Overview
What is korea?
Chorea is a movement disorder that causes involuntary, irregular, and unpredictable muscle movements. The disorder can make you look like you're dancing (the word chorea comes from the Greek word for "dance") or appear restless or restless.
Chorea is a movement problem that occurs with many different diseases and conditions. Chorea itself is not life threatening, but it can be a sign of a neurological condition, such asHuntington's disease🇧🇷 Doctors may prescribe medicine to control abnormal muscle movements. Depending on the underlying cause, chorea can be temporary or ongoing and get worse over time.
In neurological diseases, at least two other chorea-related movements are observed.
- Athetosis is a continuous stream of slow, twisting, or twisting movements that usually involve the hands and feet.
- Ballimus usually involves more intense movements, such as wild throwing of an arm or leg. The movements usually affect only one side of the body (hemiballismus).
How common is chorea?
No one knows for sure how many people suffer from chorea. Chorea is often a symptom of another disorder. About 30,000 people in the United States have Huntington's disease (a genetic condition that causes chorea). Doctors estimate that another 200,000 people are at risk of developing Huntington's disease because their parents have the genetic disease. Chorea is the most common symptom of Huntington's disease.
In the United States, about 4,000 children a year develop Sydenham's chorea after havingrheumatic fever🇧🇷 Rheumatic fever is a serious complication ofsore throat🇧🇷 Girls are more likely than boys to get rheumatic fever. It usually occurs between 5 and 15 years of age.
Who is affected by chorea?
Chorea can occur in people of all ages. However, certain groups of people are at greater risk, including:
- People with a family history of Huntington's disease:If you have a parent with Huntington's disease, there is a 50% chance that you will inherit the disease. Typically, people develop symptoms of Huntington's disease between the ages of 40 and 50. Huntington's disease is the most common type of inherited chorea.
- Children who have had rheumatic fever:Children and teenagers can develop Sydenham's chorea after rheumatic fever, which is a complication of untreated strep throat.
- People with other medical conditions:Autoimmune diseases (such as lupus) and hormonal disorders such ashyperthyroidismand metabolic disorders such ashypoglycemiacan cause chorea. There is a long list of other disorders that can cause chorea.
Symptoms and Causes
How do people catch chorea?
Chorea is a neurological symptom that originates in an area of the brain called the basal ganglia, which are groups of nerve cells deep in the brain that control movement. Dozens of genetic conditions, autoimmune diseases, metabolic disorders, infections and medications can affect the basal ganglia and lead to chorea.
The most common causes of chorea are:
- Huntington's Disease:People inherit this genetic disorder from their parents. In addition to chorea, it causes personality changes and problems with speech, coordination, and memory. Huntington's disease symptoms get worse over time (usually between 10 and 20 years).
- Rheumatic fever:About one to eight months after rheumatic fever, children may develop Sydenham's chorea (also called the St. Vitus dance). Rheumatic fever is a complication of group A streptococcal infection like strep throat that is not treated properly. Most often, children with Sydenham's chorea get better without treatment in less than 2 years.
- Other infectious diseases (rarely): lyme disease,toxoplasmosis,VIH/SIDA,endocarditis,syphilis, encephalitis,meningitis,legionnaires disease,Creutzfeldt-Jakob diseaseare among the infectious diseases that can cause chorea.
- Autoimmune diseases:People with systemic lupus erythematosus (also called SLE or justlupus) can develop chorea.Multiple sclerosis,sarcoidosis,sjogren's syndrome,behcet's diseaseare among other autoimmune diseases that can cause chorea.
- Career:Some people develop chorea if they have a stroke or a tumor that occurs in or near the basal ganglia.
- The pregnancy:Although rare, a type of chorea called chorea gravidarum can occur during pregnancy. (If pregnancy is the cause of the chorea, it may appear during the first three months of pregnancy and stop soon after the baby is born.)
- Endocrine and metabolic disorders:hypoglycemia,hyperglycemia, hyperthyroidism, hypoparathyroidism,hyperparathyroidism,hyponatremiahypernatremia, hypocalcemia, hypomagnesemia,polycythemia veraand liver failure are some of the conditions that can cause chorea.
- medicines: Levodopa, neuroleptics, amphetamines, antihistamines, tricyclic antidepressants, anticonvulsants, cocaine, and oral contraceptives are among the many medications known to cause chorea. Antipsychotic medications can also cause chorea as part of a condition calledtardive dyskinesia.
- Toxins:Carbon monoxide, mercury, and alcohol poisoning can cause chorea.
- Older:Chorea sometimes develops in older people with no known cause. This is called senile chorea and tends to affect the muscles in and around the mouth.
What are the symptoms of chorea?
The symptoms of chorea are very similar regardless of the cause of the movement disorder. The most common signs of chorea are:
- involuntary muscle movements:Also called fidget moves or dance moves, they often appear on the hands, feet, and face. They can affect the way you walk, swallow and talk. Movements can be fluid or somewhat jerky. They can make you look like you're dancing, playing the piano, or even writhing in pain. The movements are usually worse if you are stressed or anxious and disappear when you sleep.
