, medical history, and family history.
Neurological examination: Evaluating motor function, coordination, reflexes, and cognitive function.
Blood tests: To rule out metabolic disorders, autoimmune conditions, or infections.
Brain imaging: MRI or CT scans to identify structural abnormalities in the brain.
Genetic testing: To diagnose Huntington's disease or other genetic disorders.
Lumbar puncture (spinal tap): In some cases, to rule out infections or inflammatory conditions affecting the brain and spinal cord.
Electroencephalogram (EEG): To rule out seizures or other abnormal brain activity.
Timeline of Symptoms
The timeline of symptoms varies greatly depending on the underlying cause.
Sydenham's chorea: Symptoms typically appear several weeks to months after a streptococcal infection.
Huntington's disease: Symptoms usually begin in adulthood (30s-50s) and progress gradually over 10-25 years.
Drug-induced chorea: Symptoms can develop within days or weeks of starting the offending medication.
Important Considerations
Chorea is a symptom, not a disease. It is crucial to identify and treat the underlying cause.
Management of chorea often requires a multidisciplinary approach involving neurologists, psychiatrists, therapists, and other healthcare professionals.
Living with chorea can be challenging for patients and their families. Support groups and counseling can provide emotional support and practical advice.
Research is ongoing to develop new and more effective treatments for chorea and its underlying causes.
Early diagnosis and treatment can improve outcomes and quality of life for individuals with chorea.