Chorea minor
Sydenham’s chorea, also known as rheumatic chorea, is a disease of children and adolescents that is characterized by involuntary choreiform movements, decreased muscle tone, decreased muscle strength, impaired voluntary movement and mood changes.
Etiology
Group A hemolytic streptococcal infection is associated with the disease, which usually develops 2-3 months after rheumatic fever or arthritis. Prevalent in adolescence, more frequent in females. It can recur in pregnancy and in those taking oral contraceptives. Anti-neuronal antibodies can be detected in serum, with neurons of the caudate nucleus and thalamic nucleus basalis its reaction. Antibody titers correlate with disease regression, suggesting that the disease may be autoimmune related.
Pathology
Reversible changes mainly in the substantia nigra, striatum, thalamic floor nucleus cerebellopontine nucleus, and cerebral cortex.
Clinical manifestations
1. It is common in children aged 5-15 years, mostly females with fever, arthralgia, and enlarged tonsils. Most have a history of respiratory tract infection. Early manifestations are emotional, inattentive, uncoordinated hand and foot activities, skewed handwriting, unstable walking, etc. The symptoms become more and more severe.
2. Chorea-like movements are often bilateral, with acute or insidious onset. The face is obvious, manifested as squeezing the eyebrows, pouting and spitting out the tongue, making a face, extending the tongue is difficult to maintain, and the tongue keeps twisting. Rapid, irregular, purposeless involuntary movements of the limbs occur. The upper limbs are obviously and gradually involved on one side or the opposite side. The lower extremities have a lurching gait, swaying walking, and tend to fall. Constant bending, extension and twisting of the spine. It can be aggravated within 2-4 weeks. 3-6 months to relieve itself.
3.Small dance triad: decreased muscle tone, decreased muscle strength, dance-like movements, ataxia. Excessive rotation of the arm and palm forward when the upper extremity is raised flat – the rotator anterior muscle sign. Chorea hand sign – dorsal extension of the fingers with wrist flexion during anterior extension of both arms. Milkmaid’s maneuver – the grip is tight and loose when clenching the fist, also called the surplus and deficit sign.
4, the child may appear insomnia, restlessness, restlessness, hallucinations, confusion and other psychiatric symptoms, called manic chorea.
Treatment
1.Treatment of motor symptoms
For chorea symptoms, diazepam, nitrazepam, or buprenorphine, chlorpromazine, or haloperidol can be used. The latter two drugs are prone to induce extrapyramidal adverse reactions, and need to be observed, and once they occur, the dose should be reduced.
2.Treatment of psychiatric symptoms
Symptomatic treatment.
3.Anti-infection treatment
After the diagnosis of the disease, regardless of the severity of the disease, anti-streptococcal treatment needs to be applied, with the aim of minimizing or preventing the recurrence of small chorea and avoiding the occurrence of myocarditis and heart valve disease. Penicillin is generally applied for l-2 weeks as a course of treatment. Later, long-acting penicillin may be given intramuscularly, once a month. If penicillin cannot be used, other streptococcal-sensitive antibiotics, such as cephalosporins, can be used instead.
4.Immunotherapy
The child has anti-neuronal antibodies in his body during the disease, so it is still considered to use immunotherapy as early as possible. Glucocorticoids, plasma exchange and intravenous injection of immunoglobulin can be applied to treat the disease, which can shorten the course of the disease and reduce the symptoms.
Prognosis
The disease is self-limiting and may resolve on its own after 3-6 months even without treatment, and the duration of the disease can be shortened with appropriate treatment. About 1/4 of the children may have recurrence.