What is chorea?

Chorea is a symptom that causes involuntary, irregular, or unpredictable movements in the arms, legs, and facial muscles. The word "chole" comes from the Greek word meaning "to dance." This disease can make a person appear restless or fidgety while dancing.

Chorea is not fatal in itself. In some cases, it might present alone; however, this occurs most frequently when it accompanies a condition like Huntington's disease.

What are the symptoms of chorea?

Your inability to regulate your body's motions is one of the most common symptoms of chorea. Among these are:

• Involuntary muscular movements: Involuntary muscular movements may affect any muscle in the body. Too much action can cause twitching, jerking, or fidgeting of the arms, legs, and facial muscles. It may interfere with your ability to speak, swallow, and move around.
• Grip changes: When stretching out your hand or attempting to shake someone's hand, you may grasp and let go with your fingers. Healthcare practitioners call this motion the milkmaid's grip because it is the same motion a person makes when milking a cow.
• Movements of the tongue: Your tongue may move both within and outside of your mouth. We call this a jack-in-the-box tongue. Additionally, tongue movements can occur in different directions.

In addition to the involuntary movements mentioned, children with chorea may also present with:

• Slurred speech.
• Headaches.
• Seizures (which may be related to rheumatic fever and some rare diseases).

What makes chorea get worse?

Chorea symptoms may get worse if you're:

• Stress.
• Anxiety.
• Illness from another medical condition or side effects from a medication.

What is the reason for the occurrence of chorea?

Chorea is bringing in a variety of other conditions, some transient and some chronic. They are:

• Acquired immunodeficiency syndrome
• Chorea in pregnancy, chute gravidarum
• Genetic conditions such as Huntington's disease
• Metabolic and endocrine disorders, including hypoglycemia
• autoimmune disorders like systemic lupus erythematosus
• Infectious diseases such as Sydenham's chorea
• Medications such as levodopa and neuroleptics

What are the risk factors for chorea?

Chorea can occur in anyone. You might be more susceptible to developing chorea if you:

• Have a family history of Huntington's disease.
• You are over 40 years old.
• You had rheumatic fever, an infection or head trauma during childhood.
• You have an autoimmune condition.

What are the complications of chorea?

Complications can be serious and include the following, depending on the origin of the chorea:

• Malnutrition, or difficulty swallowing food and liquids.
• Emotional or behavioral difficulties, such as obsessive-compulsive disorder. Children and Huntington's disease patients frequently experience this.
• Physical harm brought on by uncontrollable motions.
• Stigmatization in society.

How is chorea diagnosed?

Since many conditions cause chorea, your doctor must ask for a detailed medical history to have an idea of potential causes. Your doctor may ask the following questions in diagnosing chorea:

• When did the symptoms start?
• What makes the symptoms worse or better?
• Do the symptoms of chorea tend to worsen when you are stressed?
• Do you have a family history of Huntington's disease?
• What medications do you take?

Some laboratory tests can be an indicator of chorea. For instance, abnormal copper levels in your body can indicate Wilson's disease, a genetic disorder that causes chorea.

Tests for spiky erythrocytes or red blood cells can indicate chorea-acanthocytosis. Blood tests for parathyroid hormones or thyroid hormones can indicate metabolic or endocrine-related chorea.

For Huntington's disease, imaging studies, such as MRI scans, can show brain activity that's an indicator of the disease.

How is chorea treated?

Treatment for chorea might include:

• Taking medications to reduce involuntary movements.
• Stopping a medication that could cause your symptoms (do not stop taking a medication unless your healthcare provider instructs you to do so).
• Treating any underlying health conditions.
• Managing your stress or anxiety by working with a mental health professional.
• Changing your nutritional intake (nutrition management) if symptoms impair your ability to swallow by incorporating easier-to-chew foods into your diet.
• Surgery to remove a brain tumor.
• Deep brain stimulation for certain kinds of severe chorea, or if other treatments are ineffective.

In very mild cases that don't impact your daily routine, you might not need any treatment. A doctor will discuss the treatment choices.

What medication is used to treat chorea?

The specific kind of medicine a doctor might prescribe to treat the symptoms of chorea varies according to its cause:

• Huntington's disease: Drugs are tetrabenazine, deutetrabenazine (Austedo®) or tetrabenazine (Xenazine®).
• Tardive dyskinesia: Drugs include tetrabenazine, valbenazine (Ingrezza®) and deutetrabenazine (Austedo®).
• Parkinson's disease medication levodopa: The alternative drug is amantadine.
• Rheumatic fever: Drugs include corticosteroids or antibiotics.
• Dopamine management: Adjusting or reducing the doses, spreading the doses out and/or using extended-release formulations of medications like antipsychotics or antiseizure medications. As antipsychotics and antiseizure medications may cause symptoms of chorea, your healthcare provider will monitor your progress on these medications closely.

Are there side effects of the treatment?

The side effects are different for each type of treatment or medication for chorea.

For example, tetrabenazine and, to a lesser extent, deutetrabenazine and valbenazine can induce suicidal thoughts and behaviors in patients with Huntington's disease. Prior to receiving these drugs, it is very important to inform your healthcare provider if you have depression. Patients who have a history of depression should not take them without approval from their provider. If you experience suicidal thoughts, contact your healthcare provider.

Your medical provider will let you know about the side effects of any medication before you start taking it so you can make an informed decision about your health.

How soon after treatment will I feel better?

Some cases of chorea resolve after treatment. Other people may have to continuously manage symptoms of chorea if the underlying condition is chronic. For children diagnosed with Sydenham chorea after rheumatic fever, they usually see their symptoms resolve within two years without treatment or sooner with treatment.

Can chorea be prevented?

You cannot prevent all causes of chorea. You can reduce your child's chances of getting rheumatic fever by taking them to a healthcare provider to get tested for strep throat if they have a sore throat. If your child's doctor prescribes antibiotics for strep throat, make sure your child takes them as directed and finishes all the medicine.

When should I seek medical care?

You should contact your medical provider immediately if you experience any weird muscle movements. You may not have chorea, but getting it checked can help determine the cause of your movements.

When to go to the ER?

If an involuntary movement causes you to injure yourself, you should visit the emergency room. People with chorea often fall. Your care team can assist you in adjusting your home to minimize or avoid falls and injuries.

If your child has their first seizure following rheumatic fever, call your local emergency services number.

What questions should I ask my doctor?

• What's causing my symptoms?
• If I take treatment for the cause of chorea, would my symptoms disappear?
• What kind of treatment do you advise?
• Are there side effects of the treatments?
• If I have depression, what medication do you suggest?
• Do you recommend any support groups or counseling?

Why Tender Palm Super-Speciality Hospital for chorea?

Tender Palm Hospital, owned by doctors, is renowned for attracting the most experienced professional in the country, with the finest neurologist and neurosurgeons specialized in chorea. Tender Palm stands out as the premier Neurology hospital in Lucknow, India. Boasting cutting-edge infrastructure and advanced technology, Tender Palm ensures top-notch medical care for its patients.

To seek an expert consultation for any Neurology condition

Call us at +91-9076972161
Email at care@tenderpalm.com

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