Chorea is a pathology of the nervous system. It refers to forms of hyperkinesis. The disease is accompanied by problems with the subcortical nodes of the brain. You can identify her by characteristic features: episodic, aimless, chaotic twitching in the arms and legs, sometimes in the torso. In later stages, mental and intellectual disorders, problems with coordination and self-care occur. In children, chorea is often mistaken for normal increased activity. In fact, at the first manifestations of pathology, you need to seek qualified help.

The term "chorea"

The term is used in two cases. It may mean independent diseases that belong to this group (for example, chorea minor or Huntington's chorea). It is also used to describe some syndromes that occur in various types of diseases. The word “trochea” itself is taken from the Greek language, where it refers to certain type dance. This explains the first ones, which manifest themselves in abrupt, uncoordinated, jerky, rapid movements of the torso and limbs. The patient's behavior is really like an involuntary, chaotic dance. Once upon a time, chorea was called the “dance of St. Vitus.” This name is associated with the ancient belief about Saint Vitus, who actively spread Christianity, for which he was martyred by Roman soldiers. After his death, a legend became popular that if someone performs an active dance near his grave on his birthday, he will receive a boost of vigor and energy for the whole year.

Reasons

The causes of the development of the disease can have different origins, but most often chorea is caused by hereditary factors or genetic disorders.

Less common is chorea caused by infectious diseases such as tuberculous meningitis, viral encephalitis, neurosyphilis, borreliosis, and whooping cough. The occurrence of chorea may also be associated with metabolic disorders(if there is hyperglycemia, hyperthyroidism or Wilson-Konovalov disease), intoxication (poisoning with oral contraceptives, mercury, lithium, digoxin, antipsychotics, levodopa), autoimmune pathologies(such as antiphospholipid syndrome, multiple sclerosis). Among the causes that provoke the onset of the disease, doctors also name damage to the structure of the brain. These include tumor formations, hypoxic encephalopathy, traumatic brain injuries, and strokes.

General signs

Chorea is a disease that is manifested by random, chaotic, short-term bodily movements. In some cases, these movements can be mistaken for normal, adequate, characteristic of healthy person, alarmed about something. In others they resemble an emotional, uncontrollable dance. Jerky twitches can be unilateral or bilateral, but they lack at least some kind of synchrony.

Depending on what form of pathology is detected, the manifestations of chorea are distinguished. If a person has mild choreic hyperkinesis, then his behavior exhibits slight motor restlessness, accompanied by motor disinhibition, increased emotionality, some antics, fussy movements, and inappropriate gestures.

Clearly expressed forms of chorea appear in the form of peculiar movements of a “jack on a string”. A severe form of choreic hyperkinesis distorts walking movements, speech and facial expressions. The patient’s gait is not only strange, but also somewhat “clown-like.” Chorea, the symptoms of which are extremely severe, does not allow any movement at all. Patients with a severe form of pathology are dependent on their environment, as they cannot move around and fully take care of themselves in everyday life.

Huntington's chorea

This pathology in most cases manifests itself between the ages of 35 and 45 years. Chorea, the symptoms of which, in addition to typical hyperkinesis, also include personality disorders and dementia (decrease in intelligence), develops gradually, sometimes it is even difficult to trace the moment when it began to manifest itself. The first violent movements usually occur on the face. They can be confused with random motor automatisms (such as sticking out the tongue, frowning, licking lips, opening the mouth). The progression of the disease manifests itself in the development of hyperkinesis in the torso and limbs. The severe form is characterized by deterioration in speech, memory, swallowing processes, level of self-care and ends in dementia. The starting point for Huntington's chorea is mental disorders in the form of hallucinatory-paranoid, affective and behavioral disorders.

Neuroacanthocytosis

Patients with neuroacanthocytosis suffer not only from choreic hyperkinesis, but also from acanthocytosis (the shape of red blood cells changes). A distinctive feature of this pathology is atrophy (weakness in the muscles of the upper and lower limbs). Other characteristics of the disease include: oral hyperkinesis with chewing movements, twitching of the lips, protruding tongue and other grimaces. With neuroacanthocytosis, the patient involuntarily bites his tongue, lips and inner surface cheeks until bloody. Complicating factors for this disease are dementia and

Lesch-Nyhan disease

Congenital diseases of the nervous system prevent a person from living full life. Such pathologies include Lesch-Nyhan disease. The main cause of the development of pathology is hereditary deficiency of hypoxanthine-guanine phosphoribosyltransferase. This chorea in children is accompanied by severe disturbances in the functioning of the nervous system. The pathology is also provoked increased production uric acid.

From the first months of life, the child experiences developmental delays. Rigidity of the limbs appears from the third month. From the second year of life, the baby develops facial grimaces, which are accompanied by signs of damage to the pyramidal tract and a delay in mental development. The baby can harm himself physically by biting his lips or fingers.

