Chorea

For the ancient Greek dance, see Choreia. For other uses, see Chorea (disambiguation).

Chorea
Classification and external resources
ICD-10	G25.5
ICD-9	333.5
DiseasesDB	16662
eMedicine	neuro/62
MeSH	D002819

Chorea (or choreia, occasionally) is an abnormal involuntary movement disorder, one of a group of neurological disorders called dyskinesias. The term chorea is derived from the Greek word χορεία (=dance; see choreia), as the quick movements of the feet or hands are compared to dancing.

The term hemichorea refers to chorea of one side of the body, such as chorea of one arm but not both (comparable to hemiballismus).

Presentation

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

These 'dance-like' movements of chorea often occur with athetosis, which adds twisting and writhing movements. Walking may become difficult, and include odd postures and leg movements.

Unlike ataxia, which affects 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. Thus, chorea is said to be a hyperkinetic movement disorder.

When chorea is serious, slight movements will become thrashing motions; this form of severe chorea is referred to as ballism or ballismus.

Causes

Chorea can occur in a variety of conditions and disorders.

• Chorea is a primary feature of Huntington's disease, a progressive neurological disorder.
• Twenty percent (20%) of children and adolescents with rheumatic fever develop Sydenham's chorea as a complication.
• Chorea gravidarum is rare type of chorea which is a complication of pregnancy.
• Chorea may also be caused by drugs (levodopa, anti-convulsants, anti-psychotics), metabolic disorders, endocrine disorders, and stroke.
• Wilson's disease, a genetic disorder that leads to toxic levels of copper in the body
• Transmissible spongiform encephalopathies: A group of neurodegenerative diseases such as Creutzfeldt-Jakob disease and Kuru, caused by prions.
• Neuroacanthocytosis, a genetic disorder that may affect the blood, brain, peripheral nerves, muscle and heart. Common features include peripheral neuropathy, cardiomyopathy and hemolytic anemia. Other features include limb chorea, facial tics, other oral movements (lip and tongue biting), seizures, a late-onset dementia and behavioral changes.

Treatment

There is no standard course of treatment for chorea. Treatment depends on the type of chorea and the associated disease. Although there are many drugs that can control it, no cure has yet been identified.

Form	Treatment
Huntington's-related	A common treatment is dopaminergic antagonists, although treatment is largely supportive. Tetrabenazine is the only FDA approved drug for the treatment of Huntington's Disease related chorea.
Sydenham's chorea	Haloperidol, carbamazepine and valproic acid. Usually involves antibiotic drugs to treat the infection, followed by drug therapy to prevent recurrence.
Chorea gravidarum	haloperidol, chlorpromazine alone or in combination with diazepam, also pimozide can also be used.
Wilson's disease	Reducing levels of copper in the body using D-penicillinamine, trientine hydrochloride, tetrathiomolybdate, and other chelating agents
Drug-induced chorea	Adjusting medication dosages.
Metabolic and endocrine-related choreas	Treated according to their causes.

See also

• Choreoathetosis
• Dancing mania