What Is Chorea?
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.
Types of Chorea
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.
What Causes Chorea?
Chorea is associated with a
number of causes, some temporary and some chronic. Examples of chorea causes
- genetic conditions, such as Huntington’s disease
- immune conditions, such as systemic lupus
- 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
- pregnancy (known as chorea gravidarum)
Because many conditions cause
chorea, a doctor must take a thorough medical history to determine potential
What Are Risk Factors for Chorea?
Patients with a history of rheumatic fever are more likely
to experience chorea. This risk factor makes pregnant women more likely to have
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
What Are the Symptoms of Chorea?
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
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.
How Is Chorea Diagnosed?
Chorea diagnosis primarily consists of taking a thorough
medical history and conducting a clinical exam. To diagnose chorea, your doctor
did the symptoms begin?
makes the symptoms worse or better? (Chorea symptoms tend to worsen when a
patient is stressed.)
you have a family history of hyperthyroidism or Huntington’s disease?
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.
How Is Chorea Treated?
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:
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
What Is the Outlook for Chorea?
The outlook for chorea depends on the condition causing it.
Antibiotics can cure Sydenham’s chorea, while there is no cure for Huntington’s
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.