Objective: We aimed to investigate and compare data on chorea following SARS-CoV-2 infection and vaccination to provide an extensive perspective on this pathology and to reveal what other, more specific, research questions can be further addressed. In addition, we aimed to highlight research gaps requiring further attention.

Background: Chorea has multiple underlying causes, like genetic, immune-mediated, infectious, vascular, or metabolic conditions. Recently, chorea was reported following SARS-COV-2 infection or vaccination. Several systematic reviews on movement disorders report only a few cases in patients with COVID-19; none have assessed thoroughly or compared these two entities.

Method: We systematically reviewed two databases (LitCOVID and the World Health Organization database on COVID-19) up to February 2023. Individual patient data from case reports and case series were extracted and analyzed according to a previously published protocol.

Results: We found 16 articles reporting 14 cases of chorea in patients with COVID-19 and 8 cases in individuals receiving different types of SARS-CoV-2 vaccines. In the infection group, 42.9% of patients developed movement disorders concomitant with the viral illness. The onset was acute in 57.1% of cases and progressive in 21.4%. Also, 85.7% had generalized chorea. In the vaccination group, all patients developed acute chorea (100%), with 87.5% of cases presenting unilateral symptoms.

Conclusion: The clinical and paraclinical spectrum of chorea in patients with SARS-CoV-2 infection and vaccination is heterogeneous. Although they share some common features, they also present essential differences, possibly due to the underlying mechanisms. Future studies should aim for a comprehensive assessment of patients. In addition, there is a need for a standardized approach to investigation and reporting in this research area. Factors including the baseline characteristics of the patients, evolution, and treatments should be consistently assessed across studies, and a thorough differential diagnosis should be employed.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/chorea-following-sars-cov-2-infection-and-vaccination-a-systematic-review/