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Recognizing red flags for alternative diagnoses in pediatric chorea beyond Sydenham's
Jennifer J Guzmán-Porras1, Oscar M Espitia Segura2, Lizeth V Gómez Diaz3
1Qualitative and Quantitative Research Network in Neuropediatrics (in Spanish RICCNeP), Colombia; Neuropediatric Department, HOMI Fundación Hospital Pediátrico la Misericordia, Bogotá, Colombia; Research Group "Neuroped-UNAL", Colombia; Medical School, Universidad Nacional de Colombia, Bogotá, Colombia.
Insights
Pediatric chorea is often caused by rheumatic fever, vascular issues, or lupus. Early diagnosis is key, as age and neurological findings can indicate different causes, and psychiatric symptoms correlate with age.
Area of Science:
- Pediatric Neurology
- Movement Disorders
- Rheumatology
Background:
- Chorea is a prevalent pediatric movement disorder requiring accurate etiological diagnosis.
- Identifying treatable causes of chorea improves patient outcomes and quality of life.
Purpose of the Study:
- To characterize the clinical, demographic, and epidemiological features of pediatric and adolescent chorea patients.
- To identify key diagnostic indicators for various chorea etiologies.
Main Methods:
- Retrospective cross-sectional study.
- Analysis of 81 pediatric patients diagnosed with chorea.
- Data collected from a tertiary hospital in Bogotá, Colombia (2008-2022).
Main Results:
- Rheumatic fever (Sydenham's chorea) was the most common cause (50.6%), followed by vascular chorea (29.3%) and lupus (11.1%).
- Patients with Sydenham's chorea were significantly older (10.36 ± 3.41 years) than those with other etiologies (8.29 ± 5.16 years).
- Psychiatric symptoms showed a positive correlation with age (OR 1.14 per year), irrespective of etiology.
Conclusions:
- Younger age, additional movement disorders, or neurological findings may suggest an etiology other than Sydenham's chorea.
- Neuropsychiatric manifestations are common in pediatric chorea and correlate with patient age.
- Timely diagnosis and etiological identification are crucial for managing pediatric chorea.
Background:
Chorea is a common movement disorder in children, requiring thorough clinical assessment and appropriate tests for etiological diagnosis. Early identification of treatable conditions can lead to effective treatment, reducing morbidity and improving quality of life.
Objective:
To describe the clinical, demographic, and epidemiological characteristics of children and adolescents diagnosed with chorea.
Methods:
A retrospective cross-sectional study of pediatric patients treated in a fourth-level hospital in Bogotá, Colombia, from January 2008 to January 2022.
Results:
81 patients with chorea were found. The most frequent etiologies were rheumatic fever (50.6 %), vascular chorea (29.3 %), and chorea secondary to lupus (11.1 %). Patients with chorea secondary to rheumatic fever (Sydenham's chorea) were older compared to other etiologies, 10.36 ± 3.41 years vs 8.29 ± 5.16, p = 0.037. The presence of another movement disorder or abnormalities during the physical examination suggests a different etiology from rheumatic fever. Moreover, the presence of psychiatric symptoms was similar in all etiologies. However, a correlation between age and psychiatric symptoms was observed with an odds ratio of 1.14 95 % CI 1.02-1.29 per year.
Conclusions:
Red flags in Sydenham's chorea suggesting an alternate etiology are younger age, the presence of other abnormal movements or other findings in the neurological exam or in the magnetic resonance imaging. No significant statistical differences were found between the etiologies with the presence of neuro-psychiatric manifestations. Nevertheless, these manifestations are very frequent in abnormal movements. This study evidenced the positive correlation between age and the presence of psychiatric symptoms.
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