Chorea minor: characteristics of the pathology, symptoms and causes. Chorea minor (Sydenham's chorea) Children's chorea causes symptoms treatment

A neurological disorder characterized by erratic muscle contractions and movement disorders. Symptoms of the disease occur in the form of attacks of hyperkinetic activity; psychoemotional disturbances are noted. The diagnosis is made on the basis of the clinical picture, laboratory data, MRI or CT, electromyography, EEG. Treatment consists in prescribing antibiotics, non-steroidal anti-inflammatory drugs, glucocorticosteroids, neuroleptics. Powerful hormonal drugs, anticonvulsant medications can also be used.

General information

Chorea minor is a disease that manifests itself in the form of hyperkinesis, developing as a result of damage to the structures responsible for muscle tone and coordination of movements. Treatment of the pathological process is within the competence of a neurologist. The disease is most often detected in childhood against the background of rheumatic changes. Girls get sick more often - this is due to the hormonal characteristics of the body and the production of female sex hormones. The involvement of the cerebellum and striatal structures of the brain in the pathological process is of the greatest importance in the course of the disease. The duration of the choreic attack is approximately 12 weeks, it can be delayed up to 5-6 months, less often for years (1-2). Relapses of the disease are possible.

Causes of minor chorea

Chorea minor most often progresses at 10-12 years of age, against the background of a streptococcal infection (tonsillitis, pharyngitis or tonsillitis), after the appearance of complications of infectious processes. Rheumatism can provoke the development of the disease. Experts note a hereditary or family predisposition to the progression of the disease. Modern neurology has not yet fully studied the nature of this neurological disorder. Research is still ongoing in this area, which should reveal all the features of chorea minor and many other neurological disorders.

Risk factors for the disease: unfavorable heredity; hormonal disorders; rheumatism; the presence of carious defects and weak immunity; psychological deviations; chronic infectious processes, especially if they are localized in the organs of the upper respiratory tract. The pathological substrate of chorea minor is damaged as a result of inflammatory, degenerative and vascular changes in the tissues of the nervous system.

Chorea minor symptoms

The clinical picture with a small chorea is characterized by various manifestations. Attacks of hyperkinetic activity are noted, followed by normal behavior and stabilization of the state. Patients have uncoordinated movements, muscle tone decreases, psycho-emotional instability, increased nervousness, a tendency to irritation, and tearfulness are observed.

The main symptoms of the pathological process can last several weeks or more. Patients make strange sounds (hyperkinesia of the larynx), which attract the attention of others and frighten them, so most children suffering from this neurological pathology cannot go to school, and with frequent relapses they are forced to be homeschooled. Hyperkinesis covers the muscles of the face, limbs, the whole body; at the end of the movement there is a short fading.

With a small chorea, mental disorders can develop. Patients experience emotional lability, increased anxiety, memory loss and the ability to concentrate. These manifestations develop at the very beginning of the disease and persist between hyperkinetic attacks. The severity of hyperkinesis is different. Sometimes sick children are not much different from their healthy peers. Like children with ADHD, children with minor chorea are restless, restless, and overly active. Some patients have swallowing disorders, problems with diction.

Complications of the rheumatic process are acquired heart defects (mitral stenosis, aortic insufficiency). The consequences of the disease can also be general weakness, sleep disturbances, neuropsychiatric disorders, etc.

Diagnosis of minor chorea

When a patient is treated with suspicion of chorea minor, the neurologist carefully examines the history, conducts an examination, prescribes appropriate laboratory and diagnostic tests. First of all, the doctor determines whether the patient has signs of rheumatic damage to the body; looking for symptoms of concomitant pathologies (rheumatic heart disease, polyarthritis); appoints additional research. Laboratory blood tests allow you to determine markers of streptococcal infection (anti-steptolysin-O, C-reactive protein, rheumatoid factor), and using electroencephalography (EEG), you can determine the diffuse appearance of slow waves of bioelectrical activity of the brain of a sick person.

A study of the cerebrospinal fluid is also carried out (it is not changed); electromyography is prescribed, which provides information about the biopotentials of the skeletal muscles and disturbances in their work, characteristic of this particular pathology. To exclude focal changes in cerebral structures, MRI or CT of the brain is used, which can detect non-specific changes in the signal in the area of ​​the putamen and caudate nuclei. PET of the brain in the active stage of chorea minor determines increased glucose metabolism in the striatum and thalamus. The disease is differentiated from tics that have a more stereotypical course (local lesion and negative Gordon's symptom); viral encephalitis and dysmetabolic encephalopathies.

