17/09/2025
CHOREA
Chorea is a movement disorder with irregular, abrupt, and purposeless movements. It often looks like dancing or fidgeting movements that flow from one muscle group to another.
Pathology
• Chorea originates from dysfunction in the basal ganglia, especially the striatum (caudate nucleus and putamen).
• Loss of inhibitory pathways in the basal ganglia-thalamic-cortical circuit causes excessive motor output.
• Imbalance between dopamine, GABA, and acetylcholine leads to reduced inhibition of unwanted movements.
• In Huntington’s disease, there is selective neuronal loss in the caudate nucleus, leading to cortical disinhibition and progressive motor, cognitive, and psychiatric symptoms.
• In Sydenham’s chorea, autoimmune antibodies attack basal ganglia neurons after group A streptococcal infection.
• Drug-induced chorea often results from increased dopaminergic activity.
Causes
• Huntington’s disease (genetic, progressive)
• Stroke affecting basal ganglia
• Autoimmune (Sydenham’s chorea, lupus)
• Drugs (levodopa, antipsychotics, oral contraceptives)
• Metabolic disorders (thyroid disease, hypoglycemia, polycythemia)
Symptoms
• Involuntary, flowing, non-repetitive movements
• Impaired coordination and balance
• Speech and swallowing difficulties
• Psychiatric and cognitive changes in neurodegenerative causes
Diagnosis
• Neurological exam focused on movement patterns
• MRI or CT to detect structural lesions
• Blood tests for autoimmune, metabolic, or infectious causes
• Genetic testing for Huntington’s disease
Treatment
• Treat underlying cause when reversible (infection, metabolic imbalance, drug side effect)
• Dopamine-depleting agents (tetrabenazine, deutetrabenazine)
• Antipsychotics (haloperidol, risperidone)
• Symptomatic support with physiotherapy, speech therapy, and occupational therapy