Has your little one suddenly started moving their limbs and body in strange ways? Does he sometimes stutter while talking? Or do you see him suddenly smiling and making faces? As a parent, it is normal for you to feel very scared when you see these things. But there can be a reason for all this. Today we are going to talk about one such condition. That is a condition called `Sydenham Chorea`.
What is `Sydenham Chorea`?
Simply put, `Sydenham Chorea` is a movement disorder of the nervous system that occurs in children. It is specifically caused by a bacterial infection called `(Group A beta-hemolytic Streptococcus)`. Yes, yes, you guessed it right, this is the same bacteria that causes strep throat and rheumatic fever.
Now you might be thinking, "How can this happen with a throat infection?" Here's what happens... Our body's immune system is there to protect us from disease. However, when this `(Streptococcus)` bacteria enters the body, some children's immune systems get a little confused. That means that instead of attacking just the bacteria, it mistakenly starts attacking some healthy parts of the brain as well. This affects the parts of the brain that control movement in particular.
The Greek word "Chorea" means "dance." So the name comes from the involuntary, rapid, and uneven jerking and jerking of the limbs that these children experience, which appear to be dancing. In some severe cases, these movements can even interfere with the child's daily activities.
This condition usually occurs in children after they have had either ``strep throat'' or ``rheumatic fever.'' This is the most common form of chorea in children caused by external causes.
How common is this condition?
In fact, in developed countries like North America and Europe, the incidence of Sydenham Chorea is now very low. The reason for this is that antibiotics are given promptly for throat infections in those countries. However, in developing countries like ours, this condition can still be seen because sometimes treatment methods are different and not everyone gets prompt treatment.
Who is more likely to develop this?
It is most often seen in children between the ages of 5 and 15. It is also slightly more common in girls than boys. It is very rare in children under 5 years of age or in adults.
What other complications can this cause?
Children with Sydenham Chorea are at risk for a condition called PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections). PANDAS is an autoimmune neuropsychiatric disorder associated with streptococcal infections. However, there is still disagreement among doctors about whether strep infection actually causes PANDAS. Children with PANDAS may experience symptoms such as:
- Behavioral changes and lack of attention.
- Obsessive-compulsive features.
- Sudden, unnatural movements or sounds (tics).
Not only that, but our immune system's response to this streptococcus infection can also affect other organs, such as the skin, joints, and heart. For example:
- Arthritis
- Inflammation of the inner lining of the heart (endocarditis)
- Heart valve disease
Important: This is why a child with Sydenham Chorea is advised to be examined by a cardiologist.
What is the exact cause of `Sydenham Chorea`?
As we have already said, the main cause of this is an abnormal response of the immune system to a bacterial infection with `(Group A beta-hemolytic Streptococcus)`. Simply put, our own defense soldiers (immune cells) mistakenly attack parts of our own brain. Especially the area of the brain that controls movement. In the blood of people with `Sydenham Chorea`, special `(antibodies)` (antibodies) have been found in the blood of people who have `Sydenham Chorea`.
What are the symptoms of `Sydenham Chorea`?
These symptoms can occur anywhere on the child's body. Sometimes they appear suddenly and can worsen when the child is tired.
Physical characteristics:
- The limbs and body are jerking and flailing about aimlessly, rapidly, and randomly. When you see this, it seems like the child is very restless and mischievous.
- Inability at work, things falling from hands.
- Difficulty holding something firmly in your hand.
- Rubbing your hands together.
- Restlessness.
- Sudden changes in facial expression (like a slight frown).
- Stumbling and falling when walking.
Speech difficulties:
- Slurring of speech, stuttering.
- Sudden outbursts of words, shouting, etc.
Mental and emotional characteristics:
- Anxiety, fear.
- Difficulty concentrating.
Imagine, when a child named Amila comes home from school, her mother notices that her handwriting is more messy than usual, and her hands shake when she writes. Even in class, she doesn't sit still when the teacher says she's going to, she just dances. When she comes home, she can't even put the rice in her mouth properly with a spoon and it spills out. If you see something like this, you should definitely seek medical advice.
When do symptoms start?