Chorea minor treatment

Today, the possibilities of neurology make it possible to suspect the development of chorea long before the onset of severe symptoms. To do this, you need to undergo a diagnosis and contact an experienced neurologist or geneticist. Treatment should cover both the causes and signs of the disease, be comprehensive and as modern as possible.

Chorea minor may be accompanied by mental disorders. Sick children are often aggressive, quarrelsome, stubborn, which requires individual psycho-emotional adjustment and long work with child psychologists, psychiatrists and pediatric neurologists. Specialists prescribe immunosuppressants, sedatives to improve the patient's sleep, relieve anxiety, and increase social adaptation.

To eliminate the signs of chorea minor, hormonal drugs, anti-inflammatory, antibacterial agents are prescribed. Neuroleptics, sleeping pills, anticonvulsants are used. Patients with minor chorea need constant professional monitoring and diagnostic observation.

In the acute period, the patient should be in bed, not overwork; stay in a separate room where there are no light, sound stimuli. Patients need constant care and attention. If sedatives do not allow to stop an attack of hyperkinesis, then corticosteroids are prescribed. Antihistamines are also used.

Forecast and prevention for minor chorea

Chorea minor does not pose a particular threat to the patient's life (lethal outcome from disorders in the work of the heart against the background of minor chorea is only 1-2% of the total number of those suffering from this pathology) and, with high-quality treatment and care, it can eliminate itself or go into a long stage of remission. But even after complete recovery, short-term relapses of chorea minor are possible against the background of pregnancy, exacerbation of viral and infectious processes, especially streptococcal nature (group A streptococci).

Nonspecific preventive measures for the development of chorea include timely and adequate antibiotic therapy in patients with rheumatism and other streptococcal infections. Early detection and treatment of rheumatoid manifestations significantly reduces the incidence of chorea minor among children 6-15 years of age.

Chorea minor (Sydenham's chorea, rheumatic chorea, infectious chorea) is a neurological manifestation of rheumatic infection. The main symptoms of the disease are erratic violent movements in the limbs and torso, as well as psycho-emotional changes. Chorea minor affects mainly children and adolescents, sometimes there are relapses at a young age. Diagnosis of the disease is based on a combination of clinical symptoms and data from additional research methods. This article will help you understand the causes, symptoms, diagnosis, and treatment of chorea minor.

Clinical symptoms were first described by the English physician Sydenham in 1686. Most often, small chorea affects children aged 5 to 15 years. The prevalence of the disease among girls is 2 times higher than among boys. It is believed that this is due to the hormonal characteristics of the female body, since this imbalance increases in adolescence.

The reasons

Back in 1780, the scientist Stol suggested the infectious nature of the disease. To date, it has been reliably established that the cause of chorea minor is a past infection with group A β-hemolytic streptococcus.

This type of streptococcus most often affects the upper respiratory tract with the development of tonsillitis and tonsillitis. The body fights the pathogen by producing antibodies against it, which destroy the streptococcus. In a number of people, antibodies are simultaneously produced to the basal ganglia of the brain. This is called a crossover autoimmune response. The antibodies attack the nerve cells in the basal ganglia. Thus, an inflammatory reaction occurs in the subcortical formations of the brain, which manifests itself as specific symptoms (hyperkinesis).

Of course, this parallel production of antibodies to the basal ganglia does not occur in everyone. It is believed that some role in the development of chorea minor is played by:

• hereditary predisposition;
• hormonal jumps;
• the presence of chronic infectious processes of the upper respiratory tract;
• untreated carious teeth;
• weak immunity;
• increased emotionality (a tendency to overreact the nervous system);
• thinness, asthenia.

Since β-hemolytic streptococcus can cause the production of antibodies to other body structures (joints, heart, kidneys), causing rheumatic damage, chorea minor is considered to be one of the variants of an active rheumatic process in the body as a whole. Currently, chorea has become less common due to the specific prevention of rheumatic processes (bicillin therapy).

Symptoms

Clinical manifestations occur, as a rule, a few weeks after suffering a sore throat, or tonsillitis. Less often, the disease manifests itself without preliminary signs of upper respiratory tract infections, which happens when β-hemolytic streptococcus has settled in the body imperceptibly.

