Chorea is a movement disorder characterized by unpredictable, involuntary body movements due to the overactivity of a neurotransmitter known as dopamine in the parts of the brain responsible for movement. This abnormality is often associated with another underlying issue, like immune system conditions, genetic conditions, AIDS, infection-related conditions, endocrine disorders, and pregnancy. Symptoms of chorea can be specific to what is causing it and may include the inability to move the hands properly, involuntary sticking out of the tongue, shoulder shrugs, pelvic thrusts, teeth grinding, seizures, muscle weakness, sensation loss, abnormal gait, and slurred speech. Diagnosis of chorea is made through a physical examination, blood testing, and MRI scans of the brain and body. Treatment of chorea varies depending on its underlying cause and may include medications, surgery, and home care.
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Hemiballismus is a type of chorea that primarily affects one side of the body with more severe involuntary movements of the arm or legs than those in individuals affected by other forms of chorea. Hemiballismus is a result of reduced activity of the basal ganglia subthalamic nucleus or certain metabolic abnormalities in rare cases. A previous stroke, traumatic brain injury, amyotrophic lateral sclerosis, nonketotic hyperglycemia, neoplasms, vascular malformations, tuberculomas, demyelinating plaques, and HIV infection complications can cause this reduced activity. Hemiballismus causes an individual to have involuntary and violent flinging extremity motions. These motions have amplitudes that are wide and tend to be continuous. These movements affect proximal or distal muscles located on one side of a patient's body. The affected individual's legs and arms often move together, and facial muscles can also be involved. These movements tend to become more severe when the patient performs physical activities.
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Sydenham's chorea is a type of chorea that occurs following a rheumatic fever or streptococcal infection. The pathophysiology of Sydenham's chorea is thought to involve the action of antibodies in the patient's immune system that has been induced by the streptococcus infection. This type of chorea is most common among adolescents and children. Sydenham's chorea can disrupt normal voluntary movements in an affected individual, which makes it challenging to perform basic everyday tasks like getting dressed and feeding oneself. Patients tend to experience specific symptoms such as abnormal gait, reduced verbal fluency, compulsions, obsessions, diminished muscle tone, slurred speech, dropping items frequently, spilling things frequently, dysfunction of the hands, and harlequin tongue. There is no biological or serological marker of this type of chorea, so diagnosis is made based upon a patient's clinical features. Some Sydenham's chorea patients may experience spontaneous remission of their symptoms, while others experience symptoms persistently.
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Athetosis is a variant of chorea where an individual exhibits involuntary writhing movements that can be rolling, slow, and continuous. Athetosis can be caused by several different factors, including diseases that cause damage to the basal ganglia, difficulties during the birth process, jaundice, cerebral palsy, drug toxicity, stroke, and trauma. The most common areas of the body affected by athetosis include the arms, feet, and hands. A patient experiences symptoms in the same part of the body repeatedly. Patients are often unable to maintain a stable and normal posture and experience worsening symptoms when they attempt to control this movement. A common feature of athetosis is referred to as muscle overflow. Muscle overflow is a phenomenon where an individual attempts to control one muscle group or muscle and then has uncontrolled movement in a different muscle group. A physical examination, blood tests, gross motor function tests, MRI scans, and other brain imaging tests are used to make a diagnosis of athetosis.
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Tardive dyskinesia is a form of chorea that occurs as a side effect of certain medications in the antipsychotic class used to treat schizophrenia, bipolar disorder, and other brain conditions. These medications work by inhibiting the effects of a chemical referred to as dopamine that helps communication between nerves and muscles. Without enough dopamine, uncontrollable jerky movements can be the result. Medications known to induce tardive dyskinesia after taking them for three months or longer include chlorpromazine, haloperidol, trifluoperazine, fluphenazine, and thioridazine. Other drugs that have caused tardive dyskinesia include metoclopramide and prochlorperazine. Symptoms of tardive dyskinesia include sticking out of the tongue unintentionally, chewing, smacking of the lips, puffing out of the cheeks, grunting, frowning, and rapid blinking of the eyes. Symptoms involving the limbs include wiggling of the fingers, tapping of the feet, flapping of the arms, thrusting of the pelvis, and swaying from one side to the other. The AIMS test, blood tests, CT scans, and MRI scans are used to diagnose tardive dyskinesia.
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Senile chorea is a rare form of chorea that primarily affects adults in their senior years. This form of chorea rarely occurs in individuals younger than fifty years old. Senile chorea is caused by certain medications, genetic neurodegenerations, sporadic neurodegenerations, hematological disorders, immune system disorders, and metabolic disorders. This form of chorea causes the affected individual to produce fast and complex movements of the body that appear purposeful, but are actually involuntary. The involuntary movements produced in senile chorea patients tend to occur symmetrically. Symptoms of senile chorea are similar to some symptoms that occur in Huntington's disease patients, but individuals who have senile chorea do not have the genetic defect that is present in Huntington's disease. Genetic testing is used to rule out other causes of the symptoms to make an accurate diagnosis of senile chorea.