Benign chorea

Benign chorea in children manifests itself in infancy or early childhood. Pathology refers to hereditary diseases. Generalized hyperkinesis in this disease recedes only when the child is sleeping. This type of pathology differs from Huntington’s chorea in its non-progressive course and normal development intelligence. At an older age, with benign chorea, hyperkinesis can be reduced if you contact a medical facility in time.

Secondary forms of chorea

The most common secondary forms of pathology are considered to be two: minor chorea and chorea of ​​pregnant women.

The first is also called Sydenham's chorea. Its occurrence can be provoked by exacerbations of streptococcal infection or rheumatism. Light form characterized by exaggerated grimaces, expressive gestures, and disinhibited movements. More complex shapes choreic hyperkinesis manifests itself in the fact that it is difficult for the patient to move, speak normally, even breathe. The disease also causes “tonic” knee and “freezing” reflexes and muscle hypertension.

In pregnant women, chorea is a disease that returns from childhood. That is, those women who encountered in childhood with minor chorea. The pathology may appear during the first pregnancy at 2-5 months. With the subsequent course of the “interesting” situation, chorea may also occur. Treatment in such cases is rarely carried out, since the disease disappears on its own after termination of pregnancy or after childbirth.

Chorea rheumatica

The onset of the disease occurs against the background of acute rheumatism or endocarditis, which is accompanied by damage to the heart valves. Many cases of the disease are not associated with this factor, and the disease manifests itself independently.

Rheumatic chorea most often affects children aged 6 to 15 years. In girls, the pathology is more common. At the first stage, the disease may not cause concern, since the symptoms are limited to grimaces, and parents take it as a joke. The process continues with small involuntary movements of the limbs, starting from the fingertips and gradually spreading throughout the body. A week later, the period of manifestation begins, when the child’s movements become fast and sweeping. This condition prevents the baby from continuing his normal activities, that is, eating, walking, writing.

Rheumatic chorea distorts the child's face with thousands of grimaces. Severe forms of the disease prevent the patient from standing on his feet, swallowing, speaking, while the body is constantly moving. If chorea is diagnosed, treatment must be carried out carefully and urgently.

Diagnostics

Suspicions of chorea arise due to strange behavior of a person. At preliminary inspection the doctor must conduct a conversation with the patient or his relatives. In particular, it is important to find out whether anyone else in the family had this disease, how long ago the symptoms of chorea appeared, whether the patient took medications, or suffered from inflammatory diseases. Next, the specialist must evaluate the involuntary movements. It is also necessary to diagnose and describe diseases that may accompany chorea and cause serious intellectual disabilities. Symptoms of such diseases do not always appear. Sometimes in order to discover similar pathology At an early stage, a whole range of examinations is carried out. A blood test will show the level of copper in the blood and the presence or absence of signs of inflammatory reactions. In addition, they carry out computed tomography, magnetic resonance tomography, electroencephalography.

Treatment

Chorea is a pathology that does not allow the patient to lead a normal, full-fledged lifestyle, so its treatment must be timely and comprehensive. Treatment tactics directly depend on the causes of the disease. For example, with Wilson-Konovalov disease, the patient is prescribed diets with minimal copper content and medications whose action is aimed at reducing its absorption.

For Huntington's chorea, antipsychotics and benzodiazepine tranquilizers are prescribed. If chorea is caused chronic failure blood supply to the brain, then drugs that lower blood pressure are needed. For vasculitis they carry out hormonal treatment. If very generalized symptoms appear, treatment should be comprehensive.

The intensity of involuntary movements can be reduced through surgery, when the ventrolateral nuclei of the thalamus are destroyed. For chorea, you need to take medications that improve brain function and nutrition, as well as B vitamins.

CHAPTER 17. RHEUMATIC CHOREA (SYDENGAM'S CHOREA, MINOR CHOREA)

CHAPTER 17. RHEUMATIC CHOREA (SYDENGAM'S CHOREA, MINOR CHOREA)

Rheumatic chorea (Sydenham's chorea, minor chorea) is a rare post-infectious complication of tonsillitis (tonsillitis) or pharyngitis caused by group A β-hemolytic streptococcus, characterized by involuntary chaotic movements in the limbs and behavioral disorders.

Thomas Sydenham (1624-1689) - a talented English explorer and insightful doctor, the British Hippocrates, as he was then called, for the first time in 1686 gave such exact description chorea, that his name remained forever associated with this form of the disease: “...mostly St. Vitus chorea occurs in children from 10 years to adolescence. Initially, there is a limp when walking, or rather dancing with dragging the leg like a jester; later similar movements appear in the hand on the same side; when this disease completely takes possession of him, he cannot remain in the same position for a single minute; the movements affect the torso or other parts of the body and change the posture and localization of the twitches... To drink from a cup, he makes a thousand gestures, like a juggler, before bringing it to his mouth properly. His hand sways from side to side, and finally he quickly pours the contents into his mouth and drinks greedily, as if he is trying to make others laugh."