The duration of a small chorea averages about 3 months, sometimes dragging on for 1-2 years. In 1/3 of persons who have had the disease, after puberty and up to 25 years, relapses of chorea minor are possible.

In its morphological nature, chorea is rheumatic encephalitis with damage to the basal ganglia of the brain.

The main manifestations of chorea minor include choreic hyperkinesis : involuntary movements. These are fast, non-rhythmic, randomly distributed, chaotic muscle contractions that occur against the will of a person and, accordingly, cannot be controlled by him. Choreic hyperkinesis can capture various parts of the body: hands, face, completely limbs, larynx and tongue, diaphragm, the entire body. Usually, at the beginning of the disease, hyperkinesis is barely noticeable (clumsiness of the fingers, a slight grimacing, which is perceived as a prank of a child), and are aggravated by excitement. Gradually, their prevalence increases, they become more pronounced in amplitude up to the so-called "choreic storm", when uncontrolled movements occur paroxysmal throughout the body.

What kind of hyperkinesis can attract attention and alert? Let's call them.

• Awkwardness of movements when writing (drawing) - the child cannot hold a pen or pencil (brush), clumsily writes letters (if previously it turned out smoothly), crawls out of the lines, puts blots and blots in more quantities than before;
• uncontrolled showing of the tongue and frequent grimaces (grimacing) - many may consider this a sign of bad manners, but if this is far from the only manifestation of hyperkinesis, then it is worth thinking about a different nature of the process;
• restlessness, inability to sit still or hold a given position (during the lesson, such children endlessly interfere with the teacher; when they are called to the blackboard, the answer is accompanied by scratching, tugging at various parts of the body, dancing and similar movements);
• shouting out various sounds or even words, which is associated with involuntary contraction of the muscles of the larynx;
• blurred speech: associated with hyperkinesis of the tongue and larynx. That is, the speech of a child who previously did not have speech therapy defects suddenly becomes fuzzy, lowing, inarticulate. In very severe cases, choreic hyperkinesis of the tongue causes a complete absence of speech ("choreic" mutism).

If the main respiratory muscle (diaphragm) is involved in the process, then "paradoxical breathing" (Czerny's symptom) occurs. This is when, when inhaling, the abdominal wall is pulled inward instead of protruding normally. It is difficult for such children to fix their gaze, their eyes “run” all the time in different directions. For the hands, the symptom of the "milkmaid's hand" is described - alternate movements of contraction and relaxation of the fingers. As hyperkinesis increases, everyday household activities become very difficult: dressing, bathing, brushing teeth, eating, and even walking. There is a saying by Wilson that most accurately describes a child with chorea: "A child with Sydenham's chorea will be punished three times before he is properly diagnosed: once for restlessness, once for breaking dishes, and once for being" made faces "grandmother." Involuntary movements disappear in sleep, but the period of going to bed because of them is accompanied by certain difficulties.

• Decreased muscle tone: usually corresponds to the severity and localization of hyperkinesis, that is, it develops in those muscle groups in which hyperkinesis is observed. There are pseudo-paralytic forms of chorea minor, when hyperkinesis is practically absent, and the tone is reduced so much that muscle weakness develops, and it becomes difficult to perform movements;
• psycho-emotional disorders: often the most initial manifestations of chorea minor, but the connection with chorea minor is usually established only after the appearance of hyperkinesis. Such children have expressed emotional lability (instability), anxiety, they become capricious, restless, touchy and whiny. Stubbornness, unmotivated disobedience, impaired concentration, forgetfulness appear. Children find it difficult to fall asleep, sleep restlessly, wake up frequently, sleep duration decreases. Emotional outbursts occur for any reason, which forces parents to turn to a psychologist. Occasionally, chorea manifests itself as more pronounced mental disorders: psychomotor agitation, impaired consciousness, the appearance of hallucinations and delusions. The following feature of the course of chorea minor was noted: severe mental disorders prevail in children with severe hyperkinesis, lethargy, apathy, lack of interest in the outside world in children with a predominance of muscular hypotension.

The changes described above should be properly evaluated. It does not mean at all that all children who suddenly began to misbehave, about whom teachers complain, are sick with minor chorea. These changes can be associated with completely different reasons (problems with peers, hormonal changes, and much more). An expert will help you understand the situation.

