Sydenham's chorea: from pathophysiology to therapeutics.

Area of Science:

• Neurology
• Immunology
• Pediatrics

Background:

• Sydenham's chorea is an autoimmune condition triggered by Group A beta-hemolytic streptococcal (GABHS) infections.
• It presents with chorea, and can involve carditis, arthritis, and neuropsychiatric symptoms like anxiety and obsessive-compulsive disorder.

Purpose of the Study:

• To review the pathophysiology, clinical characteristics, and therapeutic strategies for Sydenham's chorea.
• To address the controversies and limited high-quality evidence in treating this condition.
• To present a treatment algorithm for Sydenham's chorea.

Main Methods:

• Literature review of pathophysiology, clinical presentation, and treatment evidence for Sydenham's chorea.
• Analysis of existing therapeutic approaches including secondary prevention of GABHS infections, chorea reduction, and immune modulation.
• Development of a serial treatment algorithm based on clinical severity and treatment response.

Main Results:

• Sydenham's chorea is a model for pediatric autoimmune neuropsychiatric disorders, though research is marked by conflicting results.
• High-quality interventional studies on therapeutics are limited, often relying on clinical experience.
• A treatment algorithm is proposed, guiding management based on symptom severity and pharmacotherapy response.

Conclusions:

• Effective management of Sydenham's chorea requires addressing GABHS infection, chorea, and neuropsychiatric symptoms.
• Further high-quality research is needed to establish evidence-based therapeutic guidelines.
• The proposed algorithm offers a structured approach to treatment selection in clinical practice.