T. Sydenham did not correlate this disease with rheumatic fever, but described the main clinical symptoms of the disease, such as a variety of involuntary rapid and chaotic movements of the limbs, muscle weakness and emotional lability. Since then, this term - “St. Vitus’ dance” - has become widely used to refer to acute chorea, although this concept was known back in the 16th century, when T. Paracelsus (1493-1541) described "thorea naturalis" as an unusual choreiform disease (“dance frenzy”, “St. Vitus’s dance”), common in medieval Europe. In those days, this term was used for many nosological forms: hysteria caused by religious fanaticism, epileptic seizures, ergot poisoning, torsion dystonia. In 1894, W. Osler commented on this terminological confusion: “... it would be incorrect to say that Sydenham accidentally called the disease St. Vitus’s dance/trochea, but used this term in a new meaning; and this is not the only

There is a good example in medicine when we use a name for a disease whose original meaning has long been lost.”

Etiology and pathogenesis. The rheumatic origin of Sydenham's chorea was first suggested by M. Stol in 1780, and by the beginning of the 20th century. it has been irrefutably proven. Currently, the disease is very rare. Typically, rheumatic chorea manifests itself in childhood with a peak onset between 7-12 years. The disease most often affects girls over 10 years of age, which may be due to hormonal changes at this age. Typically, the first symptoms of minor chorea develop 2-7 months after a streptococcal infection.

Immunofluorescence analysis of blood serum in patients reveals an increase in titers of immunoglobulin G to group A β-hemolytic streptococcus. It is currently believed that the main pathogenetic mechanism for the development of the disease is the development of a cross-autoimmune response. In this case, cross-antibodies are formed to the membrane of group A β-hemolytic streptococcus and the cytoplasm of neurons of the subthalamic and caudate nuclei. However, with the disease, immunological parameters may be normal, which is associated with a long interval between the streptococcal infection and the appearance of neurological disorders (the phenomenon of molecular mimicry). Antiphospholipid antibodies are detected in 80% of patients with rheumatic chorea, but their role in the pathogenesis of the disease is still not fully understood.

Clinical manifestations. Minor chorea is usually combined with other clinical syndromes ARF (carditis, polyarthritis), however, in 5-7% of patients it may be the only manifestation of the disease.

Typically, the manifest symptoms of rheumatic chorea are behavioral disturbances (increased irritability, mood changes), awkwardness of movements and difficulty writing. “...A child with Sydenham's chorea will be punished three times before he is correctly diagnosed: once for restlessness, once for breaking dishes and once for making faces at his grandmother.” This statement by Wilson accurately illustrates the three main clinical features of chorea minor: spontaneous and involuntary movements, uncoordinated voluntary movements, and muscle weakness.

Involuntary movements are usually generalized, can rarely be asymmetrical and in 20% of cases are unilateral. Typically, hyperkinesis occurs in the facial muscles and distal sections limbs. At first they are barely noticeable and intensify only with waves.

neniya. As the disease develops, isolated sudden and short-lived involuntary movements become generalized. In the advanced stage of the disease, choreic hyperkinesis practically does not stop, disappearing during sleep and with drug sedation. IN in rare cases the disease debuts with the development of severe generalized muscle hypotonia, in which the child cannot begin voluntary movements and the impression of development flaccid paralysis, sometimes only one-sided. In this case, involuntary movements are very rare or completely absent. Speech disturbances are observed in 15-40% of cases; in severe cases, swallowing disturbances may occur. Very rarely, the first symptoms of the disease may be seizures, cerebellar, pyramidal disorders and papilledema. Carditis develops in 75% of cases.

With minor chorea, deep tendon reflexes are reduced or torpid. There are no pathological reflexes.

During a neurological examination, 4 characteristic symptoms are observed:

1) Gordon II reflex (when the knee reflex is evoked, the lower leg remains in the extension position for several seconds, caused by contraction of the quadriceps femoris muscle);

2) symptom of choreic hand - pathological position of the hand, in which it is slightly bent in wrist joint, and the fingers are in a position of hyperextension in the metacarpophalangeal joints and extended or slightly bent in the interphalangeal joints;

3) “chameleon tongue” - the inability to stick out your tongue with your eyes closed (when you try to stick out your tongue, it immediately returns to your mouth);

4) Cherny's symptom - retraction abdominal wall and rise of the diaphragm during inspiration.

The duration of rheumatic chorea is from 1 month to 2 years. The disease can recur during exacerbation of chronic streptococcal infection, but if no symptoms of the disease are observed during the first two years, chorea is unlikely to occur. The prognosis of the disease is usually favorable. However, emotional instability or minimal neurological symptoms such as awkward movements and tics may persist for several months. In girls who have had chorea, high risk its occurrence during pregnancy and when taking contraceptives, which may be associated with increased dopaminergic sensitivity.

