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Children With Sydenham Chorea and Psychiatric Disorders Had Variable Long-Term Outcomes and Required
Nadine Mushet1,2, Michael Morton2, Helen Minnis2
1Children and Young People's Services, Cumbria, Northumberland, Tyne & Wear NHS Trust, Newcastle, UK.
Insights
Sydenham chorea (SC) in children often leads to significant neuropsychiatric issues and requires long-term, multidisciplinary care. Many patients experience relapses and require ongoing support for associated conditions.
Area of Science:
- Pediatric Neurology
- Child Psychiatry
- Infectious Disease
Background:
- Sydenham chorea (SC) is a significant post-streptococcal neuropsychiatric condition in children, though less common in Western Europe.
- This study focuses on the neuropsychiatric manifestations and long-term outcomes of SC in pediatric patients.
Purpose of the Study:
- To investigate the long-term neuropsychiatric features and outcomes of Sydenham chorea in children.
- To identify associated psychopathology, co-occurring conditions, and management needs.
Main Methods:
- Retrospective single-center study of 12 children referred to a pediatric neurology department.
- Data collected via interviews on SC course, medical/family history, and semi-structured psychiatric interviews.
Main Results:
- Most participants had a significant delay in SC diagnosis and experienced debilitating physical symptoms.
- Anxiety and ADHD were common psychiatric comorbidities; 11 children had multiple psychiatric diagnoses.
- Nine children experienced relapses, highlighting the chronic and relapsing nature of SC neuropsychiatric sequelae.
Conclusions:
- Children with Sydenham chorea and psychiatric disorders exhibit variable long-term outcomes.
- Effective management necessitates a multidisciplinary approach involving various specialists and ongoing support.
Aim:
Sydenham chorea (SC) is a globally significant, post-streptococcal, childhood neuropsychiatric condition that is rare in western Europe. This retrospective single-centre study focused on children with neuropsychiatric features of SC.
Methods:
Participants were recruited from neuropsychiatry referrals to a regional paediatric neurology department in Glasgow, Scotland, from 2009 to 2012. Interviews established the course of SC and the children's medical and family histories. Semi-structured psychiatric interviews explored current and past episodes of psychopathology.
Results:
We studied 12 children (seven girls) with a mean age of 13 (range 10-15) years, and an average of six (range 4-10) years after their SC symptoms began. Before they displayed symptoms, seven children had been suspected or diagnosed neurodevelopmental problems and four had separation anxiety. Their physical symptoms were often debilitating. Psychopathology was most severe during their first episode and SC diagnoses were sometimes delayed. Educational problems were frequent. Multiple psychiatric conditions were diagnosed in 11 children and anxiety and attention deficit hyperactivity disorder were the most common. Relapses occurred in nine cases. Additional services that were accessed included cardiology, rheumatology, physiotherapy, occupational therapy and speech therapy. Medication included prophylactic penicillin and symptomatic treatment.
Conclusion:
Children with SC and psychiatric disorders had variable long-term outcomes and required multidisciplinary management.
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