Objective: To describe the prevalence, presentation and etiology of chorea (including ballism and athetosis) in adults as seen at a tertiary medical center in Israel over a period of 21 years.

Background: The diagnosis of chorea can be challenging. In the past, many cases were considered idiopathic. In the last two decades, novel etiologies for chorea have been brought to light and may account for cases that were previously undiagnosed.

Method: The medical files of Rabin Medical Center were accessed. Identification of diagnosis was done using the ICD-9 codes for `Chorea` `Other Chorea`s`, `Rheumatic Chorea`, `Huntington`s Chorea` and `Abnormal involuntary movements` between Jan 2000 – Dec 2022. Patient records were screened for demographic and clinical characteristics, blood and CSF results, imaging data, treatment and prognosis.

Results: 93 patients with sufficient data on clinical features and evaluation of chorea/choreoathetosis in the past 22 years were included. Mean age at diagnosis was 70±21. No predisposition for sex or ethnic group was identified. Onset was acute in 46%, chronic in 44% and subacute in 10%. Main etiologies included: Vascular 36%, Huntington`s Disease 23%, hyperglycemic state (Non-ketotic) 9%, rheumatic 8% and paraneoplastic 4%. 8% of cases remained idiopathic or undetermined. Of 4 cases with paraneoplastic chorea 3 were positive for Anti-Yo Antibodies in the CSF. All cases of paraneoplastic and non ketotic hyperglycemic chorea were diagnosed in the last decade.

Conclusion: The prevalence of paraneoplastic and non ketotic hyperglycemia chorea increased over the last decade. Correct diagnosis is essential for treating the underlying cause with high rates of symptom improvement. Clinicians should keep in mind the current updates when approaching workup of chorea.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-new-era-in-etiologies-of-chorea/