Diagnostics.When recognizing acute rheumatic fever, the syndromic principle developed by the domestic pediatrician A.A. is used. Kisel in 1940. He identified 5 main diagnostic criteria: migratory polyarthritis, carditis, chorea, ring-shaped erythema, rheumatic nodules, paying attention to the diagnostic significance of their combination. In 1944, American cardiologist T.D. Jones classified the indicated pentad of syndromes as “large” diagnostic criteria, highlighting along with them “small” clinical and laboratory parameters. Subsequently, the Jones scheme was repeatedly modified by the American Heart Association (AHA) and became widespread.

In table Figure 26 presents a diagram of the Kisel-Jones diagnostic criteria taking into account the latest revision of the AKA (1992) and modifications proposed by the Association of Rheumatologists of Russia (ARR) in 2003. MRI of the brain visualizes both bilateral and unilateral increases in signal intensity in T2 - weighted image in the region of the caudate nuclei and putamen. However, changes on CT/MRI of the brain are not pathognomonic for this disease. Positron emission tomography in the active stage reveals an increase in glucose metabolism in the thalamus and striatum, which is reversible.

EEG reveals nonspecific changes.

Differential diagnosis carried out with PANDAS syndrome, viral encephalitis, dysmetabolic encephalopathies, hereditary neurodegenerative diseases that occur with primary damage to the subcortical structures of the brain.

Prevention and treatment. It is recommended to prescribe bed rest and protective rest. Thus, in the acute polysyndromic course of acute rheumatic fever or with the development of pancarditis, glucocorticosteroids are indicated - prednisolone or methylprednisolone (0.6-0.8 mg/kg/day) for 10-14 days, rarely longer, under the control of clinical and instrumental data , including dynamic echocardiography monitoring. With positive dynamics, they begin to decline daily dose glucocorticosteroids at 2.5 mg per week, then transferred to non-steroidal anti-inflammatory drugs in age-related doses. Even in cases where there is no clear immunological evidence of the disease and culture from the nasopharynx for streptococcal flora did not give positive result, it is necessary to conduct a course

antibacterial therapy. Prescribe benzylpenicillin (potassium and sodium salt) 150,000 units 4-5 times a day intramuscularly or orally at a dose of 200 to 250 mg 4 times a day for 10-14 days.

Table 26.The Kisel-Jones criteria used to diagnose acute

rheumatic fever

Large criteria	Small criteria		Evidence of previous A-streptococcal infection
Carditis Polyarthritis Chorea Ring-shaped erythema Subcutaneous rheumatic nodules	Clinical	Arthralgia Fever	Positive A-streptococcal throat culture or positive rapid A-streptococcal antigen test. Increased or increasing titers of anti-streptococcal antibodies (ASL-O, anti-DNAase B)
	Laboratory	Elevated acute phase reactants: ESR, C-reactive protein
	Instrumental	Prolongation of the PR interval on the ECG Signs of mitral and/or aortic regurgitation on Doppler echocardiography

Notes: The presence of two major criteria or one major and two minor criteria in combination with documented evidence of previous infection with group A streptococci indicates a high likelihood of acute rheumatic fever. Special cases:

1. Isolated chorea - with the exclusion of other causes (including PANDAS*).

2. Late carditis - development of clinical and instrumental symptoms of valvulitis extended over time (more than 2 months) - with the exclusion of other causes.

3. Repeated acute rheumatic fever against the background of chronic rheumatic disease hearts or without it.

* PANDAS is an abbreviation English words“Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections” (children's autoimmune neuropsychiatric disorders associated with streptococcal infection." This is a condition related in pathogenesis to rheumatic chorea, but differs from it in its normal neurological status. Clinical picture characterized only by behavioral disorders in the form of obsessive-compulsive disorder and (or) tic disorder.

Undoubtedly, to the serious achievements of science of the twentieth century. should include the development of prevention of acute rheumatic fever and its relapses. The basis of primary prevention of acute rheumatic fever is timely diagnosis and adequate therapy active chronic infection of the pharynx (sore throat, pharyngitis). Taking into account the world clinical experience Recommendations for rational antimicrobial therapy of tonsillitis and pharyngitis have been developed, adapted to the conditions of Russian healthcare.

Secondary prevention is aimed at preventing recurrent attacks and progression of the disease in people who have had acute rheumatic fever, and involves regular administration of long-acting penicillin (benzathine penicillin). Application this drug in the form of bicillin-5 made it possible to significantly (4-12 times) reduce the frequency of repeated rheumatic attacks and, consequently, increase the life expectancy of patients with RPS. At the same time, a number of authors pointed out the insufficient effectiveness of bicillin prophylaxis in 13-37% of patients. Joint research carried out at the Institute of Rheumatology of the Russian Academy of Medical Sciences and the State scientific center on antibiotics, showed that currently a highly effective and safe drug for secondary prevention of acute rheumatic chorea is benzathine benzylpenicillin, prescribed at a dose of 2.4 million units intramuscularly every 3 weeks. The long-acting dosage form of penicillin, bicillin-5, produced by the domestic industry, is currently not acceptable for secondary prevention of ARF, since it does not meet the pharmacokinetic requirements for preventive drugs. In the coming 21st century. Scientists' efforts will be focused on creating and improving a vaccine containing epitopes of M-proteins from “rheumatogenic” strains that do not enter into cross reaction with tissue antigens of the human body.

