Minor chorea in adults. Types and causes of development, symptoms and treatment of chorea minor

Symptoms of the pathology manifest themselves in the form of sudden attacks of hyperkinetic activity.

During such conditions, the child experiences pronounced psychoemotional disorders. Minor chorea in children is treatable, but therapy may take long time. In the absence of timely measures taken, the prognosis for the child will be unfavorable.

What it is?

Chorea - what kind of disease is it? Chorea is a neurological manifestation of infection.

The pathology is accompanied by numerous psycho-emotional disorders and erratic movements of the limbs.

According to the morphological essence, the disease is rheumatic encephalitis, affecting the basal ganglia of the child’s brain.

If the pathology arose in childhood, then after 25 years its relapse may appear. To prevent a repeat attack, special preventive measures must be taken.

Where does it come from?

The main factor that provokes minor chorea in a child is the progression of infection in his body. At risk are children 5-15 years old.

Most often, the disease is diagnosed in girls with a thin physique and an overly sensitive psyche.

Symptoms of the disease manifests itself less intensely in warm and dry weather, and reaches maximum performance when the climate worsens.

provoke The following factors can cause chorea in a child:

1. Hereditary predisposition.
2. Weight loss or asthenia.
3. Lack of timely therapy.
4. The presence of infection in the body.
5. Excessive tendency to catch colds.
6. Consequences of hormonal imbalances in the body.
7. Critical low level immunity.
8. Consequences of psychological trauma.
9. Excessive sensitivity nervous system.
10. The child has chronic or...
11. Progression of infectious diseases of the upper respiratory tract.

Classification and forms of pathology

Downstream, minor chorea may be latent, subacute, acute and recurrent.

In the first case, symptoms are weak or completely absent.

For acute and subacute form disease signs of minor chorea appear to the maximum extent. The recurrent variant is characterized by regular outbreaks of pathology.

Additionally, minor chorea is divided into the following kinds:

• indolent disease;
• paralytic form;
• pseudo-hysterical type.

Symptoms and signs

The first symptoms of chorea in most cases appear within a few days after a child suffered infectious disease (for example, tonsillitis, sore throat, etc.). In rare cases, pathology appears suddenly.

This feature of the disease is due to the likelihood of a long-term presence of streptococcus in the child’s body in an asymptomatic form.

Symptoms of the disease may persist over several months or years. Signs of minor rheumatic chorea are the following conditions:

Alarming symptoms indicating the development of minor chorea in a child are changes in facial expressions, handwriting and gait. If these factors are ignored, the progression of the disease will lead to rapid spread infections in children's bodies.

Treatment will be difficult and will take a long time. If these deviations occur, it is necessary to as soon as possible undergo examination at a medical institution.

Neurological signs of minor chorea in a child:

Complications and consequences

Fatal outcomes as a result of complications of minor chorea in medical practice are isolated cases.

If the disease is not treated fully and in a timely manner, then main complications will concern of cardio-vascular system, brain and nervous system child's body.

In some cases, a severe degree of pathology can provoke critical physical exhaustion of the child.

Consequences The following conditions can cause minor chorea:

• purchased;
• dysfunction of the cerebral cortex;
• aortic insufficiency;
• regular muscle;
• mitral;
• violation social adaptation;
• persistent neurological abnormalities.

Diagnostics

Diagnoses minor chorea neurologist.

At the initial stage of examining the child, the specialist collects anamnesis, conducts a visual examination and applies some techniques that allow a preliminary diagnosis to be made in advance.

Additionally, examination and laboratory testing procedures are required for a small patient. For rate general condition the child may need counseling infectious disease specialist, immunologist or endocrinologist.

When diagnosing chorea, the following procedures are used:

• laboratory blood tests;
• EEG of the brain;
• cerebrospinal fluid examination;
• electroencephalography;
• CT and MRI of the brain;
• electromyography;
• PET scan of the brain.

Treatment

The goal of chorea therapy is not only to eliminate the symptoms of the pathology and causes, but also relapse prevention. With a properly designed course of treatment, the duration of remission increases significantly.

The drugs should be normalized protective functions the child’s body and stop the process of producing antibodies to its own cells.

Additionally, for the child you need to create comfortable conditions stay away from bright lights and loud sounds.

The following types are used in the treatment of chorea drugs:

A good addition to the main course of chorea therapy are physiotherapeutic procedures. As a result of their use, some brain functions are normalized and blood supply is improved.

