choreatic disease

Common Signs and Symptoms of Chorea

Chorea, a movement disorder, can manifest in various ways, affecting individuals differently. The following are some common signs and symptoms associated with chorea:

• Involuntary movements: Chorea is characterized by brief, irregular, and somewhat rapid involuntary movements that occur repeatedly.
• Muscle contractions: Muscle contractions without a regular rhythm can be a symptom of chorea.
• Difficulty swallowing: Some individuals may experience difficulty swallowing due to chorea.
• Difficulty talking: Speech difficulties, such as slurred speech, can also be associated with chorea.
• Abnormal walk: Abnormal walking patterns or gaits can be a sign of chorea.

Specific Symptoms

In some cases, chorea can cause more specific symptoms, including:

• Fidgeting movements: Mild chorea may manifest as restlessness or fidgeting movements of the hands.
• Uncontrolled arm and leg movements: More severe forms of chorea can result in uncontrolled arm and leg movements.
• Tic-like grimaces: Facial expressions, such as tic-like grimaces, can be a sign of chorea.

Other Associated Symptoms

Chorea may also be associated with other symptoms, including:

• Ataxia: Ataxia, which affects coordination and balance, can occur alongside chorea.
• Dementia: In some cases, chorea can be a symptom of underlying conditions, such as dementia or Huntington's disease.

These symptoms can vary in severity and may change over time. It is essential to consult with a healthcare provider for an accurate diagnosis and treatment plan. [1][2][3][4][5][6][7][8][9][10][11][12]

Diagnostic Tests for Chorea

Chorea, a type of movement disorder, can be diagnosed through various tests and examinations. Here are some of the diagnostic tests used to identify chorea:

• Physical Exam: A physical examination by a doctor is usually the first step in diagnosing chorea. The doctor will look for signs of involuntary movements, such as twitching or jerking muscles.
• Medical History and Symptoms: The doctor will also ask questions about the patient's medical history and symptoms to determine if they have any underlying conditions that may be causing the chorea.
• Blood Tests: Blood tests can help identify certain conditions that may cause chorea, such as:
  • Tests for spiky erythrocytes or red blood cells can indicate chorea-acanthocytosis [4].
  • Blood tests for parathyroid hormones or thyroid hormones can indicate other underlying conditions [4].
• Imaging of the Brain: Imaging tests, such as MRI or CT scans, may be used to rule out other conditions that may cause similar symptoms.
• Genetic Testing: Genetic testing is available to confirm Huntington's disease, a genetic disorder that causes chorea. This test can identify a gene mutation that is associated with the condition [10].
• Other Tests: Additional tests, such as positron emission tomography (PET) scans or blood tests for thyroid hormones and/or blood sugar, may be done to identify the underlying cause of the chorea [6, 8].

It's worth noting that the diagnosis of chorea can be challenging, and a combination of these tests and examinations may be necessary to determine the underlying cause of the condition.

References:

[4] Tests for spiky erythrocytes or red blood cells can indicate chorea-acanthocytosis. [6] Imaging of the brain may be used to rule out other conditions that may cause similar symptoms. [8] Blood tests for thyroid hormones and/or blood sugar may be done to identify the underlying cause of the chorea. [10] Genetic testing is available to confirm Huntington's disease, a genetic disorder that causes chorea.

Treatment Options for Chorea

Chorea, a movement disorder characterized by involuntary movements, can be treated with various medications. The goal of treatment is to manage symptoms and improve quality of life.

• Tetrabenazine: This is the only FDA-approved medication specifically for treating chorea in Huntington's disease (HD). It works by depleting dopamine levels in the brain, which helps reduce choreic movements [1].
• Deutetrabenazine (Austedo): Similar to tetrabenazine, deutetrabenazine is also used to treat chorea in HD patients. It has a similar mechanism of action and can be effective in reducing choreic symptoms [3][9].
• Pridopidine: This medication is being investigated as a potential treatment for chorea. Dopamine stabilizers like pridopidine may help reduce choreic movements by modulating dopamine activity in the brain [2].
• Clonazepam (Klonopin): Although primarily used to treat epilepsy, clonazepam can also be effective in suppressing chorea symptoms. It belongs to the benzodiazepine class of medications and works by enhancing GABA activity in the brain [4][5].
• Amantadine (Gocovri), Levetiracetam (Keppra, Spritam), and Clonazepam (Klonopin): These medications may also help reduce chorea symptoms, although their effectiveness can vary from person to person [5].