Chorea minor is a rather rare neurological pathology, the main manifestations of which are movement disorders and disorderly muscle contractions.

This disease affects children and adolescents, but relapses can also occur at a young age.

Otherwise, the disease is called Sydenham's chorea, rheumatic or infectious. This is the most common form of acquired chorea, occurring mainly in childhood.

The disease requires immediate treatment, otherwise serious complications may develop.

Causes and features of failures

The symptoms of the disease were first described in 1686 English doctor- Thomas Sydenham. It was he who discovered that children from five to fifteen years of age are susceptible to the development of minor chorea, and the incidence among girls is somewhat more common than among boys. This is due hormonal characteristics female body.

Lesions of the central nervous system in chorea minor are localized in the cerebral cortex. But after opening antibacterial drugs, to chorea Sydenham accounts for only ten percent of all neurological pathologies in children.

As already mentioned, the symptoms of the disease are more common in girls, and the peak incidence is in the autumn and winter.

The average duration of the disease is three to four months. In some cases, after a prolonged absence of symptoms, exacerbations may occur, most often during pregnancy.

The disease, as a rule, is not fatal, but pathological changes in rheumatism that occur in the cardiovascular system can still cause death.

As for the reasons for the development of the disorder, the leading one is past infection beta-hemolytic streptococcus group A, which is why the disease, in addition to its neurological nature, is also infectious.

This type of streptococcus in most cases affects the upper respiratory tract (upper respiratory tract). It is enough to get a sore throat and tonsillitis and the child automatically falls into the risk group. With the development of such diseases, the child’s body begins to actively fight the pathogen; it produces antibodies against it.

Quite often, antibodies can also be produced to the basal ganglia of the brain. Cross autoimmune response is what this phenomenon is called. Antibodies begin to attack the nerve cells of the ganglia, and as a result, an inflammatory reaction appears, manifested by hyperkinesis.

This does not always happen, otherwise every second child would suffer from chorea minor. It is believed that the disease can develop as a result of:

• presence of rheumatic disease;
• genetic predisposition;
• disruptions in the functioning of the endocrine system;
• chronic infectious processes VDP;
• untreated caries;
• decreased immunity;
• increased emotionality;
• use of certain medications, for example, from nausea;
• chronic insufficiency of blood supply to the brain;
• presence of cerebral palsy - cerebral palsy.

Since beta-hemolytic streptococcus provokes the production of antibodies to other organs and systems and becomes the cause of rheumatic lesions, then this pathology is considered as one of the variants of the active rheumatic process.

Varieties of rheumatic chorea

Besides classic version minor chorea is also noted atypical course. The following types of pathology are distinguished:

• erased (sluggish, low-symptomatic);
• paralytic;
• pseudo-hysterical.

Along the course, the disease can be latent, subacute, acute and recurrent.

Clinical manifestations

The general symptoms of the disease are quite clear. The disease can manifest itself differently in each individual case. The main symptoms of minor chorea include hyperkinesis (involuntary movements).

There is the appearance of chaotic muscle contractions that occur randomly and which the child is unable to control.

At the beginning of the disease, hyperkinesis is hardly noticeable. Parents do not perceive grimacing, awkwardness of hands, or unsteadiness of gait as a reason to seek the help of a specialist.

Over time, hyperkinesis becomes more noticeable. They usually occur during excitement. If you ignore manifestations of a violation, movement disorders become more complicated. They become pronounced, up to a choreic storm - a paroxysmal occurrence of uncontrolled movements in the entire body.

What is especially worth paying attention to?

Handwriting of a child diagnosed with chorea minor

There are a number of symptoms that should be alarming. Initial manifestations illnesses are perceived by many parents as banal antics. But timely detection of pathology is the basis for successful therapy. The main warning signs of minor chorea include:

1. Awkward movements when drawing or writing. The child is not able to hold a pencil; if he writes, then only clumsy, disproportionate letters are obtained.
2. Uncontrolled frequent grimacing.
3. Restlessness. The baby is unable to sit in one place, he constantly scratches himself and twitches in different parts bodies.
4. Involuntary shouting different sounds (due to involuntary contraction of the muscles of the larynx).
5. Blurred, confused speech. In some cases, tongue hyperkinesis provokes the appearance of choreic mutism ( complete absence speech).

In addition, the disease is characterized by:

• decreased muscle tone;
• psycho-emotional disorders(anxiety, moodiness, touchiness, tearfulness).

There are several neurological manifestations that are characteristic only of this disease, which, when examined in mandatory The neurologist will note:

In almost all cases, the pathology is characterized by autonomic disorders: cyanosis of the feet and hands, coldness of the extremities, marbled coloration skin, irregular pulse, tendency to low blood pressure.

Moreover, a third of children who have had the disease may subsequently develop heart defects.

