Managing and treating Sydenham chorea: A systematic review.

Area of Science:

• Neurology
• Pediatric Neurology
• Infectious Diseases

Background:

• Sydenham's chorea (SC) is a challenging neurological disorder resulting from Group A Beta-Hemolytic Streptococcus infection, often lacking systematic diagnostic and treatment guidelines.
• This review addresses the clinical challenge posed by SC, particularly its prevalence in developing nations and sporadic occurrence worldwide.

Approach:

• A comprehensive literature search was conducted across PubMed, Cochrane Library, Google Scholar, and ClinicalTrials.gov up to July 24, 2022.
• Eleven articles involving 579 patients were reviewed, with study quality assessed using Cochrane's RoB-1 and ROBINS-I tools.

Key Points:

• Dopamine antagonists, primarily haloperidol, were the most common first-line treatment for SC.
• Antiepileptics, notably valproic acid (VPA), and corticosteroids like prednisolone were also utilized, with prednisolone showing promise and minimal side effects.
• Immunomodulators, including IVIG and PE, were used in a small subset of patients, highlighting a potential area for further investigation.

Conclusions:

• Dopamine antagonists are recommended as initial agents for managing Sydenham's chorea, with antiepileptics as a subsequent option.
• The efficacy and role of immunomodulators in SC treatment require additional research to establish definitive recommendations.