Neurological Disorders: Chorea

Chorea by itself is not a disease; rather it is a neurological manifestation of some underlying disease process. A Neurologist is frequently involved in the care of these patients.

This condition is defined as abnormal, non repetitive, irregularly occurring and randomly distributed movements of the limbs, head/face/tongue etc in different combination. Patients with condition may appear restless, fidgety and uncoordinated.

A milder form with a more sinusoidal pattern is called as athetosis and if they occur together the called as choreoathetosis. Ballismus is another type where the movements are more violent and having flinging flavor. Hemiballismus is the term used when only one side of the body is involved.

It is classified under movement disorders, and like majority of them this condition also results due to underlying dysfunction in the basal ganglia, an important structure complex in the brain. Although the exact pathology at the molecular level is not fully clear, however it appears to be related with an imbalance among certain neurochemicals named as dopamine, GABA, acetylcholine, serotonin etc. There are different causes for this movement disorder; accordingly there appears to be different types of imbalance.

There are myriad conditions that are associated with this condition and some of the important include;

• Drug induced (e.g. antiparkinson medication levodopa)
• Huntingtons disease
• Neuroacanthocytosis
• Senile type (old age)
• Rheumatic fever associated
• Pregnancy related
• Benign hereditary type etc

Since variety of conditions can precipitate chorea different diagnostic approaches may be necessary depending upon what is causing it.

Blood tests like ASO titer, calcium, lupus anticoagulant, ESR, ANA, thyroid tests; imaging studies like CT or MRI of the brain are some of those tests usually required. Every patient doesn’t require all these tests and they are ordered on case to case basis.

There are two aspects of treatment; treating the chorea itself (symptomatic treatment) and the treatment of what is causing it.

Symptomatic treatment includes medications like sodium valproate, haloperidol, risperidone, carbamaepine, clonazepam etc.

The specific treatment is focused towards the cause of this movement disorder and may include medications to cure or control thyroid problems, lupus, rheumatic fever etc.