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Updated: Aug 23, 2026
Handwriting Analysis Indicates Spontaneous Dyskinesias in Neuroleptic Naïve Adolescents at High Risk for Psychosis
Published on: November 21, 2013
Dyskinesias and associated psychiatric disorders following streptococcal infections
R C Dale1, I Heyman, R A H Surtees
1Neurosciences Unit, Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, London, UK. R.Dale@ion.ucl.ac.uk
Background:
The classical extrapyramidal movement disorder following beta haemolytic streptococcus (BHS) infection is Sydenham's chorea (SC). Recently, other post-streptococcal movement disorders have been described, including motor tics and dystonia. Associated emotional and behavioural alteration is characteristic.
Aims:
To describe experience of post-streptococcal dyskinesias and associated co-morbid psychiatric features presenting to a tertiary referral centre 1999-2002.
Methods:
In all patients, dyskinetic movement disorders followed BHS pharyngeal infection. BHS infection was defined by pharyngeal culture of the organism, or paired streptococcal serology. Movement disorders were classified according to international criteria, and validated by experienced child neurologists. Psychiatric complications were defined using ICD-10 criteria using a validated psychiatric interview.
Results:
In the 40 patients, the following dyskinetic movement disorders were present: chorea (n = 20), motor tics (n = 16), dystonia (n = 5), tremor (n = 3), stereotypies (n = 2), opsoclonus (n = 2), and myoclonus (n = 1). Sixty five per cent of the chorea patients were female, whereas 69% of the tic patients were male. ICD-10 psychiatric diagnoses were made in 62.5%. Using the same psychiatric instrument, only 8.9% of UK children would be expected to have an ICD-10 psychiatric diagnosis. Emotional disorders occurred in 47.5%, including obsessive-compulsive disorder (27.5%), generalised anxiety (25%), and depressive episode (17.5%). Additional psychiatric morbidity included conduct disorders (27.5%) and hyperkinetic disorders (15%). Psychiatric, movement, and post-streptococcal autoimmune disorders were commonly observed in family members. At a mean follow up of 2.7 years, 72.5% had continuing movement and psychiatric disorders.
Conclusion:
Post-streptococcal dyskinesias occur with significant and disabling psychiatric co-morbidity and are potential autoimmune models of common "idiopathic" movement and psychiatric disorders in children. Multiple factors may be involved in disease expression including genetic predisposition, developmental status, and the patient's sex.
Insights
Post-streptococcal dyskinesias, including Sydenham's chorea, are linked to significant psychiatric issues in children. These movement disorders often persist, highlighting a potential autoimmune connection to common childhood conditions.
Area of Science:
- Pediatric Neurology
- Neuroimmunology
- Child Psychiatry
Background:
- Sydenham's chorea (SC) is a known movement disorder following beta-hemolytic streptococcus (BHS) infection.
- Other post-streptococcal movement disorders, such as tics and dystonia, have been increasingly recognized.
- These conditions are often accompanied by emotional and behavioral changes.
Purpose of the Study:
- To document the clinical experience of post-streptococcal dyskinesias.
- To characterize associated psychiatric comorbidities in affected children.
- To analyze presentation at a tertiary referral center between 1999 and 2002.
Main Methods:
- Patients diagnosed with dyskinetic movement disorders following BHS pharyngeal infection.
- BHS infection confirmed by throat culture or serology.
- Movement disorders classified using international criteria and psychiatric complications by ICD-10 criteria.
Main Results:
- Chorea, tics, and dystonia were the most common dyskinetic disorders observed.
- A high prevalence of psychiatric diagnoses (62.5%) was noted, significantly exceeding general population rates.
- Obsessive-compulsive disorder, anxiety, and conduct disorders were frequent comorbidities.
Conclusions:
- Post-streptococcal dyskinesias present with substantial psychiatric morbidity.
- These disorders may serve as autoimmune models for idiopathic childhood movement and psychiatric conditions.
- Genetic predisposition, developmental stage, and sex may influence disease manifestation.
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