View source for Chorea

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  Image          = |
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  DiseasesDB     = 16662 |
  ICD10          = {{ICD10|G|25|5|g|20}} |
  ICD9           = {{ICD9|333.5}} |
  ICDO           = |
  OMIM           = |
  MedlinePlus    = |
  eMedicineSubj  = |
  eMedicineTopic = |
  MeshID         = D002819 |
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==Overview==
'''Chorea sancti viti''' (Latin for "St. Vitus' dance") is an abnormal involuntary movement disorder, one of a group of neurological disorders called [[dyskinesia]]s. The term ''[[chorea]]'' is derived from a Greek word ''χορεία'' (a kind of dance), as the quick movements of the feet or hands are vaguely comparable to dancing or piano playing.

== Presentation ==

Chorea is characterized by brief, irregular contractions that are not repetitive or rhythmic, but appear to flow from one muscle to the next. 

These 'dance-like' movements of chorea (from the same root word as "choreography") often occur with [[athetosis]], which adds twisting and writhing movements.

== Causes ==

Chorea can occur in a variety of conditions and disorders. 
* Chorea is a primary feature of [[Huntington's disease]], a progressive, hereditary movement disorder. 
* Twenty percent of children and adolescents with [[rheumatic fever]] develop [[Sydenham's chorea]] as a complication. 
* [[Chorea]] may also be caused by drugs ([[levodopa]], [[anti-convulsant]]s, [[anti-psychotic]]s), metabolic disorders, endocrine disorders, and vascular incidents.



===Causes by Organ System===
* To obtain the coding for the table seen below, click [[Differential diagnosis by organ system table|here]]. You need to copy the table content from the edit box, and paste it into the edit box.
* You can then list the causes by organ system. List the causes, separated by a comma under the appropriate category where it says "No underlying causes". Erase "No underlying causes" if you are listing causes in that category.
* For an example of the causes by organ system table in a causes microchapter, click [[Jaundice causes#Causes by Organ System|here]].

{|style="width:75%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
|bgcolor="Beige"| No underlying causes
|-
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| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
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|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
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| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
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| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
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|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
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|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
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|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
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|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"| No underlying causes
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|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
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| '''Nutritional / Metabolic'''
|bgcolor="Beige"| No underlying causes
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|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
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|-bgcolor="LightSteelBlue"
| '''Opthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
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|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"| No underlying causes
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|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}

== Ballism ==

When [[chorea]] is serious, slight movements will become thrashing motions; this form of severe [[chorea]] is referred to as [[ballism]]. Walking may become peculiar, and include odd postures and leg movements. Unlike [[ataxia]] and [[dystonia]], which affect the quality of voluntary movements or [[parkinsonism]], which is a hindrance of voluntary movements, the movements of chorea and ballism occur on their own, without conscious effort.

== Causes In alphabetical order. <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>==

[[Amphetamines  ]]

[[Carbon monoxide toxicity ]]

[[Ceruloplasmin deficiency ]]

[[De Barsy syndrome ]]

[[Ethotoin ]]

[[Hypoglycaemia ]]

[[Hypoparathyroidism.]]

[[Lamotrigine ]]

[[Levodopa, Dopamine agonists  ]]

[[Levomepromazine ]]

[[Lithium  ]]

[[McLeod phenotype  ]]

[[Methadone ]]

[[Oral contraceptive pills ]]

[[Phenothiazines ]]

[[Phenytoin ]]

[[Polycythemia ]]

[[Porphyria ]]

[[Thyrotoxicosis ]]

[[Tolcapone ]]

[[Toulene poisioning ]]

[[Tricyclic antidepressants ]]

[[Rheumatic Fever ]]

[[HIV ]]

[[Huntington’s disease ]]

[[Movement disorders ]]

[[Ganglion ]]

[[Wilson’s disease ]]

[[Neuroacanthocytosis ]]

[[Paroxysmal choreoathetosis  ]]

[[Cerebral birth injury ]]

[[Kernicterus ]]

[[cerebral trauma ]]

[[Lacunar infarction ]]

[[Creutzfeldt- Jacob disease  ]]

[[Cebral Palsy ]]

[[Spinocerebellar ataxia 17 ]]

[[Olivopontocerebellar atrophy  1 ]]

[[Idiopathic basal ganglia  calcification ]]

[[Hallervorden – Spatz disease  ]]

