This condition is now fortunately quite rare, a contradistinction to its relative frequency a quarter of a century ago, when it was a common childhood ailment. It may result from rheumatism and rheumatic fever (now also uncommon), and is most common in the age group between ten to fifteen years. Girls are more likely to be affected than boys.
Children who suffered from “growing pains” in fact have been rheumatic, and have developed chorea. A sore throat may give rise to rheumatism. Often there is no obvious sign of rheumatic fever. Emotional disturbances either at home or at school may lead to the sudden onset of symptoms. It may occur during the first and third months of a pregnancy most likely the first; usually on careful checking, there may have been a rheumatism history in evidence, even though vague.
Sydenham’s Chorea Symptoms
The child tends to become inattentive and clumsy, often dropping objects she is handling. This may be in association with an emotional upset. Involuntary, irregular movements set in, often repetitive in nature, but not in time, starting and ending abruptly. Often the child makes voluntary movements to try to cover up the purposeless ones. Frequently several muscle groups are involved. Twitching of the lips and muscle groups about the eyes takes place. Often there is muscle weakness and loss of precision in voluntary actions.
Psychological disturbances are common, and there is frequent emotional instability. Depression, laughing and weeping without any obvious reason as well as becoming capricious, irritable and obstinate, are all part of the normal picture. Sensations, attention and memory are usually not impaired. As the condition improves, these features usually subside, and with a permanent recovery, do not tend to recur. About one third have more than one attack, and this is more likely with girls. Disorders of the heart system are most likely to be present.
Sydenham’s Chorea Treatment
This must be under the supervision of the doctor. In the early stage, hospital care may be necessary. A few days of complete rest in bed is customary, and ordinary rest periods should be prolonged. The salicylate family of medication is used (such as aspirin), together with sedatives and tranquillizers, such as diazepam and related benzodiazepines. Treatment may be in conjunction with that for rheumatic fever, if this is present at the same time.
Skilled nursing is essential especially with a young child. The sides of the cot should be padded to avoid injury occurring to the child from striking this with her limbs or body. Sometimes the limbs are best padded also.
The outcome is usually satisfactory. Cases treated in hospital average ten weeks. Some cases appear cured in a few weeks, while others may take as long as six months, a year or even more.