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Predictors of recurrence in Sydenham’s chorea: Clinical observation from a single center

      Abstract

      Objective

      Sydenham’s chorea is the most common cause of acquired chorea in children and is the major manifestation for acute rheumatic fever. Despite being known as a benign, self-limiting condition, recurrences and persistence of symptoms can be seen. In this study, we aimed to evaluate retrospectively the clinical and laboratory features of patients with Sydenham’s chorea and the rate and the course of recurrences, and to assess the risk of recurrences.

      Methods

      The study was a retrospective study conducted in a tertiary hospital. Patients with Sydenham’s chorea who were admitted to our outpatient clinics between January 2013 and June 2015 were included. Both newly diagnosed and follow-up patients were enrolled during this period. We retrospectively reviewed the medical charts of the patients.

      Results

      There were 90 patients with female predominance. The mean age of onset was 11 ± 2.4 years. Complete remission was maintained in 77 patients (85.6%) at 1–6 months and 4 patients had symptoms at more than 12 months. Patients were followed for 6 months to 9 years. The recurrence rate was 16%. When we compared recurrent patients with the non-recurrent group, complete remission in 6 months, the presence of persistent chorea, and regular use of prophylaxis were significantly different between the 2 groups.

      Conclusions

      Sydenham’s chorea is still an important health problem and has high morbidity in patients with recurrent and persistent chorea. The irregular usage of antibiotic prophylaxis, failure to achieve remission within 6 months, and prolongation of symptoms for more than 1 year are risk factors for recurrence of chorea.

