What is Sydenham Chorea

Sydenham chorea is a nervous system disorder that affects a child’s brain. Most cases occur after the development of rheumatic fever, which can be a complication of infection caused by Streptococcus bacteria. Rheumatic fever occurs when the body’s defense system (immune system) reacts to the infection by making proteins (antibodies) against the bacteria. These antibodies mistakenly attack normal parts of the body instead of the bacteria (autoimmune reaction). In rheumatic fever, antibodies can attack a child’s joints, heart, or brain.

Sydenham chorea is when the rheumatic fever affects your child’s brain. This may occur several weeks to six months after the initial infection. It causes uncontrolled movements and behavior changes. Most children recover completely within a few months.

What are the causes?

This condition is caused by antibodies that attack the parts of the brain responsible for movement and behavior. These attacks cause changes in brain chemicals and lead to the signs and symptoms of Sydenham chorea.

What increases the risk?

Your child is more likely to develop this condition if he or she had a Streptococcus infection, and the infection was not treated or was treated incompletely. The risk is also greater if the child:

• Is a girl.
• Is 5–15 years old.
• Has a family history of Sydenham chorea or rheumatic fever.

What are the signs or symptoms?

The main symptom of this condition is rapid, irregular, and uncontrolled body movements. These movements can be on one side of the body or both. They usually affect the hands, arms, and face.

Signs and symptoms may start suddenly or gradually. They may be present when your child is resting and can be made worse by stress. They usually go away during sleep. They may also include:

• Weakness.
• Clumsiness.
• Slurred speech.
• Explosive speech, such as blurting out a question or answer during a conversation.
• Poor handwriting.
• Changes in behavior.
• Emotional outbursts.

How is this diagnosed?

This condition may be diagnosed based on:

• A physical exam.
• Your child’s symptoms.
• Your child’s personal or family history, especially if:
  • The child recently had a sore throat.
  • There is a family history of rheumatic fever or Sydenham chorea.
• Tests to confirm the diagnosis of this condition. These may include:
  • Imaging studies of the brain.
  • Blood tests to check for Streptococcus antibodies or infection.

How is this treated?

Mild cases of Sydenham chorea do not need treatment. Signs and symptoms usually go away in several months. In some cases, symptoms may last for up to one year and can possibly return. Severe cases of Sydenham chorea may require medicines, including:

• Anti-seizure medicine.
• Antibiotic medicine. This may need to be taken for a number of years to prevent the condition from coming back.

Follow these instructions at home:

• Give your child over-the-counter and prescription medicines only as told by your child’s health care provider.
• If your child was prescribed an antibiotic medicine, give it as told by the child’s health care provider. Do not stop giving the antibiotic even if he or she starts to feel better.
• Have your child drink enough fluid to keep his or her urine pale yellow.
• Have your child rest at home if needed.
• Ask your child’s health care provider when your child can return to normal activities.
• Keep all follow-up visits as told by your child’s health care provider. This is important.

Contact a health care provider if your child:

• Has signs or symptoms that:
  • Get worse.
  • Do not go away within the amount of time told by his or her health care provider.
  • Come back.
• Has a new sore throat with a fever.
• Has any side effects from medicine.
• Develops new behavior changes or emotional problems that get worse or come back after other signs and symptoms go away.

Get help right away if your child has:

• Chest pain.
• Trouble breathing.

Summary

• Sydenham chorea is a nervous system complication of rheumatic fever. It causes uncontrolled movements and behavior changes.
• Signs and symptoms may start suddenly or gradually. They may be present when your child is resting and can be made worse by stress.
• Mild cases of Sydenham chorea do not need treatment. Signs and symptoms usually go away in several months.
• Contact a health care provider if your child develops new behavior changes or emotional problems that get worse or come back after other signs and symptoms go away.