[[Troyer syndrome ]]

[[Dentatorubropallidoluysian  degeneration ]]

[[Westphal disease ]]

[[Neuhauser- Eichner –Opitz  syndrome ]]

[[Alternating hemiplegia of  childhood ]]

[[Spinocerebeller ataxia  recessive 1 ]]

[[Microcephaly-pontocerebellarhypoplasia-dyskinesia  ]]

[[Ataxia – telangiectasia ]]

[[Cross- McKusick-Breen  syndrome ]]

[[Paroxysmal kinesigenic  choreoathetosis ]]

[[Neuroferritinopathy ]]

[[Wolfram’s disease ]]

[[Mount Reback syndrome ]]

[[Paroxysmal nonkinesigenic  choreathetosis ]]

[[Gilles de la tourette  syndrome ]]

[[Fahr’s syndrome ]]

[[Familial benign chorea]]

[[Pyruvate decarboxylase  deficiency ]]

[[3- Methylglutaconic aciduria  type 3 ]]

[[Benedikt’s syndrome ]]

[[3- methyglutaconic aciduria  type 3 ]]

[[Infantile epileptic –  dyskinetic encephalopathy ]]

[[Ceroid lipofuscinosis ]]

[[Glutaric aciduria type 1 ]]

[[Lesch-Nyhan syndrome ]]

[[Pregnancy]]

[[Respiratory failure ]]

[[SLE ]]

[[Henosch - scholein purpura]]

[[Arterio-venous malformations  ]]

[[Senile chorea ]]

[[Haw river syndrome  ]]

== Diagnosis == 
== History and Symptoms == 
* Complete history required
* Psychiatric symptoms (Huntington's)

== Appearance of the Patient ==
=== Eyes ===
* Appearance of [[Kayser-Fleischer ring]]s in [[cornea]] is diagnostic for [[Wilson's disease]] (slit-lamp examination)

== Laboratory Findings == 

* [[Antinuclear antibody]] ([[ANA]]) to diagnose [[lupus]]
* Serology ([[ASO]]) or throat cultures required to rule out streptococcal infection
* [[Urinalysis]] (Wilson's)
* Serum [[ceruloplasmin]] (Wilson's)
* [[Thyroid function test]]s to diagnose [[hyperthyroidism]]

=== MRI and CT === 

* [[CT scan]]s and/or [[MRI]]s are required to rule out [[Huntington's disease]] and mass lesions

=== Echocardiography or Ultrasound === 

* In order to diagnose carditis, an [[ECG]] may be indicated

=== Other Imaging Findings ===

* In order to reveal cerebral and cerebellar atrophies in patients with [[DRPLA]], various imaging studies are indicated

=== Other Diagnostic Studies ===

* Genetic testing may be required for those patients suspected of having [[Huntington's disease]]
* Peripheral smear for diagnostic [[neuroacanthocytosis]]

==Treatment==

* Disease-specific treatment for [[AIDS]], [[hyperthyroidism]], [[lupus]]
* Symptom resolution occurs within 15 weeks for those patients with [[Sydenham's chorea]]
* Within nine years of onset of symptoms, [[neuroacanthocytosis]] is usually fatal
* Discontinue use of drugs that may have caused drug-induced [[chorea]]
* Genetic counseling is usually recommended for those patients with [[Huntington's disease]]

{| class="wikitable"
! '''Cause''' !! '''Treatment''' 
 |- 
 |  [[Huntington's disease]] || A common treatment is [[dopaminergic]] [[receptor antagonist|antagonists]], although treatment is largely supportive. 
 |- 
 | Sydenham's chorea   || Usually involves [[antibiotic]] drugs to treat the infection, followed by drug therapy to prevent recurrence. 
 |- 
 |  Drug-induced chorea.  || Adjusting medication dosages.
 |- 
 | Metabolic and endocrine-related choreas || Treated according to the cause(s) of symptoms.
|}

== Acute Pharmacotherapies == 

* For patients with [[Wilson's disease]], copper-chelating agents are recommended
* For patients with [[acute rheumatic fever]], antibiotic therapy and possibly [[corticosteroids]]
* For patients with [[Huntington's disease]], [[antidepressant]]s, [[neuroleptics]]

==References==
{{Reflist|2}}

==See also==
*[[Movement disorder]]
*[[Choreoathetosis]]

{{Diseases of the nervous system}}


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