Sydenham’s chorea

In the last few years there has been increased interest in the immune aspects of OCD and related disorders. It has been proposed that some cases of childhood-onset OCD may be related to an infection-triggered autoimmune process similar to that of Sydenham s chorea, a late manifestation of rheumatic fever (Swedo, 1994 Chapter 14, this volume). 

Swedo, S.E. (1994) Sydenham s chorea. A model for childhood autoimmune neuropsychiatric disorders. JAMA 272 1788-1791. 

Sydenham s chorea and TS share common anatomic areas—the basal ganglia of the brain and the related cortical and thalamic sites. Furthermore, some SC patients display motor and vocal tics, OC, and ADHD symptoms, suggesting the possibility that at least in some instances these disorders share a common etiol-... 

Ayoub, E.M. and Wannamaker, L.W. (1966) Streptococcal antibody titers in Sydenham s chorea. Pediatrics 38 946-956. 

Swedo, S.E., Rapoport, J.L., Cheslow, D.L., Leonard, H.L., Ayoub, E.M., Hosier, D.M., and Wald, E.R. (1989a) High prevalence of obsessive-compulsive symptoms in patients with Sydenham s chorea. Am J Psychiatry 146 246-249. 

Conditions in the immune system also seem to play a role in OCD. This connection arose because the development of a movement disorder called Sydenham s chorea, which occurs in children following a particular type of bacterial infection that causes rheumatic fever, also often produces obsessive-compulsive behaviors. 

There are various reports of chorea (144,145), hemi-chorea (146), and paraballism (147). In one case, chorea was the first sign of lupus erythematosus (148). Although it has been suggested that in such cases the contraceptive simply triggered the reactivation of latent Sydenham s chorea, there has been a report of a case with no evidence... 

Improvement has been reported following the use of haloperidol and chlorpromazine in other choreatic movement disorders including senile chorea, Sydenham s chorea and the chorea asociated with hyperthyroidism (14,15). 

Sydenham s chorea can be difficult to recognize if there is no recent history of rheumatic fever or polyarthritis and no clinical evidence of cardiac involvement, but this disorder is a self-limiting one, usually clearing in 3 to 6 months. 

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