Chorea

Chorea is a particular kind of abnormal movement problem that is a key feature of Sydenham’s chorea, although it can be seen in other conditions.

The movements are involuntary, that is to say the child cannot help control them, and in this sense they are similar to tics.  

The child will often look as if they are unsteady, as if there legs are going away from under them, or as if they are staggering.  They will often find it difficult to do things with their hands, such as writing or playing, because their hands and arms will keep going the wrong way.

The chorea usually develops over a day or two.  Sometimes it only involves one side of the body.

There are other abnormal movements that are seen in Sydenham’s Chorea, such as grimacing (odd facial expressions) and “piano playing” movements of the hands and fingers.  Speech is often affected. The whole body tends to be more floppy than usual (this is called “hypotonia”).

Symptoms can vary over time, for example the chorea is often more noticeable if a child is tired or unwell. 

Your Neurologist may try to treat the movement disorder if it is having a major impact on the child’s day to day functioning. With or without medication, It almost always settles down although it usually takes 2 to 4 months, and in some cases it can take a year or more.  It just varies from patient to patient.

See our Youtube Playlist for more examples.

Tics

There are children who suddenly develop tics, where it isn’t clear whether the diagnosis is Sydenham’s chorea or something else, for example PANDAS.  Tics are quite common in childhood, more common in boys, they often come and go over the years before disappearing around or after puberty.  It can be hard to tell the difference between tics and chorea, which is why having an experienced doctor is important.  

Tics are sudden, jerky or flailing movements, typically of the eyes, face, neck, shoulders and arms.  You will see the same movement happening over and over (this is called “stereotyped”), although there can be long breaks in between.  Many different tics can be present at the same time, and one kind of tic can go away after a while, only to be replaced by another.  Some children also make involuntary noises, such as grunts and yelps, these are also a kind of tic (“vocal tic”).

Chorea tends to be a mixture of fast (jerky) and slower (writhing) movements, and tends to be more chaotic and unpredictable.   

So observing and describing all the different kind of movements is really important for getting to a diagnosis, as is looking for the other features of Sydenham’s chorea such as the grimacing and “piano playing” fingers mentioned above, plus features of streptococcal infection and evidence of rheumatic fever (such as heart damage).