Diagnostic approach

In addition to a physical examination, history taking and blood sampling, the following is prescribed:

• computed tomography;
• electroencephalography;

All this will help identify pathological foci in the brain, assess muscle function, and identify markers of streptococcal infection and C-reactive protein.

Therapy: goals, methods

The basis of treatment is to fight the infection, namely hemolytic streptococcus groups A. B in this case antibiotics of the penicillin and cephalosporin series are prescribed.

In order to reduce the inflammatory process in the kidneys, anti-inflammatory drugs from the NSAID group are prescribed.

Since the disease is characterized by psycho-emotional disorders, an appointment is required sedatives and tranquilizers. If necessary, antipsychotics are used. Medicines that help improve brain functioning, as well as B vitamins, are often prescribed.

Only a neurologist can treat minor chorea. Dosages of drugs are selected individually for each individual case.

IN acute period Bed rest is recommended. At this time, it is important to create the proper conditions, without or with minimal exposure to the stimulus - this applies to both light and sound. The child's diet should be balanced and fortified.

What's the prognosis?

At timely treatment the prognosis is positive, the disease ends in recovery. However, relapses cannot be ruled out. Exacerbations of the disease can be caused by repeated tonsillitis or a rheumatic process.

After an illness, asthenia may persist for a fairly long period. The main complications of the pathology include heart disease, aortic insufficiency, and mitral stenosis.

The disease is not fatal and proper treatment does not pose a threat to the patient's life. A fatal outcome is possible in the event of a sudden failure in the functioning of the cardiovascular system that is incompatible with life.

Preventive measures

In addition, it is necessary to take care of the child’s proper physical development, balanced nutrition, anti-relapse therapy, strengthening immune system, as well as getting rid of chronic foci of infection.

Chorea It is considered a childhood disease that primarily occurs in children aged 5 to 16 years. During it, involuntary increased motor activity occurs.

The disease is neurological in nature and manifests itself as a rheumatic infection. Children who suffer from chorea minor have pronounced psycho-emotional disorders.

The pathology is treatable, but it should be understood that the therapy itself may take a long period of time. If measures are not taken in a timely manner, then the prognosis for the child will be extremely unfavorable.

Lesser chorea in children is considered essentially rheumatic encephalitis. It affects the brain and directly affects the basal ganglia. If the disease occurred in early age, then after about 25 years it may relapse. That is why people will be forced to adhere to all their lives preventive measures so that the possibility of recurrence of minor chorea can be excluded.

It should be noted that the problem can be provoked various factors. The main one is the progression of infection in the body. The risk group includes children aged 5 to 15 years. It is worth noting that during this period the body is weak and therefore susceptible to many diseases.

Most often, chorea minor is diagnosed in girls., while they should have a thin physique, as well as an overly sensitive psyche. At the same time, boys are also susceptible to the disease, so it is important for parents to exercise caution, because it is important to identify the symptoms of the disease in a timely manner.

There are a number of factors that provoke the appearance of minor chorea:

• Lack of weight. Moreover, asthenicity can be natural, and even in this case it can lead to the development of pathology.
• The presence of an infection caused by streptococci. This can also contribute to the appearance of minor chorea.
• Caries that was not treated in a timely manner. When dental diseases appear, it is important to consult a doctor in time so that your condition can be improved.
• Various psychological factors. Minor chorea can be a consequence of such injuries.
• Significantly low levels of the immune system. Parents need to make sure that everything is in order with this indicator. Otherwise, rheumatic chorea may occur.
• The presence of sinusitis and tonsillitis. Such diseases also need to be treated on time, otherwise they can lead to the formation of minor chorea.
• Increased sensitivity of the central nervous system. Similar feature a child may develop chorea minor.
• Increased susceptibility to viral diseases. Even if a child catches colds often, he may still experience rheumatic chorea.
• Progression of respiratory tract infection. It is dangerous to let such diseases occur because they can lead to various disorders, including involuntary movements.
• Hereditary predisposition. If at least one of the parents suffered from minor chorea, then the child may also encounter it.
• Hormonal imbalances in the body. They can lead to different negative consequences, and one of them is rheumatic chorea.

Regardless of the cause, treatment will definitely need to be started in order to improve the person’s well-being. Lesser chorea requires long-term treatment, and what formerly man starts it, the better it will be. It is important to know the main symptoms of the disease in order to understand in what situations you need to immediately consult a doctor. You should not wait until your health condition worsens significantly and serious complications appear.

Symptoms

To begin with, it is worth noting that rheumatic chorea occurs different types. The symptoms a person will experience directly depend on this. In particular, the disease occurs following forms: latent, subacute, recurrent, as well as acute. In the first situation, symptoms may be very mild or completely absent.

At the same time, the subacute and acute forms are most clearly manifested, so the signs of minor chorea will be difficult to miss. As for the recurrent type, it is characterized by outbreaks of pathology. At the same time, the child becomes better, then worse again.