      Keywords

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      References

        • Zomorrodi A.
        • Wald E.R.
        Sydenham’s chorea in western Pennsylvania.
        Pediatrics. 2006; 117: e675-e679
        • Oosterveer D.M.
        • Overweg-Plandsoen W.C.
        • Roos R.A.
        Sydenham’s chorea: a practical overview of the current literature.
        Pediatr Neurol. 2010; 43: 1-6
        • Demiroren K.
        • Yavuz H.
        • Cam L.
        • Oran B.
        • Karaaslan S.
        • Demiroren S.
        Sydenham’s chorea: a clinical follow-up of 65 patients.
        J Child Neurol. 2007; 22: 550-554
        • Gewitz M.H.
        • Baltimore R.S.
        • Tani L.Y.
        • Sable C.A.
        • Shulman S.T.
        • Carapetis J.
        • et al.
        Revision of the Jones Criteria for the diagnosis of acute rheumatic fever in the era of Doppler echocardiography: a scientific statement from the American Heart Association.
        Circulation. 2015; 131: 1806-1818
        • Seckeler M.D.
        • Hoke T.R.
        The worldwide epidemiology of acute rheumatic fever and rheumatic heart disease.
        Clin Epidemiol. 2011; 3: 67-84
        • Cunningham M.W.
        Rheumatic fever, autoimmunity, and molecular mimicry: the streptococcal connection.
        Int Rev Immunol. 2014; 33: 314-329
        • Aron A.M.
        • Freeman J.M.
        • Carter S.
        The natural history of Sydenham’s chorea: review of the literature and long-term evaluation with emphasis on cardiac sequelae.
        Am J Med. 1965; 38: 83-95
        • Walker K.G.
        • Wilmshurst J.M.
        An update on the treatment of Sydenham’s chorea: the evidence for established and evolving interventions.
        Ther Adv Neurol Disord. 2010; 3: 301-309
        • Punukollu M.
        • Mushet N.
        • Linney M.
        • Hennessy C.
        • Morton M.
        Neuropsychiatric manifestations of Sydenham’s chorea: a systematic review.
        Dev Med Child Neurol. 2016; 58: 16-28
        • Korn-Lubetzki I.
        • Brand A.
        • Steiner I.
        Recurrence of Sydenham chorea: implications for pathogenesis.
        Arch Neurol. 2004; 61: 1261-1264
        • Teixeira Jr., A.L.
        • Maia D.P.
        • Cardoso F.
        UFMG Sydenham’s chorea rating scale (USCRS): reliability and consistency.
        Mov Disord. 2005; 20: 585-591
        • Tumas V.
        • Caldas C.T.
        • Santos A.C.
        • Nobre A.
        • Fernandes R.M.
        Sydenham’s chorea: clinical observations from a Brazilian movement disorder clinic.
        Parkinsonism Relat Disord. 2007; 13: 276-283
        • Cardoso F.
        Sydenham’s chorea.
        Handb Clin Neurol. 2011; 100: 221-229
        • Ozer S.
        • Hallioglu O.
        • Ozkutlu S.
        • Celiker A.
        • Alehan D.
        • Karagoz T.
        Childhood acute rheumatic fever in Ankara, Turkey.
        Turk J Pediatr. 2005; 47: 120-124
        • Zühlke L.
        • Mirabel M.
        • Marijon E.
        Congenital heart disease and rheumatic heart disease in Africa: recent advances and current priorities.
        Heart. 2013; 99: 1554-1561
        • Walker A.R.
        • Tani L.Y.
        • Thompson J.A.
        • Firth S.D.
        • Veasy L.G.
        • Bale Jr., J.F.
        Rheumatic chorea: relationship to systemic manifestations and response to corticosteroids.
        J Pediatr. 2007; 151: 679-683
        • Kiliç A.
        • Unüvar E.
        • Tatli B.
        • Gökçe M.
        • Omeroğlu R.E.
        • Oğuz F.
        • et al.
        Neurologic and cardiac findings in children with Sydenham chorea.
        Pediatr Neurol. 2007; 36: 159-164
        • Faustino P.C.
        • Terreri M.T.
        • da Rocha A.J.
        • Zappitelli M.C.
        • Lederman H.M.
        • Hilário M.O.
        Clinical, laboratory, psychiatric and magnetic resonance findings in patients with Sydenham chorea.
        Neuroradiology. 2003; 45: 456-462
        • Ekici A.
        • Yakut A.
        • Yimenicioglu S.
        • Bora Carman K.
        • Saylısoy S.
        Clinical and neuroimaging findings of Sydenham’s chorea.
        Iran J Pediatr. 2014; 24: 300-306
        • Traill Z.
        • Pike M.
        • Byrne J.
        Sydenham’s chorea: a case showing reversible striatal abnormalities on CT and MRI.
        Dev Med Child Neurol. 1995; 37: 270-273
        • Castillo M.
        • Kwock L.
        • Arbelaez A.
        Sydenham’s chorea: MRI and proton spectroscopy.
        Neuroradiology. 1999; 41: 943-945
        • Van der Merwe P.L.
        • Kalis N.N.
        Sydenham’s chorea – analysis of 27 patients and a review of the literature.
        S Afr Med J. 1997; 87: C157-C160
        • Walker K.G.
        • de Vries P.J.
        • Stein D.J.
        • Wilmshurst J.M.
        Sydenham Chorea and PANDAS in South Africa: review of evidence and recommendations for management in resource-poor countries.
        J Child Neurol. 2015; 30: 850-859
        • Garvey M.A.
        • Snider L.A.
        • Leitman S.F.
        • Werden R.
        • Swedo S.E.
        Treatment of Sydenham’s chorea with intravenous immunoglobulin, plasma exchange, or prednisone.
        J Child Neurol. 2005; 20: 424-429
        • Fusco C.
        • Ucchino V.
        • Frattini D.
        • Pisani F.
        • Della Giustina E.
        Acute and chronic corticosteroid treatment of ten patients with paralytic form of Sydenham’s chorea.
        Eur J Paediatr Neurol. 2012; 16: 373-378
        • Teixeira A.L.
        • Cardoso F.
        • Maia D.P.
        • Cunningham M.C.
        Sydenham’s chorea may be a risk factor for drug induced Parkinsonism.
        J Neurol Neurosurg Psychiatry. 2003; 74: 1350-1351
        • Walker K.G.
        • Lawrenson J.
        • Wilmshurst J.M.
        Neuropsychiatric movement disorders following streptococcal infection.
        Dev Med Child Neurol. 2005; 47: 771-775
        • Gebremariam A.
        Sydenham’s chorea: risk factors and the role of prophylactic benzathine penicillin G in preventing recurrence.
        Ann Trop Paediatr. 1999; 19: 161-165
        • Al-Eissa A.
        Sydenham’s chorea: a new look at an old disease.
        Br J Clin Pract. 1993; 47: 14-16
        • Berrios X.
        • Quesney F.
        • Morales A.
        • Blazquez J.
        • Bisno A.L.
        Are all recurrences of “pure” Sydenham chorea true recurrences of acute rheumatic fever?.
        J Pediatr. 1985; 107: 867-872
        • Manyemba J.
        • Mayosi B.M.
        Penicillin for secondary prevention of rheumatic fever.
        Cochrane Database Syst Rev. 2002; 3 (CD002227)
        • Emery E.S.
        • Vieco P.T.
        Sydenham chorea: magnetic resonance imaging reveals permanent basal ganglia injury.
        Neurology. 1997; 48: 531-533