Rheumatic chorea is a possible symptom of childhood rheumatic fever. It is characterized by involuntary muscle jerks and twitches, generalized muscle weakness, and poor coordination. Many patients who develop rheumatic chorea also experience other symptoms associated with the underlying bacterial infection such as skin rashes, sore throats, and high fevers. The infection can usually be cured in less than two weeks with oral or intravenous antibiotics, but symptoms of rheumatic chorea may persist for several months following medical care. Most children who receive early treatment do not experience serious lasting complications.
Severe streptococcus infections such as strep throat and scarlet fever that are not treated right away can induce rheumatic fever symptoms. Chorea occurs when bacteria invade the central nervous system, triggering an inflammatory response from the immune system. As inflammation worsens, neurotransmitter receptor sites in the brain are damaged and nerve cells cannot communicate properly with muscle groups throughout the body. Rheumatic chorea most often affects young children who live in regions with little or no access to quality health care.
Rheumatic chorea typically develops several days or weeks after the initial infection. The first symptoms may include weakness in the arms and an inability to control fine motor movements. A child might also develop an awkward gait and suffer from uncontrollable muscle twitches in his or her face, arms, and legs. In addition to muscular problems, some patients experience psychiatric changes, such as depression, extreme anxiety, or an inability to control emotions.
A doctor can usually diagnose rheumatic chorea by reviewing the patient's symptoms and his or her medical history. Blood tests may reveal active streptococcal infections or traces of antibodies that suggest an infection was present in the recent past. Since rheumatic fever can potentially cause serious heart complications, ultrasounds and echocardiograms are usually performed on patients who have chorea symptoms.
Rheumatic chorea often disappears spontaneously after the underlying infection is treated with antibiotics. An extended course of antibiotics may be given even after symptoms resolve to reduce the chances of recurring streptococcal infections in young children. If a patient's symptoms are severe enough to significantly interfere with his or her daily life, a doctor may prescribe additional medications. Anti-inflammatory steroids and anticonvulsant drugs such as carbamazepine and might be given to reduce nervous system activity and allow muscles to relax. In the majority of cases, children are able to make full recoveries from rheumatic chorea in less than five months.