Sydenham's chorea in western Pennsylvania

Area of Science:

• Pediatric Neurology
• Infectious Diseases
• Rheumatology

Background:

• Chorea is a movement disorder characterized by involuntary, irregular movements.
• Sydenham's chorea (SC), a sequela of group A streptococcal infection, is a common cause of childhood chorea.
• Diagnostic workups for pediatric chorea often include extensive laboratory and radiographic studies.

Purpose of the Study:

• To determine the causes of childhood chorea in an area endemic for acute rheumatic fever (ARF).
• To evaluate the utility of neuroimaging in diagnosing SC.
• To identify characteristic features of SC in pediatric patients.

Main Methods:

• Retrospective chart review of patients diagnosed with chorea between 1980 and 2004.
• Inclusion criteria: new-onset chorea without pre-existing neurologic disorders.
• Analysis of demographic, clinical, laboratory, and imaging data.

Main Results:

• SC accounted for 96% of childhood chorea cases in this study population.
• Female predominance (71%) and mean age of 9.8 years observed in SC patients.
• Neuroimaging (MRI/CT) was abnormal in a minority of SC patients and did not aid diagnosis; it was useful in atypical cases.

Conclusions:

• SC is the predominant cause of acute chorea in pediatric populations in ARF-endemic regions.
• Diagnosis of SC is best achieved through clinical assessment and laboratory evaluation.
• Neuroimaging should be reserved for atypical chorea presentations, not routine SC diagnosis.