An unusual cause of recurrent chorea

Abstract

Recurrent chorea is described in a 61-year-old woman who had had chorea gravidarum when she was younger. The recurrent chorea appeared to be induced by a topical vaginal cream that contained conjugated estrogen. This case is consistent with the existence of a recurrent syndrome of hormone-induced chorea. The effect of estrogen on the basal ganglia is complex and not fully understood.

Moyamoya‐induced paroxysmal dyskinesia

“…The influence of sexual hormones on the basal ganglia has been studied, although it is not yet understood completely 21–23. Hormonal factors are known to play a role in the pathophysiology of chorea, as exemplified by chorea gravidarum and oral contraceptive or estrogen‐induced chorea 24–26. In our reviewed cases there was a female predominance.…”

A case of dystonia with onset during pregnancy

“…In particular, it has been reported that human chorionic gonadotropin, whose levels significantly increase in the first days of pregnancy, decreases the maximum number of action potentials in neurons of the hippocampus, preventing choreoathetotic attacks [2]; vaginal estrogen therapy decreases chorea attacks in a patient with chorea gravidarum [3]; and oral contraceptive therapy has been reported to be associated to movement disorders (like chorea) -this has been attributed to estrogens that can increase dopamine levels in the brain or dopamine receptor sensitivity [4,5].…”

Dystonia gravidarum: A new entity?

“…Van Hartesveldt and Joyce have shown that estrogen regulates behaviors mediated by the basal ganglia 8. Caviness and Muenter have described how estrogen, absorbed through a topical vaginal cream, precipitated recurrence of chorea in a 61‐year‐old lady who had chorea gravidarum when she was younger 9. It is possible that other hormones that are increased in pregnancy might play a role in the development of movement disorders in pregnancy.…”