Minor chorea
Minor chorea is a disease that manifests itself as a rheumatic infection of a neurological nature. Minor chorea is also called Sydenham’s chorea, rheumatic or infectious chorea. In a sense, it is an encephalitis of a rheumatic breed. This brain disease has a muscular origin and manifests itself in the form of hyperkinesis, which develop as a result of damage to brain structures that provide the function of coordination of movements and are responsible for muscle tone. At the heart of the disease is a lesion of the cerebral vessels, mainly subcortical nodes suffer. Minor chorea rheumatically affects the heart.
The content of the article:
Causes of minor chorea
Symptoms of minor chorea
Other symptoms of minor chorea
Diagnosis of minor chorea
Treatment of minor chorea
Prognosis and prevention of minor chorea
Minor chorea
According to statistics, girls get sick twice as often as boys. The manifestation occurs at the age of 6-15 years, often in the cold season. The fact of a more frequent incidence of girls is associated with the hormonal characteristics of the growing organism and the production of female sex hormones. The fact of involvement of the cerebellum and striatal brain structures in the pathological process is of significant importance. It manifests itself in the form of uncontrolled attacks, the duration of which is about three months, in some cases it can last up to six months or even several years. Minor chorea may have a relapse.
Adults aged 30-45 years also suffer from minor chorea. In this case, the clinical picture is accompanied primarily by severe mental disorders, most often irreversible.
Causes of minor chorea
The disease has an infectious nature. It has been established that the cause of the development of minor chorea can be considered the transfer of infection of beta-hemolytic streptococcus group A. Such an infection mainly affects the upper respiratory tract and provokes the development of tonsillitis and angina. In the process of fighting the disease, antibodies are produced in the human body that fight streptococcus bacteria. Sometimes there is a so—called autoimmune response – simultaneously with these antibodies, antibodies to the basal ganglia of the brain also begin to be produced. Then there is an attack by nerve cells of the basal ganglia, which provokes inflammatory processes in the subcortical formations of the brain, which manifest themselves in the form of hyperkinesis.
The main provocateurs of the production of antibodies to the basal ganglia of the brain can be considered:
genetic predisposition;
instability of the nervous system, for example, excessive emotionality;
hormonal failures;
a weak immune system;
development of inflammatory processes in the upper respiratory tract;
dental caries;
lean body structure.
The presence of beta-hemolytic streptococcus can provoke the production of antibodies to other structures of the human body (heart, joints, kidneys), and cause rheumatic damage to these organs. This will cause the disease to be considered as a variant of the rheumatic process as a whole.
Modern neurology is still investigating the nature and cause of the development of minor chorea. The assumption about the infectious nature of the disease was made at the end of the XVIII century by the scientist Stolom. Today, this issue is still under investigation.
Symptoms of minor chorea
The clinical picture of minor chorea is visible already a few weeks after the transfer of an infectious disease (sore throat or tonsillitis).
The main clinical manifestations of minor chorea are motor disorders (involuntary twitching of the arms and legs). This is called choreic hyperkinesis — rapid, chaotic, uncontrolled muscle contractions. Choreic hyperkinesis can manifest itself in the face, hands, limbs in general. They can affect the larynx and tongue, the diaphragm, or even the whole body at the same time.
At the initial stage, hyperkinesis is almost invisible, very often they are not paid attention to. Awkwardness and numbness of the fingers or barely noticeable twitching of the facial muscles can be perceived at first as a child’s grimacing. Twitching becomes more noticeable with excitement or other emotional outbursts. Over time, hyperkinesis becomes more pronounced and prolonged, can manifest itself in the form of a so-called “choreic storm” when uncontrolled twitching occurs simultaneously throughout the body.
In order to diagnose the disease as early as possible, it is necessary to pay attention to the symptoms of the following hyperkinesis at the very beginning of their manifestation:
Awkward movements when writing or drawing. The child hardly holds a pencil or a brush, cannot concentrate to draw a straight line, puts blotches, makes blots in greater numbers than before; sometimes you can observe the “milkmaid” syndrome, when the hands involuntarily contract and relax.
Uncontrolled antics (tongue sticking out, grimaces). Many attribute these signs to the child’s bad manners, but if there are other types of hyperkinesis, then they should be paid attention to.
Inability to hold a given pose for a long time.
Involuntary shouting of words or sounds. This may be due to a contraction of the laryngeal muscles.
Vagueness and confusion of words in conversation. This can be explained by involuntary contractions of the laryngeal muscles and tongue. If a child who has not previously been distinguished by defective speech suddenly begins to pronounce words indistinctly, speech becomes inarticulate, then you should contact a neurologist, especially if other signs of hyperkinesis have been noticed.
In severe cases, hyperkinesis of the larynx and tongue muscles leads to a complete absence of speech (“choreic mutism”).
Sometimes hyperkinesis also affects the respiratory muscles of the diaphragm. In this case, the so-called Cherni syndrome or paradoxical breathing occurs. When inhaling, the stomach sinks inwards, and does not bulge out, as is normal. The child cannot concentrate his eyes on one object. The eyeball is constantly running in different directions.
As hyperkinesis progresses, self-care becomes difficult (the process of eating, dressing, walking). Signs of hyperkinesis disappear when the child sleeps, but the process of going to bed is accompanied by certain difficulties.
Other symptoms of minor chorea
Decreased muscle tone. Most often, a decrease in tone corresponds to the localization of hyperkinesis. But there are such forms of minor chorea, when there are almost no signs of hyperkinesis, and muscle tone is lowered so much that the child becomes practically immobilized.
Disorders of the psychoemotional state. Often, this symptom is the first alarming sign of this disease, but such manifestations are associated with minor chorea only after the manifestation of hyperkinesis. The child behaves inadequately, often cries and is capricious, there is frequent forgetfulness and lack of concentration. In some cases, on the contrary, the child shows apathy to the outside world, becomes sluggish.
When contacting a neurologist, the doctor may identify several more symptoms during the examination and testing of the child:
The Gordon phenomenon. When checking the knee reflex, the leg freezes in an unbent position for a few seconds (hyperkinesis of the femoral muscle).
“A symptom of flabby shoulders” — when a sick child is lifted by the armpits, his head sinks heavily into the shoulders.
“Chameleon tongue” — a child cannot keep his tongue out if his eyes are closed.
“Choreic brush” — with outstretched hands there is a special arrangement of brushes.
Diagnosis of minor chorea
Diagnosis of minor chorea usually begins with the patient’s life history. The diagnosis is made on the basis of a blood test, which identifies markers of streptococcal infection. Electromyography (examination of skeletal muscle biopotentials), electroencephalogram, CT, MRI are also performed, which reveal focal changes in the brain.
Treatment of minor chorea
Treatment of minor chorea occurs in a stationary mode. The patient is intramuscularly injected with antibiotics, anti-inflammatory drugs, salicylates. Sometimes hormonal drugs are used. In the acute period, it is necessary to create the most comfortable conditions for the child with minimal stimuli — light, sounds.
Prognosis and prevention of minor chorea
The prognosis for minor chorea is positive in most cases. With its early detection, treatment can be considered successful, although relapses may occur against the background of exacerbation of infectious diseases.
Prevention of minor chorea consists in timely administration of antibiotics for viral and infectious diseases, as well as adequate and early treatment of rheumatoid manifestations, which prevents the progression of the disease in childhood.
