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Chorea (Rheumatic Chorea)

Involuntary, forcible, rapid, jerky movements that may be subtle or become confluent, markedly altering normal patterns of movement. Hypotonia and pendular reflexes are often associated. Conditions which feature recurrent or persistent episodes of chorea as a primary manifestation of disease are referred to as CHOREATIC DISORDERS. Chorea is also a frequent manifestation of BASAL GANGLIA DISEASES.

Also Known As:

Rheumatic Chorea; Chorea, Rheumatic; Chorea, Sydenham; Sydenham Chorea; Choreas; Chorea Disorders; Chorea Syndromes; Chorea, Benign Hereditary; Chorea, Chronic Progressive; Chorea, Senile; Choreatic Syndromes; Choreic Movement; Dyskinesias, Paroxysmal; Hereditary Chorea; Paroxysmal Dyskinesias; Senile Chorea; St. Vitus's Dance; Sydenham's Chorea; Benign Hereditary Chorea; Benign Hereditary Choreas; Chorea Disorder; Chorea Syndrome; Chorea, Hereditary; Chorea, Sydenham's; Choreas, Benign Hereditary; Choreas, Chronic Progressive; Choreas, Hereditary; Choreas, Rheumatic; Choreas, Senile; Choreas, Sydenham; Choreatic Disorder; Choreatic Syndrome; Choreic Movements; Choreiform Movements; Chronic Progressive Chorea; Chronic Progressive Choreas; Dance, St. Vitus's; Dances, St. Vitus's; Disorder, Chorea; Disorder, Choreatic; Disorders, Chorea; Disorders, Choreatic; Dyskinesia, Paroxysmal; Hereditary Chorea, Benign; Hereditary Choreas; Hereditary Choreas, Benign; Movement, Choreic; Movement, Choreiform; Movements, Choreic; Movements, Choreiform; Paroxysmal Dyskinesia; Progressive Chorea, Chronic; Progressive Choreas, Chronic; Rheumatic Choreas; Senile Choreas; St. Vitus Dance; St. Vitus's Dances; St. Vituss Dance; Sydenham Choreas; Sydenhams Chorea; Syndrome, Chorea; Syndrome, Choreatic; Syndromes, Chorea; Syndromes, Choreatic; Vitus's Dance, St.; Vitus's Dances, St.; Choreatic Disorders; Choreiform Movement

Networked: 1115 relevant articles (87 outcomes, 70 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Chorea (Rheumatic Chorea)
2.	Huntington Disease (Huntington's Disease)
3.	Dystonia (Limb Dystonia)
4.	Movement Disorders (Movement Disorder)
5.	Dyskinesias (Dyskinesia)

Experts

1.	Cardoso, Francisco: 16 articles (11/2015 - 11/2003)
2.	Jankovic, Joseph: 14 articles (02/2013 - 11/2002)
3.	Dale, Russell C: 8 articles (12/2015 - 08/2010)
4.	Cunningham, Madeleine W: 8 articles (01/2015 - 07/2003)
5.	Sullivan, Kelly L: 8 articles (01/2011 - 06/2005)
6.	Zesiewicz, Theresa A: 8 articles (01/2011 - 06/2005)
7.	Giovannoni, G: 8 articles (01/2007 - 11/2001)
8.	Swedo, Susan E: 7 articles (02/2015 - 07/2003)
9.	Hauser, Robert A: 7 articles (03/2008 - 06/2005)
10.	Richter, Angelika: 7 articles (10/2005 - 11/2002)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Chorea:

1.	Tetrabenazine (Nitoman)FDA Link 12/01/2011 - "The antichorea efficacy of tetrabenazine was maintained in an 80-week extension study (n = 75), with the adjusted mean UHDRS total maximum chorea score significantly (p < 0.001) reduced from baseline (score of 14.9) by 4.6 points (primary outcome). " 03/01/2015 - "On the basis of some research evidence and clinical experience, tetrabenazine may be effective in treating chorea. " 01/01/2012 - "This pilot study demonstrates tetrabenazine's potential effects beyond improvement in chorea." 01/01/2013 - "Tetrabenazine treatment was associated with long-term improvement in chorea. " 01/01/2013 - "Safety and Efficacy of Tetrabenazine and Use of Concomitant Medications During Long-Term, Open-Label Treatment of Chorea Associated with Huntington's and Other Diseases."
2.	Valproic Acid (Valproate, Semisodium)FDA LinkGeneric 02/01/1996 - "Sodium valproate, whenever used, was effective in controlling the chorea." 09/01/1985 - "Valproic acid is proposed as an effective treatment for severe cases of Sydenham chorea." 09/01/2004 - "Valproic acid is an effective and safe drug in the treatment of Sydenham's chorea." 04/01/1988 - "Efficacy of valproic acid in the treatment of Sydenham's chorea." 07/01/1987 - "Efficacy of valproic acid in the treatment of Sydenham's chorea."
3.	Haloperidol (Haldol)FDA LinkGeneric 09/01/2007 - "All affected individuals presented slowly progressive choreic movements in their upper and lower extremities, trunk and head with an age of onset ranging from 40 to 66 (average 54.3), which were markedly improved by haloperidol. " 10/01/1989 - "However, haloperidol reduction in the chorea scores was significantly greater in 3 patients, while there was no difference in 2 other cases. " 10/01/1989 - "Though improvement in chorea scores over baseline values was greater under TBZ (46.3 +/- 23.4) than haloperidol (28.6 +/- 47.7), the difference did not reach statistical significance (Student t tests). " 03/01/2001 - "His chorea responded to haloperidol but encephalo-duro-arterio-synangiosis on the right side improved all symptoms. " 01/01/2013 - "The impairment of D2 receptor function in the basal ganglia may result in exacerbation of the chorea induced by haloperidol. "
4.	Levodopa (L Dopa)FDA LinkGeneric 06/14/2005 - "Surprisingly, treatment with levodopa improved gait dramatically and reduced chorea in two patients. " 06/01/1991 - "We conclude that any patient with levodopa-associated chorea who cannot be regulated on the basis of observation alone should be studied with simultaneous plasma levodopa measurements and clinical monitoring to detect an unusual plasma levodopa pattern that may be improved by adjustment of dosing schedule." 06/01/1999 - "All of the patients also had severe diphasic and peak-dose chorea, so that it was possible to study the effect of high-frequency stimulation on the different types of levodopa-induced dyskinaesias. " 03/01/2012 - "We describe the clinical phenotype and response to levodopa treatment in a 6 year-old girl affected with sporadic non-progressive chorea, and a de novo TITF-1 gene mutation, in order to increase understanding of this rare and misdiagnosed disorder." 05/01/2006 - "Twelve patients developed severe levodopa induced chorea. "
5.	Antipsychotic Agents (Antipsychotics)IBA 09/01/2007 - "Our knowledge about treatment of chorea is limited, and studies have focused on the use of neuroleptics only. " 09/15/2014 - "However, its use has limitations, and in the setting of specific contraindications or comorbidities the treatment of choice for chorea is still the multipurpose antipsychotics. " 06/01/2012 - "High susceptibility of extrapyramidal effects of neuroleptics in patients with Sydenham's chorea suggests underlying nigro-striatal dysfunction. " 06/30/2004 - "Neuroleptic agents alleviated the chorea and the patients did not relapse after neuroleptic agents were halted." 02/01/2002 - "She had not taken neuroleptic drugs and there was no family history of chorea. "
6.	Carbamazepine (Tegretol)FDA LinkGeneric 08/01/2000 - "We suggest that carbamazepine may serve as a first-line treatment for rheumatic chorea." 01/01/2007 - "We present a case of rheumatic chorea, in which carbamazepine therapy produced excellent clinical response." 01/01/2007 - "[Sydenham's chorea: report of a case treated with carbamazepine with excellent clinical response]." 12/21/2006 - "They also share features with paroxysmal dyskinesia and carbamazepine markedly ameliorated the symptoms at least in one patient. " 11/01/2003 - "We also report an excellent response to carbamazepine in subthalamic paroxysmal dyskinesias."
7.	Dopamine (Intropin)FDA LinkGeneric 06/01/2003 - "Despite medication with a dopamine antagonist, choreiform movement of the left limb had not improved, and the patient complained of rigidity and slowness of ambulation owing to the side effects of the medicine. " 03/01/1979 - "It is suggested that increased dopamine metabolism is involved in the pathogenesis of Sydenham's chorea and that the determination of urinary HVA and the HVA:VMA ratio may be helpful in establishing this diagnosis. " 10/01/2011 - "Some clinical assessments correlated with striatal dopamine D(2) receptor binding, including severity of chorea and cognitive test performance. " 01/01/2007 - "This review emphasizes the advantage of TBZ over dopamine-depleting compounds used in the treatment of chorea and reveals its clinical efficacy and side effects." 06/01/2004 - "Striatal increase of extracellular dopamine levels during dystonic episodes in a genetic model of paroxysmal dyskinesia."
8.	etiracetam (levetiracetam)FDA LinkGeneric 07/01/2005 - "Side effects from levetiracetam resolved completely within 7 days of levetiracetam discontinuation, and chorea returned to baseline." 06/01/2005 - "The chorea improved markedly with the use of levetiracetam (LEV, Keppra)." 07/01/2015 - "A New Alternative Drug With Fewer Adverse Effects in the Treatment of Sydenham Chorea: Levetiracetam Efficacy in a Child." 01/01/2006 - "Treatment of chorea with levetiracetam." 01/01/2005 - "Levetiracetam in the treatment of vascular chorea: a case report."
9.	LithiumIBA 01/01/2014 - "In humans, several clinical studies of HD patients found that lithium treatment improved mood, and that VPA treatment both stabilized mood and moderately reduced chorea. " 12/01/1989 - "Spontaneous choreiform movements were again relieved on lithium withdrawal. " 11/01/1996 - "Chorea caused by lithium intoxication: a case report and literature review." 07/16/1980 - "Chorea-a complication of lithium." 07/15/1978 - "Amine metabolites in cerebrospinal fluid from Huntigton's chorea patients treated with lithium."
10.	olanzapine (Zyprexa)FDA Link 09/16/2002 - "The improvement of chorea suggests that olanzapine has a dopaminergic D2 receptors blocking action." 09/16/2002 - "[Olanzapine improves chorea in patients with Huntington's disease]." 09/01/1999 - "Olanzapine, an atypical antipsychotic drug, was administered to a patient with Huntington's disease (HD) with marked choreiform movements. " 01/01/2014 - "Some newer neuroleptic agents, such as olanzapine and aripiprazole, may have adequate efficacy with a more favorable adverse effect profile than older neuroleptic agents for treating chorea and psychosis. " 03/26/2010 - "Newer antipsychotic agents such as olanzapine and aripiprazole may have adequate efficacy with a more favourable adverse-effect profile than older antipsychotics for treating chorea and psychosis. "

