Chorea is an abnormal involuntary movement disorder, one of a group of neurological disorders
called dyskinesias.
The term chorea is derived from the Greek word χορεία, as the quick movements
of the feet or hands are comparable to dancing.
The term hemichorea refers to chorea of one side of the body, such as chorea of one arm
but not both.
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 athetosis, which adds twisting
and writhing movements.
Walking may become difficult, and include odd postures and leg movements.
Unlike ataxia, which affects the quality of voluntary movements, or Parkinsonism, which
is a hindrance of voluntary movements, the movements of chorea and ballism occur on their
own, without conscious effort.
Thus, chorea is said to be a hyperkinetic movement disorder.
When chorea is serious, slight movements will become thrashing motions; this form of severe
chorea is referred to as ballism or ballismus.
Causes Chorea can occur in a variety of conditions
and disorders.
Chorea is a primary feature of Huntington's disease, a progressive neurological disorder.
Twenty percent of children and adolescents with rheumatic fever develop Sydenham's chorea
as a complication.
Chorea gravidarum is rare type of chorea which is a complication of pregnancy.
Chorea may also be caused by drugs, metabolic disorders, endocrine disorders, and stroke.
The relationship between chorea and L dopa administration seems to be dependent on blood
concentrations of the drug in the body Wilson's disease, a genetic disorder that
leads to toxic levels of copper in the body Transmissible spongiform encephalopathies:
A group of neurodegenerative diseases such as Creutzfeldt-Jakob disease and Kuru, caused
by prions.
Neuroacanthocytosis, a genetic disorder that may affect the blood, brain, peripheral nerves,
muscle and heart.
Common features include peripheral neuropathy, cardiomyopathy and hemolytic anemia.
Other features include limb chorea, facial tics, other oral movements, seizures, a late-onset
dementia and behavioral changes.
Types Huntington’s disease
This is a type of chorea that is inherited, meaning the phenotype is displayed in generation
after generation.
Generally, the choreic movements accompanied by the mental disorder do not skip a generation,
making it a dominant trait.
Huntington's disease includes the generic traits of chorea such as the progressive tremors
which affect the head and limbs, and increasing mental deterioration.
However, this disease can also consist of just some of these traits and to varying degrees.
It has also been observed that chorea differs in families depending on their specific backgrounds,
which can be expected based on its heritability.
Huntington’s chorea usually accompanies other diseases depending on the family line.
Other diagnoses such as epilepsy, infantile convulsions, meningeal inflammations, hydrocephaly,
mental handicap, and tics occurring mostly in small families are joined with chorea.
This information leads doctors and scientists to believe that the families that are susceptible
to inheriting chorea are also more likely to have nervous or mental troubles.
Sydenham's chorea Sydenham’s chorea is an acquired version
of chorea.
This type is increasingly rare and it may be partially due to penicillin, improved social
conditions, and/or a natural reduction in the virus it has stemmed from.
While chorea is known for its cause of involuntary movements, the psychological symptoms precede
this acquired chorea and may be relapsing and remitting.
They include: emotional liability, obsessive-compulsive behavior, cognitive defects, personality change,
or attention deficit and hyperactivity.
However, the hereditary and acquired types of chorea are generally have the same effects
on their victims.
Chorea gravidarum This type of chorea simply refers to choreic
symptoms that occur during a women’s pregnancy.
In 1900, an average 1 in 300 cases were recorded.
Most cases are a reappearance of Sydenham's chorea in the primary hormonal period of the
pregnancy but it can also be caused by the use of oral contraceptives.
A history of acute rheumatic fever is also a very likely cause of gravidarum chorea.
Some women experience chorea during their following pregnancies and several cases have
been described in which attacks occurred in three, four and even five pregnancies.
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.
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.
See also Choreoathetosis
Dancing mania Notes
External links http:emedicine.medscape.com1149725-clinical
Chorea Gravidarum Clinical Presentation