Objective: To study the clinical features, investigations and treatment outcome in Sydenham’s chorea patients.

Background: Sydenham’s chorea is one of the major clinical manifestations of acute rheumatic fever. It is the most common form of acquired chorea in childhood. The incidence of acute rheumatic fever and Sydenham’s chorea has declined in developed countries due to regular use of antibiotics for group A streptococcal infections and better living conditions. However, acute rheumatic fever still possesses a major public health concern in poor countries. 1, 2

Method: This is a chart review of 20 patients of Sydenham’s chorea who were diagnosed among all the patients of chorea admitted in a tertiary care university teaching hospital. Their details regarding demographic, clinical, investigations, treatment and outcome data were recorded in a pre-structured proforma. Videos of patients were also analyzed to look for abnormal movements.

Results: Our cohort had a mean age at onset of disease was 10.7 years (range 5-20 years). We found asymmetric chorea in 20% patients. Chorea was mild in one, moderate in eight and severe in eleven patients. Significant behavioral disturbances like irritability, attention deficit hyperactivity disorder, obsessive-compulsive disorder, and depression was observed in 18 patients. Our study also revealed some co-existing conditions like tuberous sclerosis (n=1), and old left intra-cerebral hemorrhage (n=1). Other associated features of acute rheumatic fever like arthritis/arthralgia (n=6), carditis (n=4) and mitral regurgitation (n=1) were also detected. Eight patients had a preceding history of seizures. Interestingly, three children of the same family were affected with Sydenham’s chorea. Raised ASO titers were seen in 85%, and anti-DNase in 15% of the patients. Patients were treated with either sodium valproate (n=14) or haloperidol (n=4) or a combination of the two (n=2). Relapses were seen in 3 (15%) patients over an average period of 5.1 months (range 4 months to 1 year).

Conclusion: Our report suggests that Sydenham’s chorea, a manifestation of ARF is still a major health problem in our country. In our cohort, some interesting observations regarding Sydenham’s chorea were made which included very common neuropsychiatric comorbidities, co-existing conditions, including a history of seizure and familial cases in three siblings. The abstract was presented during MDSICON 2019, 22-24 February, New Delhi

References: 1) Seckeler MD, Hoke TR. The worldwide epidemiology of acute rheumatic fever and rheumatic heart disease. Clin Epidemiol. 2011 Feb 22;3: 67-84. 2) Eshel G, Lahat E, Azizi E, Gross B, Aladjem M. Chorea as a manifestation of rheumatic fever–a 30-year survey (1960-1990). Eur J Pediatr. 1993 Aug;152(8):645-6.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/sydenhams-chorea-clinical-features-and-treatment-outcome/