Chorea

Chorea is the name given to specific types of movement disorders characterized by twisting or jerky movements of the body or limbs. Movement disorders are conditions that cause involuntary body movements. Parkinson's disease, cerebral palsy, and Lou Gehrig's disease (ALS) are all movement disorders.

Syndenham's chorea occurs in a small percentage (20 percent) of children and adolescents as a complication of rheumatic fever.

Chorea can be caused by an inherited genetic illness or disorder or it can be acquired.

Examples of inherited causes in children include, but aren't limited to:

• Cerebral palsy
• Juvenile Parkinson's disease
• Lou Gehrig's disease

Examples of acquired causes in children include, but aren't limited to:

• Rheumatic fever
• Systemic lupus
• Multiple sclerosis
• Meningitis and tuberculous meningitis
• Encephalitis
• Lyme disease
• HIV-AIDs
• Subacute bacterial endocarditis
• Stroke, including moyamoya disease
• Hormonal, or endocrine, disorders

Children, teens and young adults with chorea usually have brief, but uncontrollable jerky movements that sometimes jump from one body part to another, kind of like a wave moving through the body. Most of the time, these movements involve the extremities, or hands, feet, legs, arms and head. They may also involve the face so that your child may suddenly frown or stick out their tongue. By a certain age, kids begin to realize that these movements aren't normal, at this point, some children learn to mask these sporadic movements by making them seem like they are done "on purpose." Kids with more severe symptoms may have a harder time covering them up. Children may also have trouble walking or holding things so they appear to be clumsy. And in some cases, your child may have uncontrollable speech.

Because there are so many causes of chorea, diagnosis can be somewhat difficult. For this reason, your doctor will be very thorough in examining your family medical history as well as your child's recent medical history. He or she will especially want to know when you first noticed your child's symptoms, how often they occur and how severe they are. A complete physical exam will performed, including blood work to determine if there is currently any type of infection.

Your child will most likely be tested for neurological disorders, and a cardiologist may examine him or her for any signs of rheumatic disease or scarring. Tests may include:

• Full blood count
• Thyroid function
• Renal and liver function
• Signs of tuberculosis, Lyme disease, streptococcal infection
• MRI scan
• EEG to rule out seizures

Depending on the cause, some chorea symptoms disappear on their own without any treatment. Symptoms that are extremely mild may not require any treatment either, though your doctor will probably want to monitor your child to assure symptoms don't increase, and if they do, to treat them.

For chorea symptoms that do require care, your neurology team will work with you to develop a treatment plan that addresses your child's medical, physical, mental and emotional needs. This may include:

• Medications
• Physical and occupational therapy
• Neuropsychology
• Social services
• Child Life services

The treatment plan supports the family as well. Our team works with your child's loved ones and caregivers to help them gain the most progress possible in a supportive environment, both here at Cook Children's and at home.