Chorea: Difference between revisions

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== Phenomenological Features ==
== Phenomenological Features ==


* '''Randomness'''
* Randomness
* '''Flowing Quality'''
* Flowing Quality
* '''Parakinesia'''-Patients blend their chorea-induced movements with their own normal movements.
* Parakinesia: Patients blend their chorea-induced movements with their own normal movements.
* '''Motor impersistence'''- the patient is unable to perform sustained motor activities.
* Motor impersistence: the patient is unable to perform sustained motor activities.
* '''Ballism'''- Variant of chorea which shows large-amplitude flinging movements involving proximal extremities.
* Ballism: Variant of chorea which shows large-amplitude flinging movements involving proximal extremities.
* '''Athetosis'''-Slow writhing movements involving distal limbs sometimes may be facing.
* Athetosis: Slow writhing movements involving distal limbs sometimes may be facing.
* '''Varying velocity of movements'''-quick velocity and low-amplitude movements accompanied by jerks.<ref name=":0" />
* Varying velocity of movements: quick velocity and low-amplitude movements accompanied by jerks.<ref name=":0" />


{{#ev:youtube|RxWEilu-Mf4}}
{{#ev:youtube|RxWEilu-Mf4}}
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Specific diagnosis can be made on the basis of symptoms/clinical features experienced by the patient.<ref name=":0" />Differential diagnoses include:
Specific diagnosis can be made on the basis of symptoms/clinical features experienced by the patient.<ref name=":0" />Differential diagnoses include:


* Huntington disease
* [https://www.physio-pedia.com/Huntington_Disease Huntington disease]
* [[Lyme Disease|Lyme disease]]
* [[Lyme Disease|Lyme disease]]
* [[Multiple System Atrophy|Multiple system atrophy]]
* [[Multiple System Atrophy|Multiple system atrophy]]
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Chorea requires a Multidisciplinary Approach to be treated.<ref>Feinstein E, Walker R. [https://link.springer.com/article/10.1007/s11940-018-0529-y An update on the treatment of chorea. Current Treatment Options in Neurology]. 2018 Oct;20(10):1-5.</ref>                                   
Chorea requires a Multidisciplinary Approach to be treated.<ref>Feinstein E, Walker R. [https://link.springer.com/article/10.1007/s11940-018-0529-y An update on the treatment of chorea. Current Treatment Options in Neurology]. 2018 Oct;20(10):1-5.</ref>                                   


The team includes  
The team includes:


* Psychiatrist
* Psychiatrist
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* Social worker
* Social worker
=== Medical Management ===
=== Medical Management ===
There is no cure for this disease but symptoms can be managed. Importantly an evaluation and creation of a patient's support system is needed. With disease progression, the patient will need specialized caregiving. Nutrition management is important, due to difficulty swallowing.<ref name=":1" />
There is '''no cure''' for this disease but symptoms can be managed. Importantly an evaluation and creation of a patient's support system is needed. With disease progression, the patient will need specialized care. Nutrition management is important, due to difficulty swallowing.<ref name=":1" />


1. '''Dopamine-depleting agents'''-Tetrabenazine, Deutetrabenazine, Valbenazine.
1. Dopamine-depleting agents: Tetrabenazine, Deutetrabenazine, Valbenazine.


2. '''Dopamine D2 receptor-blocking agents'''-Haloperidol, Clozapine, Olanzapine.
2. Dopamine D2 receptor-blocking agents: Haloperidol, Clozapine, Olanzapine.


3. '''Anticonvulsants'''- Valproic acid, Carbamazepine, Benzodiazepines, Levetiracetam.
3. Anticonvulsants: Valproic acid, Carbamazepine, Benzodiazepines, Levetiracetam.


4. '''Anti-glutamatergic agents'''-Amantadine, Riluzole.
4. Anti-glutamatergic agents: Amantadine, Riluzole.


5. '''Cannabinoids'''-Nabilone.
5. Cannabinoids: Nabilone.


6. '''Deep Brain Stimulation'''
6. [[Deep Brain Stimulation]]


== Physiotherapy Management ==
== Physiotherapy Management ==
The management will be same as of Huntington's Disease. You can read it [https://www.physio-pedia.com/Huntington_Disease?utm_source=physiopedia&utm_medium=search&utm_campaign=ongoing_internal#Physiotherapy_Management here].
The management will be same as of [https://www.physio-pedia.com/Huntington_Disease?utm_source=physiopedia&utm_medium=search&utm_campaign=ongoing_internal#Physiotherapy_Management Huntington's Disease].  