There are several neurological symptoms that are characteristic of chorea minor, which the doctor will definitely check during the examination:

• Gordon's phenomenon: when checking, the lower leg seems to freeze for a few seconds in the extension position, and then returns to its place (this occurs due to the tonic tension of the quadriceps femoris muscle). Also, the lower leg can make several pendulum movements and only then stop;
• "language of a chameleon" ("eyes and tongue of Filatov"): the inability to keep the tongue hanging out of the mouth with closed eyes;
• “choreic hand”: with outstretched arms, a specific position of the hands occurs, when they are slightly bent at the wrist joints, while the fingers are unbent, and the big one is attached (adjusted) to the palm;
• symptom of "pronator": if you ask slightly bent arms to raise above your head (as if in a semicircle, so that the palms are directly above the head), then the palms involuntarily turn outward;
• a symptom of "flabby shoulders": if a sick child is lifted by the armpits, then his head sinks deep into his shoulders, as if sinking into them.

Most children with minor chorea develop vegetative disorders of varying severity: cyanosis of the hands and feet, marbling of the skin, cold extremities, a tendency to low blood pressure, irregularity of the pulse.

Since chorea is part of an actively ongoing rheumatic process, in addition to the signs characteristic of it, such children may experience symptoms of damage to the heart, joints, and kidneys. In 1/3 of patients who have had a small chorea, subsequently, due to the rheumatic process, a heart disease is formed.

The duration of the disease is different. A tendency towards a favorable course and a relatively quick recovery was noted in cases with the rapid development of hyperkinesis and without a sharp decrease in muscle tone. The slower the symptoms develop and the more pronounced problems with muscle tone, the longer the course of the disease.

Usually a small chorea comes to an end with recovery. Relapses of the disease may be associated with repeated tonsillitis or exacerbations of the rheumatic process. After the illness, asthenia persists for a rather long period, and some psycho-emotional personality traits can remain for life (for example, impulsivity and anxiety).

For females who have had a small chorea, you should refrain from taking oral contraceptives, as they can provoke the appearance of hyperkinesis.

Diagnostics

To confirm the diagnosis of chorea minor, the history of the disease with an indication of tonsillitis or tonsillitis, clinical symptoms and neurological examination data, as well as data from additional research methods play a role. Damage to the heart, joints, kidneys (that is, other rheumatic manifestations) only suggest a diagnosis.

Laboratory methods confirm an active rheumatic process in the body (markers of streptococcal infection - antistreptolysin - O, C-reactive protein, rheumatoid factor in the blood). There are situations when laboratory methods do not detect rheumatic changes in the body, which greatly complicates the diagnosis.

Of the additional research methods, electroencephalography is shown (reveals nonspecific changes in electrical activity that indirectly confirm disorders in the brain), magnetic resonance or computed tomography (they also allow detecting nonspecific changes in the basal ganglia or the absence of any at all. The main purpose of using CT or MRI remains differential diagnosis with other brain diseases, for example, with viral encephalitis,).

Treatment

The treatment of chorea minor is complex and is aimed, first of all, at eliminating the rheumatic process in the body, that is, at stopping the production of antibodies against the cells of one's own body and fighting streptococcus. An important role is played by the elimination of hyperkinesis.

If chorea is accompanied by pronounced changes in the blood (increased ESR, high titers of antistreptolysin-O, increased C-reactive protein, and so on) and damage to other organs and systems, then antirheumatic drugs are indicated for such patients. These can be non-steroidal anti-inflammatory drugs and glucocorticosteroids.

Among non-steroidal anti-inflammatory drugs, salicylates (Acetylsalicylic acid), Indomethacin, Diclofenac sodium are used. Of the glucocorticosteroids, Prednisolone is most often used.

Antibiotics of the penicillin series are usually not effective for chorea minor, since streptococcus is no longer in the body by the time the disease begins.

To eliminate the active inflammatory process, along with non-steroidal anti-inflammatory drugs or glucocorticosteroids, antihistamines (Suprastin, Loratadin, Pipolfen) drugs are used. Askorutin is used to reduce vascular permeability. Multivitamin complexes are shown.

To eliminate hyperkinesis and psycho-emotional disorders, neuroleptics (Aminazine, Ridazine, Haloperidol and others), tranquilizers (Klobazam, Phenazepam), sedatives (Phenobarbital, valerian preparations and others) are used. Sometimes anticonvulsants are effective: sodium valproate and the like. Many of these drugs are potent, so only a doctor should prescribe them.

