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Sydenham's chorea: a possible presynaptic dopaminergic dysfunction initially.

S Naidu, N Narasimhachari

    Annals of Neurology
    |October 1, 1980
    PubMed
    Summary
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    This study highlights a case of childhood chorea linked to streptococcal infection. Reserpine treatment effectively reduced symptoms and homovanillic acid levels, suggesting dopaminergic overactivity.

    Area of Science:

    • Pediatric Neurology
    • Neuroimmunology
    • Movement Disorders

    Background:

    • Childhood chorea can be associated with group A streptococcal infections.
    • Elevated homovanillic acid in cerebrospinal fluid may indicate dopaminergic pathway involvement.

    Observation:

    • A 10-year-old girl presented with chorea and elevated antibodies to group A Streptococcus.
    • Cerebrospinal fluid (CSF) homovanillic acid (HVA) levels were markedly elevated prior to treatment.

    Findings:

    • Haloperidol provided minimal symptom relief.
    • Reserpine monotherapy led to remarkable improvement in chorea within one week.
    • CSF HVA levels moderately decreased after one month of reserpine treatment.
    • Discontinuation of reserpine resulted in symptom recurrence.

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    Implications:

    • The findings suggest presynaptic dopaminergic overactivity in this case of chorea.
    • Reserpine's efficacy points towards a potential therapeutic role in similar neuroinflammatory movement disorders.
    • Further research into dopamine regulation in post-infectious chorea is warranted.