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Sydenham’s Chorea Sydenham’s Chorea
Sydenham's chorea is a movement disorder. It is the most common type of aquired chorea. Meaning your child isn't born with it,... Sydenham’s Chorea

by Kimberly Allen, RN

Sydenham’s chorea is a movement disorder.  It is the most common type of aquired chorea.  Meaning your child isn’t born with it, it is “aquired” after birth.  Sydenham’s chorea is usually diagnosed in children between 5-15 years of age and it is  twice as common in girls as boys.  Sydenham’s chorea can also run in families.  Though Sydenham’s chorea has become a variety in the developed nations there have been recent outbreaks of rheumatic fever with Sydenham’s chorea in both North America and Australia.

Sydenham’s chorea is most commonly caused by group A beta hemolytic streptococcus infection and is associated with rheumatic fever. Sydenham’s chorea is a neurological complication of rheumatic fever. It is characterized by involuntary movements.  Usually the symptoms of Sydenham’s chorea manifests suddenly and tends to affect all of your child’s limbs.  Sydenham’s  chorea causes abnormal signal from the brain that causes difficulty controlling the muscles in the body. Generally these movements affect only the face, arms, and hands. These movements can occur while your child is resting or active, they may also increase when your child is performing certain activities such as when counting or doing mental calculations.

Sydenham’s chorea causes loss of muscle control, leading to awkward gait and distorted hand gestures.

In addition to involuntary movements, there are also other symptoms including muscle weakness as well as poor muscle tone.  Many children experience gait disturbances as well as a loss of both fine and gross motor skill which in older children manifests with the deterioration of his/her hand writing, facial grimacing, fidgetiness as well as headaches and impaired cognition.  Some children may have hand movements called the “milk sign” where the child makes hand movements like milking a cow or uncontrollable tongue movements like a “bag of worms”.

There are also numerous behavioral and emotional symptoms that can accompany Sydenham’s chorea including personality changes, attention deficit and hyperactivity, obsessive-compulsive behavior as well as emotional lability and cognitive defects.

Because Sydenham’s chorea can develop as late as 6 months after a strep infection and rheumatic fever it can be difficult to diagnose. Frequently by the strep bacteria from the throat and the blood counts as well as the ESR (estimated sedimentation rate) and CRP (C-reactive protein) which indicate inflammation, have returned to normal.  Some Drs find the ASO titre as well as other serological tests associated with rheumatic fever helpful.  A dignosis of Sydenham’s chorea is usually made after all other potential causes have been ruled out. Treatment of Sydenham’s chorea depends on the severity of the condition.  Most of the time the symptoms are mild and will usually resove on it’s own without treatment.  However, in the more severe cases where the involuntary movements interfere with your childs ability to function the Dr may prescribe certain medications like anticonvulsants to help reduce the severity and frequency of movements
or steroids and intravenous immune globulin to help destroy the antibodies that are causing the symptoms.  All children with Sydenham’s chorea are also given penicillin or an alternative if your child is allergic to penicillin for 10 days to prevent a recurrence of rheumatic fever.  The Dr will also want to assess your childs heart to determine if there is any damage as a result of rheumatic fever.

As a rule Sydenham’s chorea is self limiting and resoves on it’s own with in a few weeks to a few months,  occasionally lasting up to a year.  Approximately 20% of children with Sydenham’s will have a recurrence with in 2 years of the initial attack.

Kimberly Allen is a registered nurse with an AND in nursing. She has worked in ACF, LCF and psychiatric facilities, although she spent most of her career as a home health expert. She is now a regular contributor to HealthAndFitnessTalk.com, dispensing advice and knowledge about medical issues and questions. You can reach her with any comments or questions at  mussatti3@gmail.com.

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