This is a bit of a special case. Symptoms do not appear immediately after a throat infection (strep throat) or rheumatic fever. Some children may not start to develop these symptoms of `Sydenham Chorea` until about 6 months of age .
How do you diagnose this?
A doctor will ask your child about their symptoms and ask if they have been exposed to Group A beta-hemolytic Streptococcus infections in the past. This means they will ask if they have had a recent sore throat, skin infection, or joint pain.
Then, a blood test can be done to check for antibodies to the strep bacteria. This can be very helpful in making a diagnosis. If your child is confirmed to have Sydenham Chorea, a heart test (usually an echocardiogram) may also be done to check for damage to the heart valves or conditions such as endocarditis.
How is Sydenham Chorea treated?
The best treatment for your child will depend on how severe the symptoms are. Sometimes, if the symptoms are very mild, no special treatment may be needed. However, the doctor will continue to monitor the child.
Treatment of moderate and severe `Sydenham Chorea`:
Children with moderate to severe symptoms may benefit from medication.
- Steroid-type medications: These help to remove the wrongly formed antibodies from the body.
- Other medications: Sometimes additional medications may be needed. Although these medications are mainly used for other conditions, they can also be used safely for Sydenham Chorea. They include:
- Anticonvulsants: Examples include drugs like valproic acid and carbamazepine. These help stabilize nerve impulses.
- Antipsychotics: For example, haloperidol. These can control tics, such as jerking movements and sudden screams.
- Dopamine depleters: An example of this is a drug called Tetrabenazine. This controls involuntary movements.
Remember, all of these medications are available only on prescription. Never use these medications without medical advice.
Can this situation be prevented?
Yes, to some extent. Timely and proper treatment (antibiotics) for ``Strep throat`` (throat infection) and ``rheumatic fever`` (rheumatic fever) can reduce the risk of developing ``Sydenham Chorea``.
Also, if your child has Sydenham Chorea, doctors may recommend continuing antibiotics until the child is an adult (perhaps until age 21 or even older) to prevent recurrent strep infections and reduce the risk of heart disease. The long-term goal is to prevent permanent damage to the heart valves that can result from heart disease.
What is the future for children with `Sydenham Chorea`? (Prognosis)
You may be happy to hear this. Most children recover completely within 3 to 6 months. However, a very small number may have symptoms for up to 2 years.
Another thing is that sometimes these symptoms can recur later in life, especially when women take birth control pills containing the hormone `(estrogen)` or become pregnant. Therefore, if you have had `Sydenham Chorea` before, it is very important to inform your doctor about it.
How is daily life with this situation?
Children with moderate to severe symptoms may find it difficult to carry out everyday activities. Imagine how much these involuntary movements interfere with schoolwork, playing, and hanging out with friends. One of the challenges of living with Sydenham Chorea is that symptoms can come on suddenly and can wax and wane throughout the day. This can make it difficult to participate in normal childhood activities.
Sydenham Chorea is an acquired neurological disorder that occurs after an infection with Group A beta-hemolytic Streptococcus. It is most common in developing countries, where children do not receive adequate antibiotic treatment for strep infections. Even after successful treatment, a small number of children may develop heart disease and other complications later in life. However, most children recover completely and do not develop any complications.
Remember as a summary (Take-Home Message)
- Sydenham Chorea is a movement disorder caused by an abnormal response of our body's immune system to a bacterium (streptococcus) that causes throat infections and rheumatic fever.
- This is most often seen among children between the ages of 5-15, especially girls.
- Symptoms such as involuntary movements of the limbs, slurred speech, and changes in behavior may be seen.
- Treating throat infections promptly and properly can help prevent this.
- Most children recover completely, but long-term medical monitoring is important because some can develop complications such as heart disease.
- If your child has any of these symptoms, don't panic and see a qualified doctor immediately. Prompt diagnosis and treatment can help your child recover quickly.
If you have any further questions about this, be sure to talk to your family doctor or pediatrician. They will be able to provide you with further explanations and help.
` Sydenham's chorea, strep throat, rheumatic fever, neurological disorders, movement disorders, pediatrics, antibiotics
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