What causes chorea? 13 possible conditions
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Chorea is a condition that causes involuntary, unpredictable body movements that do not have a pattern. Chorea symptoms can range from minor movements such as fidgeting to profound, uncontrolled movements of the arms and legs.
Medical experts consider chorea to be one of three types of hyperkinetic disorder. Chorea causes rapid involuntary motions. Ballismus (or choreoballismus) causes more-severe jerking motions that are more likely to cause injury. Athetosis (or choreoathetosis) causes slow, writhing movements.
Chorea is associated with a number of causes, some temporary and some chronic. Examples of chorea causes include:
- genetic conditions, such as Huntington’s disease
- immune conditions, such as systemic lupus erythematosus
- infection-related conditions, such as Sydenham’s chorea, which is the result of rheumatic fever
- medications, including levodopa and neuroleptics
- metabolic or endocrine disorders, including hypoglycemia
- pregnancy (known as chorea gravidarum)
Because many conditions cause chorea, a doctor must take a thorough medical history to determine potential causes.
Patients with a history of rheumatic fever are more likely to experience chorea. This risk factor makes pregnant women more likely to have chorea gravidarum.
Other risk factors are related to individual risk for disease. For example, Huntington’s disease is a hereditary disorder. Huntington’s disease may cause chorea. A person with a parent who has Huntington’s disease has a 50 percent risk of having the disease as well (Mayo Clinic, 2011).
Chorea symptoms usually depend upon the condition causing it. A common symptom is the “milkmaid” grip. This grip looks as if a person is holding an eating utensil, but the thumb is pointing upward. Another symptom is involuntarily sticking out the tongue.
The movements can be fast or slow. A patient may appear to be writhing in pain and to have no bodily control.
Chorea symptoms depend on the underlying cause:
Huntington’s disease patients may think that initial chorea symptoms are clumsiness or nervousness. Chorea is a more common symptom in people with adult-onset Huntington’s disease than in patients who were diagnosed as children. Over time, the symptoms worsen and movements affect the legs and arms.
This condition is a genetic disorder that affects brain functioning. Chorea for this condition commonly starts as lip or tongue biting, due to the tongue sticking out.
This condition is the result of rheumatic fever. Patients with this chorea type often display milkmaid grip. Another common symptom is “harlequin tongue.” This occurs when a patient tries to consistently stick the tongue out, but the tongue pops in and out instead.
Chorea diagnosis primarily consists of taking a thorough medical history and conducting a clinical exam. To diagnose chorea, your doctor may ask:
- When did the symptoms begin?
- What makes the symptoms worse or better? (Chorea symptoms tend to worsen when a patient is stressed.)
- Do you have a family history of hyperthyroidism or Huntington’s disease?
- What medications are you currently taking?
Some laboratory tests can indicate chorea. For example, a low copper level can indicate Wilson disease, a genetic disorder that causes chorea. Tests for spiky erythrocytes or red blood cells can indicate neuroacanthocytosis. Blood test for parathyroid hormones or thyroid hormones can indicate metabolic or endocrine-related chorea.
Imaging studies, such as a magnetic resonance imaging (MRI) scans, can show brain activity. These can indicate Huntington’s disease.
Chorea treatments depend upon the type of chorea a person has. For example, Sydenham’s chorea is treated and cured with antibiotics. Chorea due to Parkinson’s disease has no cure. Medications may treat an underlying condition, and this will help with chorea symptoms.
Most medications for chorea affect dopamine. Dopamine is a neurotransmitter, or brain chemical, that controls movement, thinking, pleasure, and more. Many movement disorders, including Parkinson’s disease and restless legs syndrome, are associated with dopamine levels.
Some medicines block dopamine receptors so the body cannot use the chemical. They are in the “antipsychotic” category and seem to reduce chorea. These include:
- fluphenazine (Prolixin)
- haloperidol (Haldol)
- olanzapine (Zyprexa)
- quetiapine (Seroquel)
- risperidone (Risperdal)
Other drugs reduce the amount of dopamine in the brain. These include reserpine and tertrabenazine (Xenazine). Medications known as benzodiazepines also may help to reduce chorea. These include clonazepam and Klonopin.
The last medication class associated with reducing chorea is anticonvulsants, which reduce spontaneous movements and include.
Deep brain stimulation is a surgical approach that shows promise for chorea treatment. This treatment involves implanting electrodes in the brain to regulate nerve impulses. If chorea does not respond to medications, a doctor may recommend deep brain stimulation. This procedure does not cure chorea but can reduce symptoms.
Chorea increases a person’s likelihood for falls. Home care measures may include installing non-slip surfaces on stairs and in bathrooms to prevent injury.
The outlook for chorea depends on the condition causing it. Antibiotics can cure Sydenham’s chorea, while there is no cure for Huntington’s disease.
Women with chorea gravidarum typically stop having symptoms up to six weeks after giving birth. People with metabolic or endocrine-related chorea typically stop having symptoms once a doctor treats the imbalance.
- Abdo, W. F., van de Warrenburg, B. P., Burn, D. J., Quinn, N. P., & Bloem, B. R. (2010). The Clinical Approach To Movement Disorders. Nature Reviews Neurology, 6(1), 29-37.
- Deep Brain Stimulation (2013, January 10). Mayo Clinic. Retrieved August 30, 2013, from http://www.mayoclinic.com/health/deep-brain-stimulation/MY00184/METHOD=print
- Ho, S. (n.d.). Chorea, Huntington's disease. International Parkinson and Movement Disorder Society. Retrieved October 15, 2013, from http://www.movementdisorders.org/disorders/chorea.php
- Huntington’s Disease. (2011, May 5). Mayo Clinic. Retrieved on September 2, 2013, from http://www.mayoclinic.com/health/huntingtons-disease/DS00401/DSECTION=risk-factors
- Ramachandran, T.S. (2013, February 3). Chorea Gravidarum. Medscape. Retrieved August 30, 2013, from http://emedicine.medscape.com/article/1149725-overview - showall
- Vertrees, S. (2012, February 3). Chorea in Adults. Medscape. Retrieved August 30, 2013, from http://emedicine.medscape.com/article/1149854-overview
- “What Is Chorea?” (2010, August 13). National Institute of Neurological Disorders and Stroke. Retrieved August 30, 2013. from http://www.ninds.nih.gov/disorders/chorea/chorea.htm
- Wild, E. J., & Tabrizi, S. J. (2007). The Differential Diagnosis Of Chorea. Practical Neurology, 7(6), 360-373.
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