Most procedures used for chorea minor have an anti-inflammatory effect. In addition, physical therapy allows you to prolong remission and eliminate the occurrence of relapses of the disease for a long time.

Examples physiotherapeutic procedures:

• UHF of individual parts of the brain;
• pine baths (the method has contraindications);
• calcium electrophoresis;
• electrosleep;
• UV irradiation of the collar area.

Forecast

Forecasts for minor chorea depend on the degree of damage pathology of the child's body.

If treatment began in a timely manner, the course of therapy was drawn up correctly and was carried out fully, then the risk of complications is minimal.

With favorable prognosis, there is full recovery little patient. Violation of prescribed therapy or its premature termination increases risk of complications.

Poor prognosis possible under the following factors:

• independent use of antibiotics to treat the disease;
• uncontrolled use of drugs for symptomatic treatment of the child’s emerging condition;
• ignoring the first symptoms of minor chorea;
• late contact medical institution for diagnosing pathology.

Prevention

Preventive measures to prevent minor chorea in children should be carried out at the stage of pregnancy planning. The risk of developing pathology in an unborn child can be identified through medical genetic counseling.

If one of the parents has a streptococcal infection, then therapy must be carried out in full. After the birth of a child, the prevention of chorea should begin from the first days of his life.

Measures to prevent minor chorea are as follows: recommendations:

Lesser chorea can cause difficulties in the child's social adaptation.

Attacks of the disease are accompanied by numerous motor and psychoemotional disorders.

If timely therapy is not carried out, relapses will occur at short intervals, and some consequences of the disease cannot be eliminated.

We kindly ask you not to self-medicate. Make an appointment with a doctor!

Chorea minor is a disease that manifests itself as a rheumatic infection of a neurological nature. Minor chorea is also called Sydenham's chorea, rheumatic or infectious chorea. In a sense, this is encephalitis of the rheumatic breed. This brain disease is of muscular origin and manifests itself in the form of hyperkinesis, which develops as a consequence of damage to the brain structures that provide the function of coordination of movements and are responsible for muscle tone. The disease is based on damage to the blood vessels of the brain, mainly affecting the subcortical nodes. Lesser chorea rheumatically affects the heart.

According to statistics, girls get sick twice as often as boys. Manifestation occurs between the ages of 6-15 years, often during the cold season. The fact that girls are more frequently affected is associated with hormonal characteristics the growing body and the production of female sex hormones. The fact of involvement in pathological process cerebellum and striatal brain structures. It manifests itself in the form of uncontrolled attacks, the duration of which is about three months, in some cases it can last up to six months or even several years. Minor chorea may recur.

Small chorea also affects adults aged 30-45 years. In this case clinical picture accompanied primarily by severe mental disorders, most often irreversible.

Causes of minor chorea

The disease is infectious in nature. It has been established that the cause of the development of chorea minor can be considered an infection with group A beta-hemolytic streptococcus. This infection mainly affects the upper Airways and provokes the development of tonsillitis and tonsillitis. In the process of fighting the disease, the human body produces antibodies that fight streptococcal bacteria. Sometimes a so-called autoimmune response occurs - simultaneously with these antibodies, antibodies to the basal ganglia of the brain also begin to be produced. Next comes the attack nerve cells basal ganglia, which provokes inflammatory processes in the subcortical formations of the brain, which manifest themselves in the form of hyperkinesis.

The main provocateurs of the production of antibodies to the basal ganglia of the brain can be considered:

• genetic predisposition;
• instability of the nervous system, for example, excessive emotionality;
• hormonal imbalances;
• weak immune system;
• development inflammatory processes in the upper respiratory tract;
• dental caries;
• thin body structure.

The presence of beta-hemolytic streptococcus can provoke the production of antibodies to other structures human body(heart, joints, kidneys), and cause rheumatic damage to these organs. This will be the reason for considering the disease as a variant of the rheumatic process as a whole.

Modern neurology is still exploring the question of the nature and cause of the development of chorea minor. The assumption about the infectious nature of the disease was made at the end of the 18th century by the scientist Stol. Today this issue is still under research.

Symptoms of minor chorea

The clinical picture of minor chorea is visible within a few weeks after suffering an infectious disease (tonsillitis or tonsillitis).

