Chorea

Definition
• Chorea is a movement disorder that causes involuntary, unpredictable
body movements. The term chorea is derived from the 
Ancient Greek: ("dance"),Chorea symptoms can range from minor
movements, such as fidgeting, to severe uncontrolled arm and leg
movements. It can also interfere with:
• Speech.
• Swallowing.
• Posture.
• Gait.
• Chorea result from overactivity in the basal ganglia, the part
of the brain that helps initiate and smooth out and
coordinate intended (voluntary) movements initiated by
nerve impulses from the brain.

• In most forms of chorea, an excess of dopamine, the main

neurotransmitter used in the basal ganglia, prevents the
basal ganglia from functioning normally.
Signs and symptoms of chorea:
• Chorea usually depend upon the condition causing it. A common
symptom is “milkmaid’s grip.” People with this condition don’t have
coordinated hand muscles and will squeeze and release their hand, as
if milking.
• Another symptom is involuntarily sticking out the tongue.
Conditions associated with chorea and its
symptoms:
• Huntington disease
• Chorea-acanthocytosis
• Sydenham chorea
 Huntington’s disease
• Huntington’s disease is an inherited disease. It causes the breakdown
of nerve cells in your brain. People with Huntington’s disease can
experience chorea symptoms such as involuntary jerking. Milkmaid’s
grip is also a common symptom.Chorea is more common in people
with adult-onset Huntington’s disease. Over time, symptoms may get
worse, and movements may affect the legs and arms
Chorea-acanthocytosis
• This condition is a very rare genetic disorder caused by mutations in the VPS13A
gene and is inherited in an autosomal recessive manner. It causes neurological
abnormalities and affects brain functioning.Chorea for this condition commonly
involves:
• abnormal arm and leg movements
• shoulder shrugs
• pelvic thrusts
• It can also involve rapid, purposeless movements of the face.
• People with this form of chorea can also exhibit dystonia. This is characterized by
involuntary muscle contractions of the mouth and face, such as: teeth grinding, lip and
tongue biting, difficulty with speech or communication difficulty swallowing,
involuntary speaking, or slurred speech.
Sydenham’s chorea
• Sydenham’s chorea mainly affects children and adolescents. It follows a
streptococcal infection. It can also be a complication of rheumatic fever.
• This type of chorea mainly affects the:face, arms, hands. It can impede
voluntary movements,making it difficult to perform basic tasks such as
getting dressed or feeding yourself.
• It can also lead to frequently dropping items, abnormal gait, muscle
weakness, slurred speech and diminished muscle tone. People with this
chorea type often display milkmaid grip.
• Another common symptom is called “harlequin tongue.” When a person
with this symptom tries to stick their tongue out, the tongue pops in and out
instead.
Causes of chorea
• Chorea is associated with several additional causes, some temporary and
some chronic.
These causes include:
• AIDS
• genetic conditions, such as Huntington’s disease
• immune conditions, such as systemic lupus erythematosus
• infection-related conditions, such as Sydenham’s chorea (Rheumatic fever)
• medications, including levodopa and neuroleptics.
• metabolic or endocrine disorders, including hypoglycemiapregnancy, known
as chorea gravidarum
How is chorea diagnosed
• Medical history to determine potential causes.
• When did the symptoms begin? What makes the symptoms better or
worse? Do your chorea symptoms tend to worsen when you’re
stressed?Do you have a family history of Huntington’s disease?What
medications are you taking?
• Some laboratory tests can indicate 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.
Medications
• Most medications for chorea affect dopamine. Dopamine is a neurotransmitter, or brain
chemical, that controls movement, thinking, and pleasure in your brain, among other
things.Many movement disorders are associated with dopamine levels. Many of these are
antipsychotic drugs that seem to reduce chorea. These drugs include:
• fluphenazine (Prolixin)
• haloperidol (Haldol)
• olanzapine (Zyprexa)
• quetiapine (Seroquel)
• risperidone (Risperdal)
• Other drugs reduce the amount of dopamine in the brain, such as reserpine and tetrabenazine
(Xenazine). Medications known as benzodiazepines, such as clonazepam (Klonopin), may also
help to reduce chorea.Anticonvulsants, which reduce spontaneous movements, can also reduce
chorea symptoms.
Surgeries
• Deep brain stimulation is a surgical approach that shows promise for
chorea treatment. This treatment involves implanting electrodes in
your brain to regulate nerve impulses.If chorea doesn’t respond to
medications. This procedure does not cure chorea, but it can reduce
symptoms.
Home care
• Chorea increases a person’s likelihood for falls. Home care measures
include installing nonslip surfaces on stairs and in bathrooms to
prevent injury.
Thanks! 