How To Treat Sydenham's Chorea

Sydenham's chorea is a neurological disorder that occurs after an individual has been infected by group A beta-hemolytic streptococcus bacterium, which causes rheumatic fever. Sydenham's chorea is characterized by aimless, rapid, irregular, involuntary movements of the legs, facial muscles, trunk, and arms. More females than males are affected by Sydenham's chorea, and it is most common in individuals between five and fifteen years old. Sydenham's chorea can manifest at any time up to six months following the beta-hemolytic streptococcus infection. Symptoms include muscular weakness, frequent falls, writing problems, issues with concentration, emotional instability, uncoordinated movements, stumbling, and writhing. Diagnosis of Sydenham's chorea can be challenging because the bacterial infection may have left the body by the time movement symptoms occur. Blood tests, physical examination, and brain imaging are used to help eliminate other causes of a patient's symptoms and diagnose Sydenham's chorea.

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Watch And Wait

An individual affected by Sydenham's chorea may choose the watch and wait method as part of their treatment. When the group A streptococcus bacteria have been eliminated from the patient's body and movement symptoms are controlled, a physician may recommend watching and waiting until the condition runs its course. This approach is often used in patients who do not respond well to the use of multiple medications or medications in general. As long as symptoms do not present a danger to the patient, some may choose to watch and wait due to their beliefs in the use of holistic and natural methods to heal, rather than medical methods. Over half of all individuals affected by Sydenham's chorea recover between two and six months following the initial symptoms. Watching and waiting may be a treatment method that is inappropriate or insufficient for use in individuals who experience lingering movement and or psychiatric symptoms due to Sydenham's chorea.

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Use Of Corticosteroids

The use of corticosteroids in Sydenham's chorea may help reduce the duration of symptoms, decrease the risk of permanent complications, and improve general outcomes. It is thought that Sydenham's chorea is caused by an individual's immune system launching an inappropriate attack on a specific part of the brain. The immune system attacks this part of the brain in response to the invasion of group A streptococcus bacteria. The immune system in an affected individual does not intend to cause damage to its own body tissues around where the bacteria have colonized but ends up doing so to eliminate the pathogen. This autoimmune and inflammatory process is what produces the symptoms in Sydenham's chorea patients. Corticosteroids are a type of medication often used to treat autoimmune processes and disorders because they help suppress an individual's overactive immune system. Common corticosteroid medications used in individuals with Sydenham's chorea include intravenous methylprednisolone and oral deflazacort.

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Use Of Anticonvulsants

The use of anticonvulsants in individuals affected by Sydenham's chorea may be needed when certain symptoms cannot be relieved with other methods. Anticonvulsants make up a wide group of medications that correct the abnormal way nerve impulses travel between the nerve cells that cause an individual to have seizures and exhibit involuntary movements. These medications help manage controlled impulse transmission through the nerve cells to stop events where an individual loses control of their movement. Valproic acid is an anticonvulsant medication that may be used in a Sydenham's chorea patient to treat their symptoms related to abnormal and uncontrollable movements. Carbamazepine is an anticonvulsant medication that may be utilized in individuals with Sydenham's chorea to reduce the frequency of abnormal and involuntary movement symptoms. Because Sydenham's chorea is not a lifelong condition in most patients, it is recommended for the patient to slowly taper off these medications once they have been symptom-free for a minimum of one month.

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Antibiotic Treatment

An individual affected by Sydenham's chorea may need to undergo antibiotic treatment. Antibiotic treatment is often the first part of the treatment of a Sydenham's chorea patient. The idea behind the use of antibiotic treatment in affected individuals is to ensure the successful elimination of the group A streptococcus bacteria responsible for the initial rheumatic fever infection that caused the development of Sydenham's chorea. Some Sydenham's chorea patients may only need to undergo therapy with an antibiotic called penicillin on a prophylactic basis. Prophylactic penicillin therapy is a term that describes the use of penicillin to prevent bacterial growth or regrowth in the body. Other patients may need to be treated with high dose penicillin on an acute basis to treat their rheumatic fever and to eliminate the group A streptococcus bacteria from the body. It is appropriate to ensure the initial infection is resolved before treating the other symptoms associated with Sydenham's chorea unless they are life-threatening.

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Close Heart Monitoring

A Sydenham's chorea patient may need to have close heart monitoring if the initial rheumatic fever has caused damage to tissues in their heart. This is an extremely important part of treatment, as the most severe complication of rheumatic fever is rheumatic heart disease, which is a condition where an individual incurs damage to their heart valves due to group A streptococcus bacteria attacking the tissues that make up the heart valves. When the heart valves become inflamed as a result of the infection, they can stretch and incur considerable damage. The valves may stay stretched, and the body repairs the tissue damage in the valve with scar tissue. These mechanisms can leave the heart valve with only some or very little of its initial function. The heart valves become unable to close properly, and blood flows backward into the wrong chamber of the heart. Patients diagnosed with Sydenham's chorea with heart valve damage are recommended to have echocardiograms every year. Some individuals with severe rheumatic heart disease may need to have echocardiograms every three to six months to detect any sudden changes that require surgical repair.