Chorea is a syndrome characterized by erratic, jerky, irregular movements similar to normal facial movements and gestures, but all possible with them in amplitude and intensity, that is, more pretentious and grotesque, often reminiscent of a dance. The term “chorea” is used to refer to both independent diseases in which choreic hyperkinesis is the leading manifestation (for example, chorea minor, Huntington’s chorea), and a number of syndromes that occur with various diseases.
The reasons
Hyperkinesis of a choreic nature can be a manifestation of many pathological conditions and diseases: focal disorders of cerebral circulation in the area of subcortical nodes, viral encephalitis, lupus erythematosus, polycythemia; can occur with carbon monoxide poisoning, manganese, carbon disulfide, when taking certain drugs – amphetamine, levodopa, chlorpromazine derivatives. Any external stimuli, emotional arousal increase the severity of choreic hyperkinesis, at rest it is reduced, during sleep it disappears. With severe hyperkinesis, eating, walking, staying in a standing position, etc. become incredible. Involuntary movements, as a rule, develop against the background of muscle hypotension.
Symptoms
Patients are fussy, restless, constantly grimacing, often bruising against surrounding objects, holding a given position with difficulty and for a short time. Twitching interrupts voluntary movements, giving them lack of coordination; typical dancing gait. Due to oral hyperkinesis, dysarthria occurs, in severe cases, patients cannot speak at all. The most important in the development of chorea is the defeat of striatal structures and the cerebellum.
The disease lasts from several weeks (more often) to several months. Relapses occur in 1/3 of cases. Chorea minor must be differentiated from tics, which are traditionally stereotyped and localized. It resembles chorea and Gilles de la Tourette syndrome, which also occurs in babies and is manifested by a combination of choreiform hyperkinesis with violent vocalization. Patients make grunting, barking and cooing sounds, which over time turn into the repetition of obscene words (coprolalia). Chorea of pregnancy is a variant of chorea minor that occurs in the first months of pregnancy in young women. As a rule, in the anamnesis there is an indication of chorea suffered in childhood.
Diagnostics
When differentiating, the family history is crucial; at the beginning of the disease, the diagnosis is facilitated by the administration of L-DOPA, which leads to a sharp increase in hyperkinesis. Hyperkinesis and impulsivity can be alleviated by the appointment of neuroleptics (haloperidol).
Treatment
Bed rest, haloperidol, tranquilizers. With a preventive purpose, antirheumatic therapy is indicated.