Chorea

Chorea is a neurological disorder characterized by involuntary, irregular, unpredictable, and purposeless movements. These movements can affect various parts of the body, including the face, trunk, limbs, and even the respiratory muscles. The term "chorea" is derived from the Greek word for "dance," as the movements often appear dance-like.

Causes:

Chorea can result from a variety of underlying conditions, including:

• Genetic disorders: Huntington's disease is the most well-known genetic cause of chorea. Other genetic causes include neuroacanthocytosis and Wilson's disease.
• Infections: Sydenham's chorea, a complication of rheumatic fever, is a common infectious cause, particularly in children.
• Autoimmune disorders: Systemic lupus erythematosus (SLE) and other autoimmune conditions can be associated with chorea.
• Medications: Certain medications, such as antipsychotics and antiemetics, can induce chorea as a side effect (tardive dyskinesia is a related condition).
• Metabolic disorders: Conditions like hyperthyroidism can sometimes lead to chorea.
• Stroke or brain injury: Damage to specific brain regions, particularly the basal ganglia, can cause chorea.
• Pregnancy: Chorea gravidarum is a rare form of chorea that can occur during pregnancy.

Symptoms:

The primary symptom of chorea is involuntary movements. Other associated symptoms may include:

• Restlessness: A general feeling of unease and inability to stay still.
• Grimacing: Involuntary facial movements.
• Speech difficulties: Irregular and jerky speech patterns.
• Difficulty swallowing: Problems with coordination of swallowing muscles.
• Motor incoordination: Difficulty with fine motor skills and balance.
• Cognitive and psychiatric symptoms: Depending on the underlying cause, individuals with chorea may also experience cognitive decline, depression, anxiety, or psychosis.

Diagnosis:

Diagnosis typically involves a neurological examination, review of medical history, and investigations to identify the underlying cause. These investigations may include:

• Blood tests: To check for infections, autoimmune markers, metabolic abnormalities, and Wilson's disease.
• Genetic testing: To screen for Huntington's disease and other genetic causes.
• Neuroimaging: MRI or CT scans of the brain to identify structural abnormalities.
• Lumbar puncture: To analyze cerebrospinal fluid in certain suspected infectious or inflammatory conditions.

Treatment:

Treatment focuses on managing the symptoms of chorea and addressing the underlying cause.

• Medications: Medications such as tetrabenazine, deutetrabenazine, and antipsychotics can help to reduce the severity of chorea movements.
• Physical and occupational therapy: To improve motor function, coordination, and balance.
• Speech therapy: To address speech and swallowing difficulties.
• Treatment of underlying cause: Addressing the underlying cause, such as treating infections, managing autoimmune disorders, or discontinuing offending medications, is crucial.

Prognosis:

The prognosis for chorea varies depending on the underlying cause. In some cases, chorea may be temporary and resolve with treatment of the underlying condition. In other cases, such as Huntington's disease, chorea is a progressive symptom of a chronic and ultimately fatal disease.