Basic clinical manifestations minor chorea - movement disorders(involuntary twitching of arms and legs). This is called choreic hyperkinesis - rapid, chaotic, uncontrolled muscle contractions. Choreic hyperkinesis can manifest itself in the face, hands, and limbs in general. They can affect the larynx and tongue, the diaphragm, or even the entire body at the same time.

At initial stage hyperkinesis is almost invisible, very often they are not paid attention to. Clumsiness and numbness in the fingers or subtle twitching of the facial muscles may at first be perceived as a child grimacing. Twitching becomes more noticeable with excitement or other emotional outbursts. Over time, hyperkinesis becomes more pronounced and prolonged, and can manifest itself in the form of a so-called “choreic storm,” when uncontrollable twitching occurs simultaneously throughout the body.

To diagnose the disease as early as possible, it is necessary to pay attention to the symptoms of the following hyperkinesis at the very beginning of their manifestation:

1. Awkward movements when writing or drawing. The child has difficulty holding a pencil or brush, cannot concentrate to draw a straight line, makes blots, makes more marks than before; Sometimes you can observe the “milkmaid” syndrome, when the hands involuntarily clench and relax.
2. Uncontrollable antics (tongue sticking out, grimacing). Many attribute these signs to the child’s bad manners, but if other types of hyperkinesis are present, then they are worth paying attention to.
3. Inability to hold a given position for a long time.
4. Involuntary shouting of words or sounds. This may be due to contraction of the laryngeal muscles.
5. Unclear and mixed words when speaking. This can be explained by involuntary contractions of the laryngeal muscles and tongue. If a child who was not previously distinguished by defective speech suddenly begins to pronounce words unclearly, speech becomes inarticulate, then you should contact a neurologist, especially if other signs of hyperkinesis have been noticed.

In severe cases, hyperkinesis of the muscles of the larynx and tongue leads to complete absence speech (“trochaic mutism”).

Sometimes hyperkinesis also affects respiratory muscles diaphragm. In this case, the so-called Cherny syndrome or paradoxical breathing occurs. When you inhale, the stomach sinks inward, and does not protrude, as is normal. The child cannot concentrate his gaze on one object. Eyeball constantly running in different directions.

As hyperkinesis progresses, self-care (eating, dressing, walking) becomes difficult. Signs of hyperkinesis disappear when the child sleeps, but the process of going to sleep is accompanied by certain difficulties.

Other symptoms of chorea minor

1. Decreased muscle tone. Most often, a decrease in tone corresponds to the localization of hyperkinesis. But there are forms of minor chorea when there are almost no signs of hyperkinesis, and muscle tone is so low that the child becomes practically immobilized.
2. Violations psycho-emotional state. Often this is the first symptom a worrying sign of this disease, but such manifestations are associated with minor chorea only after the manifestation of hyperkinesis. The child behaves inappropriately, often cries and is capricious, there is frequent forgetfulness and lack of concentration. In some cases, on the contrary, the child shows apathy towards the world around him and becomes lethargic.

When contacting a neurologist, the doctor may identify several more symptoms during examination and testing of the child:

1. The Gordon phenomenon. When checking knee reflex the leg freezes in an extended position for several seconds (hyperkinesis of the femoral muscle).
2. “Symptom of flabby shoulders” - when a sick child is lifted by the armpits, his head sinks heavily into his shoulders.
3. “Chameleon tongue” - a child cannot keep his tongue out if his eyes are closed.
4. “Charic hand” - with outstretched arms, a special arrangement of the hands appears.

Diagnosis of minor chorea

Diagnosis of minor chorea usually begins with the patient's life history. The diagnosis is made based on a blood test that identifies markers of streptococcal infection. Electromyography is also performed (study of biopotentials skeletal muscles), electroencephalogram, CT, MRI, which reveal focal changes in the brain.

Treatment of chorea minor

Treatment of minor chorea occurs in a hospital setting. The patient is given intramuscular antibiotics, anti-inflammatory drugs, and salicylates. Sometimes used hormonal drugs. IN acute period It is necessary to create the most comfortable conditions for the child with minimal stimuli - light, sounds.

Prognosis and prevention for chorea minor

The prognosis for minor chorea is positive in most cases. If it is detected early, treatment can be considered successful, although relapses may occur against the background of exacerbation of infectious diseases.