It is definitely worth considering the symptoms of minor chorea so that the disease can be suspected in a timely manner:

• Involuntary movements, as well as muscle contractions that the child cannot control.
• A noticeable decrease in muscle tone, weakness.
• Increased activity of facial expressions. With minor chorea, the child will often grimace.
• Inability to remain in one position for a long period of time.
• It is difficult for the patient to perform even simple manual actions.
• Mental and emotional disorders. With minor chorea, the child may be too aggressive, capricious, and often have difficulty falling asleep.
• Inability to fix your gaze on one point.
• During excitement, the minor will begin to pull himself, scratch himself, or perform other similar manipulations.
• When the muscles of the larynx are tense, caused by chorea minor, the child may make strange sounds and even wheezing.
• Unexpected speech therapy problems. It may happen that the child will not be able to speak.
• Gait disturbance due to chorea minor is considered natural symptom. The child will not be able to move normally, he will jump.
• A sharp increase in body temperature to 38 degrees.

Doctors note that rheumatic chorea can be suspected based on basic symptoms. The child will have problems with gait, facial expressions will change, as well as handwriting. In this case, you should consult a doctor, then the doctor will be able to confirm the presence of Sydenham's chorea.

Diagnostics

If a child is suspected of having rheumatic chorea, then a diagnosis will be required. To do this, doctors prescribe a number of studies that can help identify the presence of abnormalities. First of all, the patient is sent for magnetic resonance imaging. This study allows you to understand whether the child has rheumatic chorea. They may also send you for a computed tomography scan, which analyzes the brain.

For minor chorea, it is often prescribed general analysis blood, because deviations in the indicator may be detected. The patient may be sent for electroencephalography to understand whether there are any abnormalities in brain activity. All research data allow us to understand whether a person has Sydenham chorea.

The doctor will definitely analyze the child’s condition as a whole so that the diagnosis can be confirmed or refuted. Minor chorea in children should be treated only under the supervision of a specialist in order to achieve positive results.

Methods of therapy

If Sydenham's chorea is in acute form, then you will need to go to the hospital without fail. The patient should remain in bed and be in a calm environment. Sleep will facilitate rapid recovery from chorea minor, which is why doctors will calm the nervous system.

It will be important to limit physical activity patient. Doctors for Sydenham's chorea often prescribe pyramidon, as well as products that contain calcium. It is important for the patient to take vitamin complexes so that they can improve their well-being. Treatment of malochorrhea in rare cases can be carried out pituitary hormones.

If the child is already recovering, then for recovery fine motor skills It is recommended to knit, draw, sculpt or sew. In this case, when treating rheumatic chorea, you should walk on fresh air at least two hours a day.

Directly medical procedures called upon improve blood supply to the brain, as well as metabolism. It is often necessary to provide an anti-inflammatory effect. For this, with Sydenham chorea minor, salty drinks are often prescribed. pine baths, UHF frontal lobe, sodium salicylate electrophoresis, ultraviolet irradiation.

If a child had Sydenham's chorea, then parents should reconsider his diet. It is important to add more vitamins, as well as foods that contain protein. In particular, for rheumatic chorea, cottage cheese, fish, lean meat, and milk will be useful.

In order to quickly cure Sydenham's chorea, the child will need to receive more positive emotions. It is also necessary to be constantly monitored by a doctor, because you need to carefully monitor the patient’s condition. In most cases, treatment of chorea minor gives good results, If long time carry out procedures that are beneficial to humans.

Chorea is an involuntary obsessive movements torso and limbs. The movements are characterized by a sudden swinging nature, they are uncontrollable and look jerky. The twitching may be slightly noticeable, but may also be overly aggressive. The disease is also called St. Vitus's dance, since when the muscles of the body twitch, the hands and fingers tremble, the child becomes like a dancing man.

As a rule, children aged 5-12 years are more susceptible to chorea. It is noteworthy that girls are noticeably more common among sick people than boys.

Today it has been proven that the disease affects not only the nervous system - it leads to pathological changes in the work of the heart. As a result, rheumatism may well develop. In general, some doctors tend to classify chorea as a type of rheumatism.

It is important to note that sometimes chorea is just a symptom of more complex illness, and can also act as an indicator of intoxication child's body(food poisoning or drug overdose).

Symptoms

The main blow of chorea in children is the disease in the subcortical nodes of the nervous system. These nodes are entrusted with the mission of coordinating movements and ensuring normal muscle tone. It is for this reason that as the disease develops, the child begins to make involuntary movements with his arms and legs, an incomprehensible grimace appears on his face, and general muscle weakness develops.

At the beginning of the disease, the signs can be extremely mild, but over time, each of them becomes more pronounced: sometimes the child’s movements become completely chaotic, which prevents him from sitting, holding a spoon, and so on. The disease is characterized by the cessation of all manifestations during sleep.