Separately, I would like to highlight the work of child psychologists. In most cases, medical intervention is not enough to cope with psycho-emotional changes. Then psychologists come to the rescue. Their methods help to deal with behavioral disorders very effectively, and also contribute to the social adaptation of children.

The transferred chorea necessarily requires the prevention of relapses of the disease (as well as other manifestations of the rheumatic process). For this purpose, bicillin-5 or benzathine benzylpenicillin is used. These drugs are prolonged forms of an antibiotic of the penicillin series, to which group A β-hemolytic streptococcus is sensitive. The drugs are administered intramuscularly once every 3-4 weeks (each of the drugs has its own scheme and dosage according to age). The duration of use is determined by the attending physician individually and, on average, is 3-5 years.

Before the era of the use of antibiotics, angina very often gave complications in the form of a small chorea. Implementation of rational and timely antibiotic therapy and the use of bicillin prophylaxis allowed to significantly reduce the number of new cases of chorea minor, due to which this disease is becoming less and less common at the present time.

Thus, chorea is one of the rheumatic lesions of the human body. Children and teenagers are ill mainly, and girls are much more often. The first symptoms of the disease can be regarded as banal disobedience and self-indulgence. A detailed picture of the disease consists of involuntary movements, psycho-emotional disorders. Usually, against the background of treatment, chorea has a favorable outcome in the form of a complete recovery, although relapses are also possible.

Chorea is a disease of the nervous system, which is characterized by damage to the subcortical nodes of the brain and is manifested by fast, uncontrolled, involuntary and jerky movements in the trunk and limbs.

Types of chorea

The disease can take the following forms:

• Chorea minor (in children);
• Chorea of ​​Huntington;
• Chorea of ​​pregnancy.

The disease is also rheumatic and non-rheumatic, rheumatic chorea occurs in children and pregnant women.

Chorea minor is observed in childhood and adolescence in the presence of rheumatism. With timely treatment, the disease completely disappears. The causes of rheumatic chorea lie in vascular, degenerative and inflammatory changes in the nervous tissue.

The disease in pregnant women develops in the first trimester. In this case, the symptoms of chorea are the result of a small chorea suffered in childhood. Most often, the disease affects young women.

Huntington's chorea is a genetic disease that occurs in adults and is accompanied by increasing dementia over time.

Translated from Greek, "chorea" means "dance", which, in fact, clearly corresponds to the manifestations of the syndrome: the patient performs sweeping, fast and irregular actions, and this process resembles dancing.

Chorea is one of the most common types of hyperkinesis (abnormal uncontrolled muscle movement). In a state of mental or physical rest, motor activity decreases, in a dream it is absent, but at the slightest irritation it intensifies again. The disease is also characterized by a decrease in muscle tone.

Symptoms of chorea can also indicate severe brain diseases, in particular encephalitis, various tumors, and other pathologies. In most cases, rheumatic chorea occurs in children.

Chorea in children (small)

The disease develops against the background of rheumatism. In patients, diffuse changes in the cerebral hemispheres, cortex, trunk, membranes and subcortical nodes of the brain are noted. Often these lesions occur simultaneously with cardiac disorders. The risk group includes children aged 5 to 14 years.

The symptoms of chorea are as follows:

• Increase in body temperature up to 38 degrees;
• Inaccuracy of movements;
• violation of coordination;
• Change in the child's behavior (begins to grimace, frown, stick out his tongue, write poorly, twitch his shoulders);
• Bouncing gait;
• Tearfulness, irritability, rapid exhaustion and fatigue.

The symptoms of chorea in children tend to get worse over time. Often, parents do not pay attention to some moments in the behavior of the child, because they may look like innocent pranks. But soon the syndrome acquires pronounced features, which perplexes moms and dads.

When diagnosing, patients note a decrease in muscle tone, especially in those muscles that are prone to chaotic twitches. Also, the presence of the disease is checked in this way: the knee is hit with a medical hammer, as a result of which the leg freezes in the extension position - a clear sign of chorea.

Sometimes the disease is manifested by pathological reflexes, impaired sensitivity, pain syndromes. Also, the child may experience a violation of speech, increased sweating.

If the chorea is detected in time and a series of therapeutic measures are taken, then after 2-3 weeks the symptoms will disappear, but there is a possibility of relapse.