Prevention of minor chorea consists of timely administration of antibiotics for viral infectious diseases, as well as adequate and early treatment rheumatoid manifestations, which prevents the progression of the disease in childhood.

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, because 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 a more complex disease, and can also be an indicator of intoxication of the 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 when the disease develops, the child begins to commit voluntary movements 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 condition 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. The inner lining of the heart and muscle may be involved in the process, 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 the symptoms of the disease appear physical nature, emotional instability begins to appear, 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 evaluate your character motor activity the child, his neurological status, muscle tone and the presence of emotional disorders.

To make an accurate diagnosis, it is necessary to do a blood test. The results of a laboratory test will reveal a decreased 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 eliminate hereditary factor and make decisions 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 surgical intervention. However, today, when there are many truly high-quality medicines, and diagnostic methods allow timely detection the slightest signs development of the disease, surgery is extremely rare.

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

Hardening and all kinds of health promotion methods also play a 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 worry may well lead to a surge in recurrent 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!

Sydenham's chorea, minor chorea, dance of "St. Vitus"

Version: MedElement Disease Directory

Rheumatic chorea (I02)

Cardiology

general information

Short description

Rheumatic chorea is a syndrome that develops when group A streptococcus affects the basal ganglia Ganglion ( ganglion) - a collection of nerve cells
, which are located in the deep layers of both hemispheres of the brain, which leads to chaotic and involuntary movements of the body and limbs.

Classification

Depending on the severity of the main symptoms of chorea, the following are distinguished: clinical forms diseases:

1. Light forms. Characteristic manifestations:
- hyperkinesis is limited in localization, rare, weak in amplitude;
- minor coordination problems;

Slight decrease in muscle tone;

May be missing emotional lability;
- vegetative dystonia is observed.

This group also includes erased forms of chorea: barely noticeable hyperkinesis, sometimes tic-shaped or distal, or clonal, non-rhythmic, non-stereotypical.
The duration of mild forms of the disease is 1.5-2 months.

2. Moderate forms. Main manifestations:
- pronounced hyperkinesis in various parts bodies;
- impaired coordination of active movements;
- decreased muscle tone;
- severe symptoms neuroticism and autonomic dysfunction;
- "hemichorrhea" - symptoms of chorea on one side of the body.
Duration of moderate forms: 2-3 months.

3. Severe forms. Characteristic manifestations:
- hyperkinesias are widespread, large in amplitude, frequent, debilitating;
- coordination is severely impaired, simple volitional movements are difficult to perform;
- muscle tone is significantly reduced;
- major mental changes;
- pronounced disturbances of autonomic reactivity.
Duration is 4-6-8 months.

TO severe forms also include:
- “chorea of ​​the heart” - arrhythmias unfounded by heart damage are rarely detected;
- choreic “motor storm” - constant hyperkinesis is possible, pronounced, debilitating, it is impossible to perform active movements;
- “mild chorea” - pronounced hypotension;
- “pseudoparalytic chorea” - hypotension is especially pronounced, there is no hyperkinesis, active movements, reflexes, flaccid paresis and paralysis are detected;
- “autism” - sometimes children cannot speak due to a speech disorder.

Etiology and pathogenesis

Etiological factor- Group A B-hemolytic streptococcus.

The pathogenesis of chorea minor is associated with a pathological immune response to streptococcal antigens. In this case, the leading role is given to the production of autoantibodies that react with striatal antigens. Striatal - related to the striatum (paired accumulation of gray matter in the thickness of the cerebral hemispheres)
neurons. Increasing the permeability of the blood-brain barrier is a necessary condition interactions of antibodies with nervous tissue antigens.

With chorea, the process is localized mainly in the subcortical nodes. In particular - in the striatum The striatum (striatum) is a paired accumulation of gray matter in the thickness of the cerebral hemispheres, consisting of the caudate and lenticular nuclei, separated by a layer of white matter - the internal capsule
(corpus pallidum) in the superior cerebellar peduncles, in the red nucleus. Inflammatory changes are also found in other brain segments.

Epidemiology

Rheumatic chorea is one of the main symptoms of acute rheumatic fever, which occurs with a frequency of 5 to 36%.
Mostly children aged 5-12-13 years old, mostly girls, become ill. After 20 years, chorea is extremely rare.

Risk factors and groups

Anemic children with an asthenic constitution and increased excitability of the nervous system are predisposed to this disease.