Affects the disease and the cerebral cortex, which is why emotional state the child becomes unstable: he is characterized by changes in behavior, lack of colloquial speech, sometimes there is a sharp transition from laughter to crying. The child may also complain about strong headache. However, sometimes chorea is less pronounced, acquiring erased forms: the symptoms are subtle and insignificant.

Doctors note that sometimes the disease affects the heart muscle, resulting in myocarditis. May be involved in the process inner shell heart and muscle, and then we can talk about myoendocarditis. Pancarditis, which causes damage to all the membranes of the heart, is quite rare.

More often, symptoms of chorea last for about 2 months. When relief comes, erratic movements of the torso and limbs disappear, and then muscle tone returns to normal. Last but not least, handwriting returns to normal and the usual gait returns.

Classification

Depending on the speed of development of symptoms, chorea is usually divided into forms:

1. Acute form

Occurs due to acute intoxication. Chorea can be caused by excessive use of stimulants, anticolvulsants, antihistamines and lithium preparations, antiemetic drugs. Less commonly, this form of chorea occurs due to hemorrhage.

2. Subacute form

It is commonly called Sindegam chorea. The disease develops as a result of a bacterial sore throat or streptococcal infection. Main feature- presence of progression: as symptoms of a physical illness appear, emotional instability begins to appear and muscle tone decreases. This form of chorea involves an extremely gradual development, so it may well be a consequence of a brain tumor, a manifestation of lupus, or a sign of Addison's disease (an endocrine disease).

3. Chronic form

In this case, it is appropriate to talk about the development of Huntington's disease. This disease is genetically determined and can lead to dementia in mature age. As a rule, children are susceptible to this form of the disease. adolescence. Today this form is extremely rare.

Diagnostics

As soon as parents or teachers note at least a single case of manifestation of the disease in a child, it should immediately be shown to a professional physician. The fact is that chorea is an extremely dangerous disease and requires close supervision by a specialist.

Once in the specialist’s office, the child’s parents must provide information about the circumstances under which the signs of the illness arose. In addition, it is important for the doctor to be aware of the items that trigger symptoms. If a sick child was taking medications before the onset of the disease, the parents must inform the doctor.

The next step is to conduct a neurological examination. The doctor will assess the nature of the child’s motor activity, his neurological status, muscle tone and the presence of emotional disorders.

To spend accurate diagnosis, you need to do a blood test. Results laboratory research will allow us to identify reduced or increased level leukocytes in the child’s blood, note the presence or absence of streptococcal infection. In addition, a blood test can determine the causes of the disease.

If the disease is subacute, the doctor will study the medical records of the parents. This point will help to exclude a hereditary factor and make a decision regarding treatment.

As a rule, if chorea is suspected, magnetic resonance imaging and an electroencephalogram are used. In some cases, diagnosis can be made through computed tomography.

Treatment

A child who has shown signs of chorea must be admitted to a hospital to be under the constant supervision of specialists. Mental and physical peace is a must! In addition, such children must certainly receive affectionate treatment from others, including doctors and clinic staff.

Treatment recommended by a professional must be followed exactly as chorea, especially Genington's chorea, is prone to recurrence. By adhering to all prescriptions, parents can protect their child from developing a severe form of the disease.

Therapy needed to treat a child with chorea includes drug treatment. As a rule, sedative, antiviral, antipsychotic and anti-inflammatory drugs are prescribed. Medications to improve brain function and those that promote vasodilation may be indicated.

The therapy also includes physiotherapeutic procedures and pine baths.

The success of treatment depends on the speed of action and the correctness of the prescribed treatment. If the form of the disease looks advanced, it may be applicable surgery. However, today, when there are many truly high-quality medicines, and diagnostic methods allow timely detection of the slightest signs of the development of the disease, surgery is extremely rarely resorted to.

An important factor for speedy recovery For a child diagnosed with chorea, nutritional review is recommended. It should be complete, but you shouldn’t overfeed either.

Hardening and all kinds of health promotion methods also play a role big role in recovery.

As a rule, chorea can reoccur in a child due to a number of reasons. It is especially important to ensure that the body is not weakened. Overwork, infectious diseases and excessive anxiety may well lead to a surge repeated illness. Sometimes it seems to parents that the recovered child is in no hurry to delve into their adult affairs. This is not entirely true. The slightest quarrel between mom and dad can return the child to a state in which signs of chorea begin to appear.

Who is at risk?

Doctors say that children who often suffer from sore throat, flu and scarlet fever are at risk. In order to prevent the development of such a sad illness, it is important to deal with them promptly and fully, and to be attentive to the child’s condition during the period of illness.

Moms and dads whose children often suffer from tonsillitis should be no less wary. As a rule, in such patients the disease occurs without an increase in body temperature, so parents try to cure the baby on their own, refusing medical support. Meanwhile, microorganisms located in the tonsils are capable of producing toxins that over time enter the blood and spread throughout the body. The result of such negligence is a problem of a neurovascular nature.

Any child’s illness, even the most harmless one in the parent’s opinion, must be treated and monitored by a professional. Only in this case will chorea pass by your offspring!