Huntington's chorea

This type of disease is hereditary. The first symptoms make themselves felt, as a rule, between 25 and 50 years. The manifestations of the disease are:

• Choreic hyperkinesis of a relatively slow pace (non-rhythmic and sharp twitching of the limbs or trunk);
• Progressive decline in intelligence;
• Emotional instability.

In the case of Huntington's disease, the prognosis is unfavorable, that is, it is impossible to cure the disease.

Chorea treatment

Treatment of chorea of ​​a small type is carried out in a hospital. The patient is strictly shown bed rest, rest and careful care for him. The medical arsenal includes:

• Antibiotics (novocillin, penicillin, bicillin, ecmonovocillin);
• Salicylates (acetylsalicylic acid, salicylic sodium, butadiene, amidopyrine);
• Hormones of the glucocorticoid series (prednisolone and cortisone);
• Vitamins and trace elements (preparations containing calcium, multivitamins, ascorbic acid, B vitamins);
• Heart remedies.

Physiotherapy is also indicated for the treatment of chorea, including:

• Coniferous baths;
• Galvanic collar according to Shcherbak with calcium chloride;
• Electrosleep.

In order to prevent chorea minor, it is possible to recommend sanitation of the nasopharynx and oral cavity, timely diagnosis and treatment of various forms of rheumatism, as well as hardening of children.

Adult people suffering from Huntington's disease are advised to refrain from procreation - conception and the birth of children.

Chorea- a disease of rheumatic etiology, characterized by movement disorders.

The defeat of the rheumatic process of the body begins with the penetration of group A hemolytic streptococcus bacteria into the body. This microbe from the foci of infection (for example, with chronic tonsillitis from the palatine tonsils) enters the bloodstream, spreads in various tissues. At the heart of the pathogenesis of rheumatic lesions is the pathology of the connective tissue. Damage to the valves of the heart, joints can develop. The penetration of the pathogen into the central nervous system can provoke dysfunctions of the cerebral cortex, cerebellum, basal ganglia (neurorheumatism). There is a lesion of large and small vessels of the brain with the development of vasculitis and thrombovasculitis. As a result of the development of degenerative processes, coordination of movements and muscle tone are disturbed in these parts of the nervous system.

After the discovery of antibiotics, the incidence of chorea minor is up to 10% of all neurological diseases. The disease develops more often in girls than in boys, and mainly in the autumn-winter period. The duration of the disease is from 3 to 6 weeks. There may be short-term relapses for a long period of time after the height of the disease (for example, during pregnancy). In rare cases, deaths are observed due to pathological effects on the cardiovascular system.

Lesser chorea - Species

Depending on the picture of the clinical course, there are:

• The classic version of the course of small chorea
• Atypical variant of the course of chorea:
  • erased, oligosymptomatic, sluggish current form of the disease
  • paralytic chorea
  • pseudohysterical chorea

The course of the disease can be:

• Latent (hidden)
• Subacute
• Acute
• Recurrent

Chorea Minor Causes

Among the reasons for the development of chorea minor and risk factors for this pathological process, the following can be distinguished:

• hereditary predisposition
• Female
• Age from 6 to 15 years
• Previous streptococcal infection (eg, strep throat)
• Asthenic physique
• Psychological trauma
• Increased excitability of the child's nervous system
• Frequent sore throats
• Chronic tonsillitis
• Respiratory diseases
• Rheumatism
• Decreased immunity
• carious teeth

Chorea Minor - Symptoms

The development of chorea is accompanied by such clinical signs:

• Twitching of arms and legs (choreic hyperkinesis) on one side or symmetrical
• Twitching of the facial muscles (grimacing, blinking, twitching of the corner of the mouth, wrinkling of the forehead)
• Weakness in the muscles
• Gait disturbance
• Shoulder twitch
• Disorder of coordination of movements
• Head twitch
• Handwriting violation
• Sleep disorders
• Seizures
• Speech disorder (hyperkinesis of the tongue)
• Difficulty swallowing (hyperkinesis of the muscles of the larynx)
• Intermittent breathing (diaphragm hyperkinesis)
• Emotional excitability
• Memory and attention disorders
• Increased fatigue, irritability
• Psychosis with auditory and visual hallucinations