Therapies and Procedures

1.	Aftercare (After-Treatment) 03/01/2015 - "The mean time for chorea resolution after treatment was significantly shorter in C-NKH patients than in C-URE patients (4.4 ± 2.6 d vs. 73.8 ± 14.2 d, respectively; P = 0.005). " 10/01/1987 - "Two were young patients whose chorea developed long after treatment had been started and disappeared soon after it had been discontinued. " 06/01/1997 - "We report a 56-year-old man with Huntington's disease whose chorea substantially improved after treatment with electroconvulsive therapy (ECT). " 06/01/1996 - "The chorea resolved within 2 days after treatment of the hyperglycemia in 9 patients. " 09/01/1987 - "[Thirteen-year-old girl presenting chorea after treatment of hyperthyroidism]."
2.	Pallidotomy 06/25/1962 - "[Electromyographical analysis of the choreic movements and effect of pallidotomy]." 07/01/1952 - "Thalamotomy and pallidotomy in chorea." 01/01/1952 - "Thalamotomy and pallidotomy for treatment of choreic movements." 11/01/2007 - "The rate model cannot explain the improvement of ballismus and chorea by pallidotomy because pallidotomy increases the disinhibition of the thalamocortical projection, which should increase the movements. " 01/01/2007 - "The rate model cannot explain the improvement of ballismus and chorea by pallidotomy because pallidotomy increases the disinhibition of the thalamocortical projection, which should increase the movements. "
3.	Deep Brain Stimulation 05/01/2004 - "Senile chorea treated by deep brain stimulation: a clinical, neurophysiological and functional imaging study." 03/01/2012 - "Deep brain stimulation in the treatment of chorea." 09/01/2010 - "Successful bilateral deep brain stimulation of the globus pallidus internus for persistent status dystonicus and generalized chorea." 07/01/2008 - "Chronic deep brain stimulation resulted in remarkable improvement of choreic movements. " 05/01/2004 - "We report on a patient with senile chorea, treated with deep brain stimulation of the left globus pallidus internus and subsequently the left ventralis oralis posterior nucleus of the thalamus. "
4.	Activities of Daily Living (ADL) 04/11/2006 - "In an analysis based on the Random Effects Model, CAG length was significantly associated with the rate of progression of all measures except chorea and ADL. " 04/11/2006 - "Subjects were administered the Quantified Neurological Examination, with its subsets the Motor Impairment and Chorea Scores, the Mini-Mental State Examination, and the HD Activities of Daily Living (ADL) Scale. " 05/01/2005 - "The Universidade Federal de Minas Gerais (UFMG) Sydenham's Chorea Rating Scale (USCRS) was designed to provide a detailed quantitative description of the performance of activities of daily living, behavioral abnormalities, and motor function of subjects with SC. " 10/01/2003 - "We examined the correlations between the neuropathological grade and scores on the Quantified Neurological Examination (QNE) and its chorea and motor impairment subscales, the Mini-Mental State Examination (MMSE), the HD Activities of Daily Living (ADL) Scale, and a number of demographic variables (CAG number, age of onset, age at death, disease duration) in 100 subjects who had been examined within 1,000 days of death. " 05/01/1994 - "Subjective self-evaluation of all patients reported reduction of chorea and improvement of daily living activities. "
5.	Radiotherapy 01/01/1988 - "Chorea of her left arm subsided with progressing disease while remission of right-sided segmental dystonia was observed following radiotherapy of the brain. "