Clinical picture

Symptoms, course

Clinical symptoms of chorea minor develop gradually; in most patients - with normal temperature and the absence of pronounced changes in the blood.

Characteristic clinical symptoms minor chorea:

1. Hyperkinesis. They are distinguished by the following features: non-rhythmic, non-stereotypical, reminiscent of voluntary movements, performed with ease, constant. Hyperkinesis intensifies when performing active movements and during emotional reactions; become weaker in a state of static and mental rest; stop during sleep.

2.Violation of active movements- movements are not coordinated, the patient cannot maintain stable positions, the joint work of synergist and antagonist muscles is disrupted, speech is disrupted (explosive speech Explosive speech is non-rhythmic speech, in which, against the background of delays, prolongation of sounds and words, peculiar verbal “outbursts” occur, characterized by abrupt acceleration, involuntarily forced volume of sounds
, mutism Mutism is the absence of verbal communication between the patient and others while the speech apparatus is intact, refusal to speak
).

3. Violation of muscle tone. Characteristic manifestations: muscle tone and strength are reduced, hypotension is observed Hypotonia is a decreased tone of the muscle or muscle layer of the wall of a hollow organ.
and dystonia, tone changes quickly and unevenly (postures, hyperkinesis).

4. Reflex impairment- reflexes are reduced and uneven, observed positive symptom Gordon-2 (when the knee reflex is evoked, a longer extension of the lower leg is observed than in a healthy person).

5. Mental change(“neurotization of the choreic”). Typical manifestations: decreased strength and mobility of the main nervous processes- excitation and inhibition; development of fatigue, lethargy, apathy, absent-mindedness and inattention; Possible sleep disorders.

6. Violation of autonomic reactions- irritation of both departments, phasic sympathicotonia and vagotonia.

In addition, minor chorea can be combined with other manifestations of rheumatism. Of these, the most common is rheumatic carditis, less often - polyarthritis, and extremely rarely - annular erythema, rheumatic nodules, etc.

Diagnostics

Instrumental methods They allow us to obtain only data that is non-specific for rheumatic chorea, and therefore are of an auxiliary nature in diagnosing the disease.

1. Electroencephalography - reveals changes in bioelectrical activity brain
2.Electromyography to study the biopotentials of skeletal muscles. With chorea, there is an elongation of potentials and asynchrony in their occurrence.
3. Computed tomography.
4. Magnetic resonance imaging.
5. Positron emission tomography.

Laboratory diagnostics

At laboratory research The following indicators are detected:
- acceleration of ESR;
- leukocytosis;
- eosinophilia;
- dysproteinemia with a decrease in albumin and an increase in the level of alpha-2 and gamma globulins;
- CRP, increased content of DPA and sialic acids are determined;
- streptococcal antigen and increased titer of streptococcal antibodies (ASL-O, ASG) may be found;
- anticardiac autoantibodies are detected (normal, dystrophic and rheumatic);
- increased levels of all three classes of immunoglobulins (IgA, IgM, IgG).

Differential diagnosis

The greatest difficulties are caused by differential diagnosis chorea minor in situations where it appears as the only criterion for acute rheumatic fever. To exclude other etiologies of hyperkinesis, examination of such patients is carried out jointly with a neurologist.

Possible causes of hyperkinesis:
- benign hereditary chorea;
- Huntington's chorea;
- hepatocerebral dystrophy;
- systemic lupus erythematosus;
- antiphospholipid syndrome;
- thyrotoxicosis;
- hypoparathyroidism;
- hyponatremia;
- hypocalcemia;
- drug reactions;
- PANDAS syndrome.

Complications

A third of patients who have had rheumatic chorea subsequently develop heart disease. Long-term storage possible neuropsychiatric disorders in the form of weakness, lethargy, sleep disturbances.

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Treatment

From the moment the diagnosis is made, antibiotic treatment is prescribed to eradicate group A streptococci from the nasopharynx. The drug of choice is penicillin antibiotics. Recommended daily doses for children are 400-600 thousand units, for adults - 1.5-4 million units. If you are intolerant to penicillins, macrolides or lincosamides are prescribed.

