Sydenham’s chorea: an update on pathophysiology, clinical features and management

Vasconcelos, Luiz Paulo Bastos; Vasconcelos, Marcelle Cristina; Nunes, Maria do Carmo Pereira; Teixeira, Antônio Lúcio

doi:10.1080/21678707.2019.1684259

Cited by 8 publications

(8 citation statements)

References 88 publications

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“…Behavioral disorders have been consistently associated with SC, notably OCS, depression, anxiety disorders [6]. There is also evidence that RF is associated with these disorders [5].…”

Section: Discussionmentioning

confidence: 99%

“…In acute RF, carditis may be present in up to 70% of patients with SC [ 5 ]. Although a well-recognized comorbidity, there are conflicting data on the potential association between SC and severity of carditis and development of RHD.…”

Section: Discussionmentioning

confidence: 99%

“…The definition of chorea and tics followed standard clinical criteria [ 5 26 ]. Basal ganglia motor dysfunction (BGMD) was clinically defined by the presence hyperkinetic movement disorders associated with RF, suggesting the involvement of frontostriatal motor circuit, in other words patients with well-documented history of SC during childhood or adolescence, and patients with current chorea and/or tics on examination [ 5 27 ].…”

Section: Methodsmentioning

confidence: 99%

“…SC is an autoimmune condition supposedly resulting from basal ganglia dysfunction triggered by cross-reactive antibodies produced during group A beta-hemolytic streptococcus (GABHS) pharyngitis [ 4 ]. The symptoms usually begin four to eight weeks after GABHS infection, and include chorea and other motor and behavioral symptoms [ 5 ]. Obsessive-compulsive symptoms (OCS), anxiety and depressive disorders are among the most common behavioral manifestations [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…Obsessive-compulsive symptoms (OCS), anxiety and depressive disorders are among the most common behavioral manifestations [ 6 ]. Migraine, and cognitive impairment have also been reported in SC, notably in children and young adults [ 5 6 7 8 9 10 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Neurological and Psychiatric Disorders in Patients with Rheumatic Heart Disease: Unveiling what is Beyond Cardiac Manifestations

Vasconcelos

Flora

et al. 2022

Global Heart

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Background: Rheumatic heart disease (RHD) is the most serious manifestation of rheumatic fever, which may also affect the brain. The current study assessed the prevalence of neuropsychiatric manifestations in patients with RHD, including clinical features associated with basal ganglia motor dysfunction (BGMD). Methods:We conducted neurologic and psychiatric assessments in consecutive patients with RHD referred to a tertiary center for heart valve diseases. Echocardiography was performed to assess the pattern of valvular involvement and RHD severity. Validated questionnaires for the evaluation of cognition, depression, anxiety, and obsessive-compulsive symptoms (OCS) were applied. BGMD was clinically defined by the presence of hyperkinetic movement disorders.Results: Fifty patients with age of 43.2 ± 10.8 years, 84% female, were included. Mitral valve was affected in 47 patients (94%), and 21 of them (42%) also had aortic valve involvement. Chorea (22%), chronic tics (18%), OCS (48%), major depression (34%), generalized anxiety disorder (54%), cognitive complaints (66%), migraine (52%) and seizures (18%) were frequently reported. The factors associated with BGMD were age (p = 0.018), major depression (p = 0.013), and Yale-Brown Obsessive Compulsive (Y-BOCS) score (p = 0.011). The severity of heart disease was not associated with BGMD.Conclusions: Neuropsychiatric manifestations are frequent in RHD patients, which may persist up to three decades after acute rheumatic fever. Age, major depression and severity of OCS were independently associated with BGMD. These manifestations deserve a close attention of clinicians and researchers dealing with adult patients with RHD.

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“…Behavioral disorders have been consistently associated with SC, notably OCS, depression, anxiety disorders [6]. There is also evidence that RF is associated with these disorders [5].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Neurological and Psychiatric Disorders in Patients with Rheumatic Heart Disease: Unveiling what is Beyond Cardiac Manifestations

Vasconcelos

Flora

et al. 2022

Global Heart

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Managing and treating Sydenham chorea: A systematic review

et al. 2023

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Introduction Sydenham's chorea (SC), prevalent in developing countries and occasionally affecting developed ones, poses a clinical challenge due to the lack of systematic guidelines for diagnosis and treatment. Resulting from Group A Beta‐Hemolytic Streptococcus infection, SC presents various symptoms. This review aims to collect and evaluate available data on SC management to propose a cohesive treatment plan. Methods We searched PubMed, the Cochrane Library, Google Scholar, and ClinicalTrials.gov for literature on SC management from inception until 24th July 2022. Studies were screened by titles and abstracts. Cochrane Collaboration's Risk of Bias tool (RoB‐1) assessed Randomized Controlled Trials, while the Risk of Bias In Non‐randomized Studies of Interventions (ROBINS‐I) tool evaluated nonrandomized studies. Results The review includes 11 articles assessing 579 patients. Excluding one study with 229 patients, of the remaining 550 patients, 338 (61.5%) were females. Treatments used were dopamine antagonists in 118 patients, antiepileptics in 198, corticosteroids in 134, IVIG in 7, and PE in 8 patients. Dopamine antagonists, particularly haloperidol, were the primary treatment choice, while valproic acid (VPA) was favored among antiepileptics. Prednisolone, a corticosteroid, showed promising results with weight gain as the only side‐effect. Our review emphasizes the importance of immunomodulators in SC, contrasting previous literature. Conclusion Despite limitations, dopamine antagonists can serve as first‐line agents in SC management, followed by antiepileptics. The role of immunomodulators warrants further investigation for conclusive recommendations.

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Neurologic complications of rheumatic fever

Hawkes

Ameriso

2021

Handbook of Clinical Neurology

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Sydenham’s chorea: an update on pathophysiology, clinical features and management

Cited by 8 publications

References 88 publications

Neurological and Psychiatric Disorders in Patients with Rheumatic Heart Disease: Unveiling what is Beyond Cardiac Manifestations

Neurological and Psychiatric Disorders in Patients with Rheumatic Heart Disease: Unveiling what is Beyond Cardiac Manifestations

Managing and treating Sydenham chorea: A systematic review

Neurologic complications of rheumatic fever

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