Neuropsychiatric manifestations of Sydenham's chorea: a systematic review

Abstract

OCDObsessive-compulsive disorder PANDAS Paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections AIM Sydenham's chorea is a post-streptococcal, autoimmune, neuropsychiatric movement disorder. Sydenham's chorea is a major criterion for diagnosis of acute rheumatic fever with the implication of potential long-term sequelae including cardiac complications. It is well established that there is psychiatric comorbidity in Sydenham's chorea, but there are variations in the literature regarding the nature and prevalence of psychiatric diagnoses associated with Sydenham's chorea. The aim of this review was to systematically evaluate the evidence for psychiatric symptoms presenting with Sydenham's chorea. Knowledge of comorbid psychiatric symptomatology will support early diagnosis and treatment, leading to improved long-term outcomes for children with Sydenham's chorea.METHOD The study used a systematic search strategy, using MEDLINE, MEDLINE in Process, EMBASE, and The Cochrane Library. Abstracts were screened to identify relevant papers which were then assessed further. Eligible papers were summarized.

Treatment of Sydenham’s Chorea: A Review of the Current Evidence

“…In rare instances the associated hypotonia can be so profound as to be completely disabling, a variant known as chorea paralytica or chorea mollis. Neuropsychiatric symptoms, including obsessive compulsive behaviors, personality changes, emotional lability, distractibility, irritability, anxiety, age-regressed behaviors, and anorexia, are common and frequently predate the appearance of chorea 1. After improvement of their motor symptoms, many patients with SC continue to have a high rate of anxiety and depression2 as well as difficulty with cognitive tasks requiring attention and processing speed 3.…”

Methylphenidate-induced Exacerbation of Chorea in a Child Resolved with Switching to Atomoxetine

“…It has been described that Sydenham's chorea is commonly associated with psychiatric symptoms, including obsessive-compulsive disorder, tic disorders and ADHD [12]. Antibodies against group A beta-hemolytic streptococcus which cross-react with basal ganglia have been demonstrated as the etiology [13].…”

“…Antibodies against group A beta-hemolytic streptococcus which cross-react with basal ganglia have been demonstrated as the etiology [13]. The available literature indicates that the treatment of psychiatric disorders is challenging due to the high risk of motor-related side effects of psychotropic medications [12,14]. One earlier study found a high frequency of adverse reactions to central stimulants and suggested that Sydenham's chorea in childhood leads to a sensitivity to agents that augment central dopaminergic activity, which may be expressed as acute chorea [15].…”

Sydenham's chorea: beyond involuntary movements

“…Punukollu et al . report a systematic review on the neuropsychiatric manifestations of Sydenham's chorea.…”

“…Based on the significant evidence of behavioral and cognitive symptoms in patients with Sydenham's chorea, Punukollu et al . argue the need for early recognition of these symptoms and their multidisciplinary management.…”