- Dairy Grip:Instead of keeping your hand steady when trying to shake someone's hand, you can hold and release your fingers repeatedly. Doctors call this symptom milkmaid squeeze because it feels like you're milking a cow.
- Surprise box language:When you try to stick your tongue out, it can slide in and out of your mouth. This sign from Korea is sometimes called jack-in-the-box language or harlequin language.
- speech problems:Children and adults can develop slurred speech because the muscles involved in speech lose coordination.
- Headaches and seizures:Children who develop chorea after rheumatic fever may have seizures and headaches. Some children also have behavioral and emotional problems.
Diagnosis and Tests
How is chorea diagnosed?
Because many conditions and disorders can cause chorea, your doctor will ask several questions about your family history, the medications you take, and any symptoms you have other than uncontrollable movements. Your doctor will also do a physical exam and ask how often and for how long your uncontrolled muscle movements have been occurring and whether they get worse during times of stress.
To determine the cause of chorea, your doctor may order:
- Blood tests to check for infections, lupus,thyroid levelsor other endocrine or metabolic abnormalities.
- imaging tests likeMRI image(RM) or acomputed tomography(CT) to look for changes in your brain.
- Genetic tests to see if you have the Huntington's disease gene.
How do I know if I have chorea?
If you have irregular muscle movements that you cannot control, see your doctor. The risk of chorea is higher if you have an autoimmune disease, a family history of Huntington's disease, or if you have rheumatic fever.
Management and Treatment
What are the treatments for chorea?
Some people may not be aware of their chorea; others may view your mild symptoms as simply an annoyance or perhaps a social embarrassment. However, if your chorea is severe or disabling or interfering with your quality of life, you should see your doctor for treatment.
The type of treatment depends on the cause of the movement disorder.
- If Huntington's disease is the cause, although doctors cannot cure the condition, they can prescribe medications that can control movement. Doctors prescribe deutetrabenazine (Austedo®) or tetrabenazine (Xenazine®) to control muscle movements in Huntington's chorea.
- If chorea is part of a tardive dyskinesia syndrome, the drugs valbenazine (Ingrezza®) and deutetrabenazine are usually considered.
- Amantadine is sometimes tried if levodopa (a Parkinson's drug) is causing the chorea. Antipsychotics are sometimes considered if you have chorea and have psychiatric conditions such as agitation, irritability, anxiety, depression, suicidal tendencies, and apathy.
- Children with Sydenham's chorea usually get better in less than 2 years without any treatment. If chorea is severe, doctors may prescribe drugs (for example, corticosteroids) to help control movement. Doctors also prescribe antibiotics to eliminate the rheumatic fever infection.
- If the chorea is caused by medication, stopping the medication may help decrease the abnormal muscle movements.
- If chorea is caused by endocrine or metabolic disorders (such as hyperthyroidism, hypoglycemia, hypoparathyroidism, hypocalcemia, hypomagnesemia), treatment of these conditions usually decreases abnormal muscle movements.
- The use of deep brain stimulation to reduce chorea has been tried in some patients but is considered an experimental treatment for this disorder.deep brain stimulationit may be an option if the chorea is severe and all other treatments have failed.
What are the side effects of chorea treatment?
Deutetrabenazine and tetrabenazine can cause suicidal thoughts and actions in people with Huntington's disease. Before taking these medicines, it is very important to tell your doctor if you are depressed. People with a history of depression should not take these medications.
Takingcorticosteroidsfor too long can weaken bones and lead to a condition calledosteoporosis🇧🇷 People have also reported weight gain and high blood pressure after long-term use of corticosteroids.
All medications have potential side effects. Talk with your doctor about the risks and benefits of any medications being considered to treat your chorea. You and your doctor can decide which medication or treatment plan might be best for you based on your symptoms and the cause of your chorea.
What are the complications associated with chorea?
Depending on the cause of the chorea, complications can be serious. Huntington's disease is an ongoing illness that gets worse over time and has no cure. While there is no cure for lupus, doctors can help you manage the condition with medication. Children who develop Sydenham's chorea after rheumatic fever usually recover without long-term medical problems.
What can I do to help ease the symptoms of chorea?
Only a doctor can help you alleviate the symptoms of chorea. You should talk to your doctor about medications that can control muscle movements.
Prevention
How can chorea be prevented?
Some of the diseases and conditions that cause chorea, such as Huntington's disease and lupus, cannot be prevented. To prevent rheumatic fever, children withsore throatshould be tested for streptococci. If your child's doctor prescribes antibiotics for strep throat, be sure to take them as directed and finish all of the medication.
Outlook / Forecast
What is the prognosis for patients with chorea?
The prognosis depends on the cause of the involuntary muscle movements. People with Huntington's disease can live 15 to 25 years after symptoms develop. The condition slowly gets worse over time and makes it very difficult to perform everyday activities like dressing, bathing and eating.
Children who develop Sydenham's chorea after rheumatic fever usually recover within 2 years. Some children may have persistent behavioral or emotional problems, such asTOC(OCD). These problems can last a lifetime.
Chorea itself can usually be managed with currently available treatments.
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When should I call my doctor about chorea?
You should call your doctor right away if you notice unusual muscle movements or tics. Although you may not have chorea, it's important to get tested to determine what's causing the movements.