Anti-inflammatory therapy is also carried out using non-steroidal anti-inflammatory drugs (NSAIDs) and glucocorticosteroids (GCS).
NSAIDs used:
- diclofenac or indomethacin at an initial maximum dose of 2-3 mg/kg/day;
- less often - acetylsalicylic acid at a dose of 0.2 g/year of life (but not more than 1.5-2 g/day).
The duration of treatment with NSAIDs is on average 2.5-3 months. For the first 3-4 weeks, NSAIDs are prescribed at the maximum dose, then the dose is reduced by one third and taken for 2 weeks, after which the dose is reduced to half the maximum and the drug is taken for another 1.5 months.

From GKS Prednisolone is most often used at a dose of 0.7-0.8 mg/kg/day. (no more than 1 mg/kg/day). Daily dose is 15-25 mg depending on age and is distributed taking into account the daily biorhythm.
The duration of treatment is 1.5-2 months. The drug in full dose is prescribed for 10-14 days (until a clinical effect is obtained), then the dose is reduced by 2.5 mg (1\2 tablets) every 5-7 days.
For a while hormone therapy Prescribe potassium preparations (panangin, asparkam). After hormones, treatment with NSAIDs is continued (or in combination with them in 1/2 doses).

For chorea that occurs without other symptoms of acute rheumatic fever, the use of GCS and NSAIDs is considered practically ineffective. IN in this case more appropriate purpose psychotropic drugs - neuroleptics (aminazine 0.01 g/day) or tranquilizers from the benzodiazepine group (diazepam 0.006-0.01 g/day). In case of severe hyperkinesis, it is possible to combine these drugs with anticonvulsants(carbamazepine 0.6 g/day).
Electrosleep, pine baths, and vitamins B6 and B1 are also prescribed.

Chorea minor is a disease that manifests itself as a rheumatic infection of a neurological nature. Minor chorea is also called Sydenham's chorea, rheumatic or infectious chorea. In a sense, this is encephalitis of the rheumatic breed. This brain disease is of muscular origin and manifests itself in the form of hyperkinesis, which develops as a consequence of damage to the brain structures that provide the function of coordination of movements and are responsible for muscle tone. The disease is based on damage to the blood vessels of the brain, mainly affecting the subcortical nodes. Lesser chorea rheumatically affects the heart.

According to statistics, girls get sick twice as often as boys. Manifestation occurs between the ages of 6-15 years, often during the cold season. The fact of a more frequent incidence in girls is associated with the hormonal characteristics of the growing body and the production of female sex hormones. Of significant importance is the fact that the cerebellum and striatal brain structures are involved in the pathological process. It manifests itself in the form of uncontrolled attacks, the duration of which is about three months, in some cases it can last up to six months or even several years. Minor chorea may recur.

Small chorea also affects adults aged 30-45 years. In this case, the clinical picture is accompanied primarily by severe mental disorders, most often irreversible.

Causes of minor chorea

The disease is infectious in nature. It has been established that the cause of the development of minor chorea can be considered an infection with group A beta-hemolytic streptococcus. This infection mainly affects the upper respiratory tract and provokes the development of tonsillitis and tonsillitis. In the process of fighting the disease, the human body produces antibodies that fight streptococcal bacteria. Sometimes a so-called autoimmune response occurs - simultaneously with these antibodies, antibodies to the basal ganglia of the brain also begin to be produced. Next, an attack occurs by the nerve cells of the basal ganglia, which provokes inflammatory processes in the subcortical formations of the brain, which manifest themselves in the form of hyperkinesis.

The main provocateurs of the production of antibodies to the basal ganglia of the brain can be considered:

• genetic predisposition;
• instability of the nervous system, for example, excessive emotionality;
• hormonal imbalances;
• weak immune system;
• development of inflammatory processes in the upper respiratory tract;
• dental caries;
• thin body structure.

The presence of beta-hemolytic streptococcus can provoke the production of antibodies to other structures of the human body (heart, joints, kidneys), and cause rheumatic damage to these organs. This will be the reason for considering the disease as a variant of the rheumatic process as a whole.

Modern neurology is still exploring the question of the nature and cause of the development of chorea minor. The assumption about the infectious nature of the disease was made at the end of the 18th century by the scientist Stol. Today this issue is still under research.

Symptoms of minor chorea

The clinical picture of minor chorea is visible within a few weeks after suffering an infectious disease (tonsillitis or tonsillitis).

The main clinical manifestations of chorea minor are motor disorders (involuntary twitching of the arms and legs). This is called choreic hyperkinesis - rapid, chaotic, uncontrolled muscle contractions. Choreic hyperkinesis can manifest itself in the face, hands, and limbs in general. They can affect the larynx and tongue, the diaphragm, or even the entire body at the same time.