=== Goals of Management ===
=== Goals of Management ===


* Gait re-education
* [[Gait]] re-education
* [[Balance|Balance r]]<nowiki/>etraining
* [[Balance Training|Balance r]]<nowiki/>[[Balance Training|etraining]]
* [[Falls|Fall]] prevention/management
* [[Falls|Fall]] prevention/management
* Aerobic capacity
* [[Aerobic Exercise|Aerobic]] capacity
* Muscle [[Strength and Conditioning|strengthening]]
* Muscle [[Strength and Conditioning|strengthening]]
* [[Wheelchair Assessment|Wheelchair]] prescription and training
* [[Wheelchair Assessment|Wheelchair]] prescription and training

Latest revision as of 12:12, 2 October 2022

Original Editor - Muskan Rastogi Top Contributors - Muskan Rastogi, Lucinda hampton, Chelsea Mclene and Cindy John-Chu

Introduction[edit | edit source]

Rheumatic chorea

Chorea is defined as "a state of excessive, spontaneous movements, irregularly timed, non-repetitive, randomly distributed and abrupt in character. These movements may vary in severity from restlessness with mild intermittent exaggeration of gesture and expression, fidgeting movements of the hands, unstable dance-like gait to a continuous flow of disabling, violent movements."[1]

  1. The word Chorea has Greek origins meaning "to dance". It has a dance-like appearance due to the random and flowing quality of the movement.
  2. Chorea is a type of hyperkinetic movement disorder.
  3. The involuntary movements flow from one body area to another which cannot be predicted beforehand.

Etiology[edit | edit source]

Chorea traditionally is described in Huntington disease, however other disorders that can lead to chorea, for example: Spinocerebellar ataxia subtypes; Wilson disease; Sydenham chorea, and structural disease of the basal ganglia. Generally, the root of the pathology is in the basal ganglia.[1]

They are predominantly of 2 types[2]

  • Acquired Causes
  • Genetic Causes
Acquired Causes of Chorea


Genetic Causes of Chorea


Phenomenological Features[edit | edit source]

  • Randomness
  • Flowing Quality
  • Parakinesia: Patients blend their chorea-induced movements with their own normal movements.
  • Motor impersistence: the patient is unable to perform sustained motor activities.
  • Ballism: Variant of chorea which shows large-amplitude flinging movements involving proximal extremities.
  • Athetosis: Slow writhing movements involving distal limbs sometimes may be facing.
  • Varying velocity of movements: quick velocity and low-amplitude movements accompanied by jerks.[2]

This video displays the dance-like movements performed by a patient.[3]

Diagnosis[edit | edit source]

The phenomenological features mentioned above are observed to make a diagnosis of chorea.

Differential Diagnosis[edit | edit source]

Specific diagnosis can be made on the basis of symptoms/clinical features experienced by the patient.[2]Differential diagnoses include:

Multimodal Management[edit | edit source]

Mutimodal management chorea.jpg

Chorea requires a Multidisciplinary Approach to be treated.[4]

The team includes:

  • Psychiatrist
  • Physical medicine and Rehabilitation Specialist
  • Physical therapist
  • Occupational therapist
  • Speech therapists
  • Geneticist
  • Genetic Counselor
  • Social worker

Medical Management[edit | edit source]

There is no cure for this disease but symptoms can be managed. Importantly an evaluation and creation of a patient's support system is needed. With disease progression, the patient will need specialized care. Nutrition management is important, due to difficulty swallowing.[1]

1. Dopamine-depleting agents: Tetrabenazine, Deutetrabenazine, Valbenazine.

2. Dopamine D2 receptor-blocking agents: Haloperidol, Clozapine, Olanzapine.

3. Anticonvulsants: Valproic acid, Carbamazepine, Benzodiazepines, Levetiracetam.

4. Anti-glutamatergic agents: Amantadine, Riluzole.

5. Cannabinoids: Nabilone.

6. Deep Brain Stimulation

Physiotherapy Management[edit | edit source]

The management will be same as of Huntington's Disease.

Goals of Management[edit | edit source]

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 1.3 Merical B, Sánchez-Manso JC. Chorea. Available: https://www.ncbi.nlm.nih.gov/books/NBK430923/#!po=15.0000(accessed 19.9.2022)
  2. ↑ 2.0 2.1 2.2 Termsarasab P. Chorea. CONTINUUM: Lifelong Learning in Neurology. 2019 Aug 1;25(4):1001-35.
  3. ↑ neurosigns.org. Chorea. Available from https://www.youtube.com/watch?v=RxWEilu-Mf4&ab_channel=neurosigns.org
  4. ↑ Feinstein E, Walker R. An update on the treatment of chorea. Current Treatment Options in Neurology. 2018 Oct;20(10):1-5.
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