Chorea Minor - Diagnosis in Israel

Diagnosis of chorea minor begins with the collection of an anamnesis of the life and disease of the patient. The diagnosis is confirmed by a characteristic clinical picture in combination with some research methods:

• Blood analysis- allows you to identify the content of markers of streptococcal infection in the body: antisteptolysin-O, rheumatoid factor, cyclic citrulline peptide, C-reactive protein.
• Electromyography- a method that allows you to explore the biopotentials of skeletal muscles. When registering the electrical activity of the muscles with a small chorea, lengthening of the potentials and asynchrony in their appearance are revealed.
• Electroencephalogram- reveals diffuse slow-wave bioelectrical activity of the brain.
• , positron emission tomography- help to identify focal changes in the brain.

Chorea Minor - Treatment in Israel

Israeli doctors have extensive experience in the treatment of chorea minor and can offer you the following therapies:

• Penicillin antibiotics (bicillin)- are used to fight streptococcal infections.
• Non-steroidal anti-inflammatory drugs (sulindac, ketorolac, salicylic acid derivatives)- reduce inflammation in tissues.
• Glucocorticoids (prednisolone)- prevents the development of edema and inflammation in the tissues, an allergic reaction.
• Sedatives, tranquilizers (benzodiazepines, barbiturates)- Relieve mental stress.
• Antipsychotics- drugs that inhibit the transmission of dopamine (one of the neurotransmitters). Haloperidol is used in combination with chlorpromazine and reserpine, which block the transport of dopamine in the nerve endings.
• Competitors of dopamine (dopegyt)- when they are taken, the drug binds to dopamine receptors, which prevents the attachment of an endogenous mediator.
• Antihistamines (suprastin, diphenhydramine)- eliminate the allergic component of the disease.
• In the presence of risk factors (for example, chronic tonsillitis), prophylactic washing is indicated, and if it is ineffective- removal of the tonsils.
• When stopping the acute stage of the process, a stay at the sanatorium resorts of the Dead Sea, famous for its healing and restorative effect, will have a positive effect on the patient's body.

Chorea- This is a disease that requires special attention of the doctor in identifying and treating.

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Chorea minor is a rather rare neurological pathology, the main manifestations of which are motor disorders and erratic muscle contractions.

This disease affects children and adolescents, but relapses can occur at a young age.

Otherwise, the disease is called Sydenham's chorea, rheumatic or infectious. This is the most common form of acquired chorea, occurring predominantly in childhood.

The disease requires immediate therapy, otherwise serious complications may develop.

Causes and features of failures

For the first time, the symptoms of the disease were described in 1686 by an English doctor, Thomas Sydenham. It was he who revealed that children from five to fifteen years old are susceptible to the development of small chorea, and the incidence among girls is somewhat more common than among boys. This is due to the hormonal characteristics of the female body.

CNS lesions in chorea minor are localized in the cerebral cortex. But after the discovery of antibacterial drugs, chorea Sydenham accounts for only ten percent of all neurological pathologies in children.

As already mentioned, the symptoms of the disease are more often manifested in girls, and the peak incidence is in the autumn and winter.

The duration of the disease averages three to four months. In some cases, exacerbations may occur after a prolonged absence of symptoms, most often during pregnancy.

The disease, as a rule, is not fatal, however, pathological changes in rheumatism that occur in the cardiovascular system can still cause death.

As for the causes of the development of the disorder, the leading infection is the transferred infection of group A beta-hemolytic streptococcus, from which the disease, in addition to the neurological nature, also has an infectious one.

This type of streptococcus in most cases affects the upper respiratory tract (URT). It is enough to get sick with tonsillitis and tonsillitis and the child automatically falls into the risk group. With the development of such diseases, the child's body begins to actively fight the pathogen, it produces antibodies against it.

Quite often, antibodies can also be produced against the basal ganglia of the brain. Cross-over autoimmune response is what this phenomenon is called. Antibodies begin to attack the nerve cells of the ganglia, and as a result, an inflammatory reaction appears, manifested by hyperkinesis.

This does not always happen, otherwise every second child would have a small chorea. It is believed that the disease can develop due to:

• the presence of a rheumatic disease;
• genetic predisposition;
• failures in the functioning of the endocrine system;
• chronic infectious processes of the upper respiratory tract;
• caries not cured in a timely manner;
• decrease in immunity;
• increased emotionality;
• the use of certain medications, for example, for nausea;
• chronic insufficiency of blood supply to the brain;
• the presence of cerebral palsy - cerebral palsy.