At the initial stage, hyperkinesis is almost invisible, very often they are not paid attention to. Clumsiness and numbness in the fingers or subtle twitching of the facial muscles may at first be perceived as a child grimacing. Twitching becomes more noticeable with excitement or other emotional outbursts. Over time, hyperkinesis becomes more pronounced and prolonged, and can manifest itself in the form of a so-called “choreic storm,” when uncontrollable twitching occurs simultaneously throughout the body.

To diagnose the disease as early as possible, it is necessary to pay attention to the symptoms of the following hyperkinesis at the very beginning of their manifestation:

1. Awkward movements when writing or drawing. The child has difficulty holding a pencil or brush, cannot concentrate to draw a straight line, makes blots, makes more marks than before; Sometimes you can observe the “milkmaid” syndrome, when the hands involuntarily clench and relax.
2. Uncontrollable antics (tongue sticking out, grimacing). Many attribute these signs to the child’s bad manners, but if other types of hyperkinesis are present, then they are worth paying attention to.
3. Inability to hold a given position for a long time.
4. Involuntary shouting of words or sounds. This may be due to contraction of the laryngeal muscles.
5. Unclear and mixed words when speaking. This can be explained by involuntary contractions of the laryngeal muscles and tongue. If a child who was not previously distinguished by defective speech suddenly begins to pronounce words unclearly, speech becomes inarticulate, then you should contact a neurologist, especially if other signs of hyperkinesis have been noticed.

In severe cases, hyperkinesis of the muscles of the larynx and tongue leads to a complete absence of speech (“choreic mutism”).

Sometimes hyperkinesis also affects the respiratory muscles of the diaphragm. In this case, the so-called Cherny syndrome or paradoxical breathing occurs. When you inhale, the stomach sinks inward, and does not protrude, as is normal. The child cannot concentrate his gaze on one object. The eyeball constantly runs in different directions.

As hyperkinesis progresses, self-care (eating, dressing, walking) becomes difficult. Signs of hyperkinesis disappear when the child sleeps, but the process of going to sleep is accompanied by certain difficulties.

Other symptoms of chorea minor

1. Decreased muscle tone. Most often, a decrease in tone corresponds to the localization of hyperkinesis. But there are forms of minor chorea when there are almost no signs of hyperkinesis, and muscle tone is so low that the child becomes practically immobilized.
2. Psycho-emotional disorders. Often this symptom is the first alarming sign of this disease, but such manifestations are associated with minor chorea only after the manifestation of hyperkinesis. The child behaves inappropriately, often cries and is capricious, there is frequent forgetfulness and lack of concentration. In some cases, on the contrary, the child shows apathy towards the world around him and becomes lethargic.

When contacting a neurologist, the doctor may identify several more symptoms during examination and testing of the child:

1. The Gordon phenomenon. When testing the knee reflex, the leg freezes for several seconds in an extended position (hyperkinesis of the femoral muscle).
2. “Symptom of flabby shoulders” - when a sick child is lifted by the armpits, his head sinks heavily into his shoulders.
3. “Chameleon tongue” - a child cannot keep his tongue out if his eyes are closed.
4. “Charic hand” - with outstretched arms, a special arrangement of the hands appears.

Diagnosis of minor chorea

Diagnosis of minor chorea usually begins with the patient's life history. The diagnosis is made based on a blood test that identifies markers of streptococcal infection. Electromyography (study of the biopotentials of skeletal muscles), electroencephalogram, CT, and MRI are also performed, which reveal focal changes in the brain.

Treatment of chorea minor

Treatment of minor chorea occurs in a hospital setting. The patient is given intramuscular antibiotics, anti-inflammatory drugs, and salicylates. Sometimes hormonal drugs are used. In the acute period, it is necessary to create the most comfortable conditions for the child with minimal stimuli - light, sounds.

Prognosis and prevention for chorea minor

The prognosis for minor chorea is positive in most cases. If it is detected early, treatment can be considered successful, although relapses may occur against the background of exacerbation of infectious diseases.

Prevention of minor chorea consists of timely administration of antibiotics for viral infectious diseases, as well as adequate and early treatment of rheumatoid manifestations, which prevents the progression of the disease in childhood.