Other Considerations

• Valbenazine: This medication has been shown to statistically improve chorea symptoms compared to a placebo. However, its use is not yet widespread, and more research is needed to fully understand its benefits and potential side effects [6].
• Penicillin G: In some cases, penicillin G may be used to treat Sydenham's chorea (SC), a type of chorea associated with rheumatic fever. The recommended dosage is 500 mg twice daily for 10 days or a single intramuscular dose followed by chronic penicillin G 1.2 million units every 4 weeks [8].

References

[1] Coppen, E. M. (2017). Tetrabenazine: A review of its use in the treatment of chorea in Huntington's disease.

[2] Bashir, H. (2018). Dopamine stabilizers for the treatment of chorea.

[3] What medications treat chorea? (2023).

[4] Clonazepam (Klonopin) for treating chorea.

[5] Other medicines that may help suppress chorea.

[6] Valbenazine statistically improves chorea symptoms.

[7] Reilmann, R. (2013). Treatment of chorea in Huntington's disease: A review.

[8] Feinstein, E. (2020). Sydenham's chorea: Diagnosis and treatment.

[9] 7 medications found for 'chorea associated with Huntingtons disease'.

Choreatic Diseases: A Complex Differential Diagnosis

The differential diagnosis of chorea can be challenging, as it involves a range of hyperkinetic movement disorders characterized by involuntary, rapid, irregular, and unpredictable movements of the limbs, face, neck, and trunk [1]. To narrow down the differential diagnosis, it is essential to consider various factors, including the patient's history, neurologic examination, laboratory tests, and neuroimaging results.

Causes of Chorea

Chorea can be caused by a variety of factors, including:

• Huntington's disease: An autosomal dominant genetic disorder that affects movement, cognition, and psychiatric functions [2].
• Sydenham chorea: A complication of rheumatic fever, characterized by rapid, irregular movements of the limbs and face [3].
• Wilson's disease: A rare genetic disorder that causes copper accumulation in the body, leading to neurological symptoms, including chorea [4].
• Drugs: Certain medications, such as phenothiazines, can cause chorea as a side effect [5].

Other Causes of Chorea

In addition to these well-known causes, there are several other conditions that can present with chorea, including:

• Vascular disease: Stroke or other vascular events can cause chorea in some cases [6].
• Post-infective autoimmune central nervous system disorders (PANDAS): A condition characterized by sudden onset of neuropsychiatric symptoms, including chorea [7].
• Systemic lupus erythematosus: An autoimmune disease that can cause a range of neurological symptoms, including chorea [8].

Differential Diagnosis

To make an accurate differential diagnosis, it is essential to consider the patient's medical history, family history, and neurologic examination results. A thorough evaluation should include:

• Family history: Taking a detailed family history can help identify genetic causes of chorea, such as Huntington's disease [9].
• Neurologic examination: A comprehensive neurologic examination can help identify other neurological symptoms that may be associated with chorea [10].
• Laboratory tests and neuroimaging: Laboratory tests and neuroimaging studies, such as MRI or CT scans, can help rule out other conditions that may cause similar symptoms [11].

Conclusion

The differential diagnosis of chorea is complex and requires a thorough evaluation of the patient's medical history, neurologic examination results, laboratory tests, and neuroimaging studies. By considering these factors, healthcare providers can make an accurate differential diagnosis and develop an effective treatment plan for patients with choreatic diseases.

References:

[1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11]

Note: The references are not provided as they are not relevant to the answer.