Chorea

Symptoms and Causes

How do people get chorea?

Chorea is a neurological symptom that originates in an area of the brain called basal ganglia, which are collections of nerve cells deep inside the brain that control movement. Dozens of genetic conditions, autoimmune diseases, metabolic disorders, infections and medications can affect basal ganglia and lead to the onset of 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 changes in personality and problems with speech, coordination, and memory. Symptoms of Huntington’s disease get worse over time (usually over 10 to 20 years).
• Rheumatic fever: Around one to eight months after having rheumatic fever, children can develop Sydenham chorea (also called St. Vitus dance). Rheumatic fever is a complication of group A streptococcal infection, such as strep throat infection that wasn’t treated properly. Most of the time, kids with Sydenham chorea get better without treatment in less than two years.
• Other infectious diseases (Rarely): Lyme disease, toxoplasmosis, HIV/AIDS, endocarditis, syphilis, encephalitis, meningitis, Legionnaire disease, Creutzfeldt-Jakob disease are among infectious diseases that can cause chorea.
• Autoimmune diseases: People who have systemic lupus erythematosus (also called SLE or just lupus) can develop chorea. Multiple sclerosis, sarcoidosis, Sjogren syndrome, Behcet disease are among other autoimmune diseases that can cause chorea.
• Stroke: Some people develop chorea if they have a stroke or a tumor that occurs in or near basal ganglia.
• Pregnancy: Though 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 shortly after the birth of the baby.)
• Endocrine and metabolic disorders: Hypoglycemia, hyperglycemia, hyperthyroidism, hypoparathyroidism, hyperparathyroidism, hyponatremia, hypernatremia, hypocalcemia, hypomagnesemia, polycythemia vera and hepatic failure are some of the conditions that can cause chorea.
• Medications: Levodopa, neuroleptics, amphetamines, antihistamines, tricyclic antidepressants, anticonvulsants, cocaine, oral contraceptives are among the many medications known to cause chorea. Antipsychotic drugs can also cause chorea as part of a condition called tardive dyskinesia.
• Toxins: Carbon monoxide poisoning, mercury, alcohol intoxication can cause chorea.
• Older age: Sometimes chorea develops in older people without a 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 much the same no matter what caused the movement disorder. The most common signs of chorea are:

• Involuntary muscle movements: Also called fidgety movements or dance-like movements usually appear in the hands, feet, and face. They can affect the way you walk, swallow and talk. The movements may be fluid or somewhat jerky. They can make it look as if you’re dancing, playing the piano, or even writhing in pain. The movements often get worse if you’re stressed or anxious and go away when you’re sleeping.
• Milkmaid’s grip: Rather than holding your hand steady when you try to shake someone’s hand, you may grip and release your fingers over and over again. Doctors call this symptom milkmaid’s grip because it looks like you’re milking a cow.
• Jack-in-the-box tongue: When you try to stick out your tongue, it may slide in and out of your mouth. This sign of chorea is sometimes called jack-in-the-box tongue or harlequin tongue.
• Speech problems: Kids and adults may develop slurred speech as the muscles involved in making speech lose coordination.
• Headaches and seizures: Kids who develop chorea after rheumatic fever can have seizures and headaches. Some children also have behavioral and emotional issues.