| Chorea gravidarum | |
|---|---|
| Specialty | Neurology,obstetrics  |
Chorea gravidarum is a rare[1] type ofchorea which presents with involuntary abnormal movement, characterized by abrupt, brief, nonrhythmic, nonrepetitive movement of any limb, often associated with nonpatterned facial grimaces. It is a complication ofpregnancy which can be associated witheclampsia and its effects upon thebasal ganglia. It is not a causal or pathologically distinct entity but a generic term for chorea of any cause starting during pregnancy. It is associated with history ofSydenham's chorea. It mostly occurs in young patients; the average age is 22 years.[2][3]
Recently there has been a decline in incidence which is probably the result of a decline inrheumatic fever (RF), which was a major cause of chorea gravidarum before the use ofantibiotics forstreptococcal pharyngitis.[citation needed]
Several pathogenetic mechanisms for chorea gravidarum have been offered, but none have been proven.History of eitherrheumatic fever or chorea is suspected:[2][3] the suggestion is thatestrogens andprogesterone may sensitizedopamine receptors (presumably at astriatal level) and induce chorea in individuals who are vulnerable to this complication by virtue of preexistingpathology in thebasal ganglia.The relation to rheumatic fever was strengthened by many studies that showed that women with normal pregnancies before rheumatic fever developed chorea in subsequent pregnancies.[4][5] At least 35% of patients have a definite history of acute rheumatic fever andSydenham chorea; 4% of those with chorea gravidarum hadacute rheumatic fever.[2][3]
It has been suggested that use of oral contraceptives is an infrequent cause of chorea. A patient developed this chorea with no definite evidence of previous Sydenham's chorea or recent streptococcal infections, but had anti-basal gangliaantibodies, suggestingimmunological basis for the pathophysiology of this chorea.[6][7]
Chorea can also be a manifestation of drug toxicity (for example,anticonvulsants,antiparkinson agents,neuroleptics,steroids, andestrogen), or a result of an infectious disease such asmeningovascular syphilis,Lyme disease,viral encephalitis, and many others.[citation needed]
Drug treatment is indicated for patients with severe disabling chorea. It is treated withhaloperidol,[9][10][11]chlorpromazine alone or in combination withdiazepam, and alsopimozide, which is another neuroleptic drug which may have fewer adverse effects than haloperidol.[12]Valproic acid,chloral hydrate,risperidone, orphenobarbital can also be used.[13]
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