Treatment for Sydenham’s Chorea is based on the following steps:

• Most doctors will try to remove any Streptococcal infection from the child using a treatment course of Penicillin.  But the infection may have already cleared by the time the diagnosis is made
• In most cases, preventive, long term penicillin (or an alternative antibiotic, if you are allergic) is then recommended.  If your Sydenham’s chorea is part of rheumatic fever, then long term penicillin should definitely be given, to prevent heart damage, or worsening of any heart damage.
  • If you don’t have rheumatic fever, then it’s not clear whether long term penicillin prevents relapses of chorea, but it makes sense that it might.  There doesn’t appear to be a risk of heart damage if you have SC without other features of rheumatic fever.
  • See here for more on long term penicillin.

• Your doctor may offer medicines to treat the chorea if it is having a major impact on the child’s day to day functioning. There are not any large trials to help decide which medication is best, but doctors often use an epilepsy medicine called Sodium Valproate which can help reduce the chorea. Other medications which may be tried include Haloperidol, Pimozide, Carbamazepine and Clonidine.
• Your doctor may offer immune treatment.  There is certainly good evidence that steroid treatment reduces the severity and duration of the movement disorder (from an average of 119 days to just 54 days).  There is also good evidence that intravenous immunoglobulin (IVIG) treatment helps.  But there isn’t enough information from research yet to know about which children will benefit most from these treatments, which is better, or possible longer term benefits or harms. A brief scientific review is available here.
• Occupational therapy, physiotherapy and sometimes speech and language therapy is important for trying to help the child do as much for themselves as possible, and prevent loss of muscle strength.
• Mental health team input may be necessary where there are big problems  with mood or anxiety.