Sydenham chorea, also referred to as chorea minor or historically as St. Vitus dance is a manifestation of rheumatic fever.
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Clinical presentation
hyperkinetic movement disorder
neuropsychiatric manifestations with or without the presence of carditis or arthritis
cognitive and behavioral symptoms, including emotional lability, anxiety, depressive and obsessive-compulsive symptoms
Pathology
Sydenham chorea is thought to be an autoimmune process caused by antigenic mimicry between central nervous system basal ganglia cells and Group A beta-hemolytic Streptococcus antigens. Anti-basal ganglia antibodies attack these portions of the brain and are responsible for the pathological findings and symptoms.
Treatment and prognosis
The underlying Streptococcus infection is treated with antibiotics. Valproic acid is the treatment of choice for hyperkinetic manifestations. Risperidone may be employed if there is no response to valproic acid or in severe cases, e.g. chorea paralytica.
History and etymology
The condition is named after Thomas Sydenham (1624-1689), an English physician. He himself referred to it as "chorea minor". The historical name "St. Vitus Dance" derives from a "dancing plague" that occurred in Europe in the Middle Ages and involved large groups of people moving erratically and involuntarily. People would go to temples dedicated to St. Vitus and pray there in an effort to cure the plague, which was later diagnosed as Sydenham chorea.
The term "chorea" is derived from the Greek word for "dancing".
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