Since beta-hemolytic streptococcus provokes the production of antibodies to other organs and systems and causes rheumatic damage, this pathology is considered as one of the options for an active rheumatic process.

Varieties of rheumatic chorea

In addition to the classic variant of chorea minor, an atypical course is also noted. There are the following types of pathology:

• erased (sluggish, oligosymptomatic);
• paralytic;
• pseudo-hysterical.

The course of the disease can be latent, subacute, acute and recurrent.

Clinical manifestations

The general symptoms of the disease are quite bright. The manifestation of the disease can be different in each individual case. The main symptoms of chorea minor disease include hyperkinesis (involuntary movements).

The appearance of chaotic muscle contractions that occur randomly and which the child is not able to control is noted.

At the beginning of the disease, hyperkinesis is hardly noticeable. Grimacing, clumsiness of hands, unsteadiness of gait, parents do not perceive as a reason to seek the help of a specialist.

Over time, hyperkinesis becomes more noticeable. They usually occur during agitation. If the manifestations of the disorder are ignored, movement disorders become more complicated. They become pronounced, up to a choreic storm - a paroxysmal occurrence of uncontrolled movements throughout the body.

What is worth paying special attention to?

Handwriting of a child diagnosed with chorea

There are a number of symptoms that should be alarming. The initial manifestations of the disease are perceived by many parents as a banal antics. But the timely detection of pathology is the basis of successful therapy. The main warning symptoms of small ferret include:

1. Awkward movements while drawing or writing. The child is not able to hold a pencil, if he writes, then only clumsy disproportionate letters are obtained.
2. Uncontrolled frequent antics.
3. restlessness. The baby is unable to sit in one place, he constantly scratches himself and twitches with different parts of the body.
4. Involuntary shouting out of different sounds(due to involuntary contraction of the muscles of the larynx).
5. Blurring, confusion of speech. In some cases, tongue hyperkinesis provokes the appearance of choreic mutism (complete absence of speech).

In addition, the disease is characterized by:

• decreased muscle tone;
• psycho-emotional disorders(anxiety, capriciousness, touchiness, tearfulness).

There are several neurological manifestations that are characteristic only for this disease, which, upon examination, the neurologist will definitely pay attention to:

In almost all cases, the pathology is characterized by vegetative disorders: cyanosis of the feet and hands, cold extremities, marbled skin, irregular pulse, and a tendency to low blood pressure.

Moreover, a third of children who have had the disease may subsequently develop a heart disease.

Diagnostic approach

In addition to a physical examination, history taking, and blood sampling, the following may be done:

• computed tomography;
• electroencephalography;

All this will contribute to the identification of pathological foci in the brain, the assessment of muscle function, the identification of markers of streptococcal infection and C-reactive protein.

Therapy: goals, methods

The basis of treatment is the fight against infection, namely, group A hemolytic streptococcus. In this case, antibiotics of the penicillin and cephalosporin series are prescribed.

In order to reduce the inflammatory process in the kidneys, anti-inflammatory drugs from the NVPS group are prescribed.

Since the disease is characterized by psycho-emotional disorders, sedatives and tranquilizers are prescribed without fail. If necessary, neuroleptics are used. Often, medications are prescribed to improve the functioning of the brain, as well as B vitamins.

Chorea minor can only be treated by a neurologist. Dosages of drugs are selected individually for each individual case.

In the acute period, bed rest is recommended. At this time, it is important to create the right conditions, with no or minimal exposure to irritants - this also applies to light and sound. The nutrition of the child should be balanced and fortified.

What is the prognosis?

With timely treatment, the prognosis is positive, the disease ends in recovery. However, the occurrence of relapses is not excluded. Exacerbations of the disease may be due to repeated tonsillitis or a rheumatic process.

After an illness, asthenia may persist for a fairly long period. The main complications of the pathology include heart disease, aortic insufficiency, mitral stenosis.

The disease is not fatal and, with proper treatment, does not pose a threat to the life of the patient. A fatal outcome is possible in the event of a sharp failure in the functioning of the CCC, incompatible with life.

Preventive actions

In addition, it is necessary to take care of the correct physical development of the child, rational nutrition, anti-relapse therapy, strengthening the immune system, as well as getting rid of chronic foci of infection.