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Talk:Sydenham's chorea

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Yes -merge the articles they are the same thing

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This article and the other one should be merged - they are clearly the same 79.72.120.227 (talk) 21:30, 2 January 2010 (UTC)[reply]

The main article has a minor grammatical error. It does not appear to be editable. Atoizzard (talk) 18:47, 3 June 2013 (UTC)[reply]

New Source

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We seriously need some new sources, as it relies heavily on a website called wemove.org, which was bought up by an internet company and now no info is accessible. JoshMuirWikipedia (talk) 11:31, 24 August 2016 (UTC)[reply]

Plagiarism

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This article contains many passages lifted verbatim from its sources, one of which is: "PAEDIATRIC LESSONS FROM THE PAST Tracing Sydenham’s chorea: historical documents from a British paediatric hospital" Articles directly cut and pasted from sources are all too common on Wikipedia.--75.164.142.57 (talk) 17:39, 17 October 2016 (UTC)[reply]

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Potential respiratory (and other) complications?

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After reading a couple of papers about extrapyramidal disorders in general, including Parkinson's disease, Huntington's disease, tardive dyskinesia, hemiballismus and Sydenham's chorea, I found that for most of them respiratory complications like aspiration pneumonia are more or less common and may even be fatal. One of few exceptions is Sydenham's chorea, where a risk of dysphagia and aspiration was AFAIK never mentioned, even when the case subject was a severe manifestation of SC, where I would have expected such a risk to exist. Are serious respiratory complications really unknown (or overtly rare) in Sydenham's chorea? Or may they just be overshadowed by co-existing rheumatic carditis, which is present - and sometimes insideous - in a significant number of SC sufferers?

By the way, I was also interested in the prevalence of severe neuropsychiatric symptoms (e.g. psychosis, anorexia) in SC but could not find anything from which one could tell a number (e.g. 1%, 0.1%, or just 0.01% ?). What I mainly found were single case reports, and one German book from the 19th century that claimed the prevalence of "insanity" to be at most 1%.

Seemingly we don't know that much about this illness although it is known since more than 300 years... probably because of effective antibiotic therapy that prevents most cases nowadays in industrialized countries. Is this also the answer to my first question - it's too rare for us to know if it causes a risk of aspiration? --2003:E7:771F:1580:4089:FC75:44B0:6763 (talk) 02:26, 27 February 2019 (UTC)[reply]


Sydenham's appears to be a rather heterogenic disease, with widely varying severity and long-term outcomes (in part also related to presence or absence of carditis). Recent case reports usually indicate good recovery without noticeable long-term sequelae, even in dramatic cases, and although permanent lesions in the brain are sometimes seen on MRI (surprisingly not always in the basal ganglia). But the good recovery from severe cases is likely to a large part the result of modern immunomodulatory therapy, which means prognosis could have been much worse centuries ago. For example, there is an open-access case report of chorea paralytica, where severe muscle hypotonia rendered the subject bedridden, and marked dysphagia necessitated nasogastric feeding. Without medical treatment, this state can continue for months, and such a case may well end up with cachexia, fluid loss, pneumonia and death. But the good responsivity of SC to immunomodulation can for the most part prevent disastrous outcomes (alongside intensive care, where necessary). BTW, the prevalence of chorea paralytica in SC seems highly variable as well, as estimates range from "very rare" to several %'s.

Chorea paralytica source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4711077/

The incertainity in prevalence I found for chorea paralytica also appears to affect other severe manifestations like ballismus and dramatic psychiatric symptoms, e.g. psychosis. For the case of psychosis, it seems to be most common in young adults suffering from SC, and very rare in smaller children. This appears typical for autoimmune encephalitis in general. In addition, a genetic susceptibility to psychosis is usually suspected in those suffering psychotic SC. Some catatonia-like symptoms like mutism appear to be more common.
Interestingly, there is some older literature about the relationship between SC and schizophrenia, mostly from times when autoimmune disease wasn't yet well understood and SC was treated purely on a symptomatic basis. Some longitudinal studies found a marked increase in schizophrenia prevalence in former SC patients, as well as a higher prevalence of relentlessly progressing courses with poor prognoses in these schizophrenics. Few newer systematic investigations exist about this topic, and these don't really reproduce this grave picture. Again a benefit from modern medical science? Or were some ancient cases of "Chorea minor" in fact more severe diseases like pediatric anti-NMDAR encephalitis?

The Sydenham's-schizophrenia relationship is illustrated, for example, in https://bmcmedgenet.biomedcentral.com/articles/10.1186/1471-2350-6-7.

Apart from these more or less rare complications of SC, it is a rather mild type of encephalitis with often tolerable symptoms and a surprisingly good prognosis, given that the body attacks neurons in the brain, which generally has poor regeneration capabilities.

Sorry for spamming this discussion page. I just wanted to share my current knowledge about the topic. --2003:E7:771F:1500:F56B:8F91:C09C:727F (talk) 01:04, 4 March 2019 (UTC)[reply]

One could mention rhabdomyolysis as another possible but avoidable complication of severe chorea (caused by constant muscle activity combined with fluid loss due to dysphagia). Although rhabdomyolysis secondary to extrapyramidal hyperkinesia seems to be more common in older individuals than in young ones. --130.83.182.66 (talk) 16:38, 5 March 2019 (UTC)[reply]
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