Chorea is a pathology of the nervous system.It refers to forms of hyperkinesis. The disease is accompanied by problems with the subcortical nodes of the brain. It can be identified by its characteristic features: episodic, aimless, chaotic twitching in the arms and legs, sometimes in the body. In the later stages, mental and intellectual impairments, problems with coordination and self-care arise. In children, chorea is often mistaken for the usual increased activity. In fact, at the first manifestations of pathology, you need to seek qualified help.
The term is used in two cases.It can designate independent diseases that belong to this group (for example, a small chorea or Huntington's chorea). It is also used to describe some syndromes that occur in diseases of different types. The word "chorea" is taken from the Greek language, where it denotes a certain type of dance. This explains the first symptoms of the disease, which are manifested in steep, uncoordinated, jerky, rapid movements of the trunk and limbs. The behavior of the patient is really like an involuntary, disorderly dance. Once upon a time, chorea was called “the dance of St. Witt.” This name is associated with the ancient belief about St. Witt, who actively spread Christianity, for which he was tortured by Roman soldiers. After his death, the legend became popular that if someone performs an active dance near his grave on his birthday, he will receive a charge of vigor and energy for a whole year.
The causes of the development of the disease may have a different origin, but most often, hereditary factors or genetic disorders cause chorea.
Less common chorea caused by suchinfectious diseases such as tuberculous meningitis, viral encephalitis, neurosyphilis, borreliosis, whooping cough. The occurrence of chorea can also be associated with metabolic disorders (if Fabry disease occurs, hyperglycemia, hyperthyroidism or Wilson-Konovalov disease), intoxication (poisoning with oral contraceptives, mercury, lithium, digoxin, neuroleptics, levodopa), autoimmune pathologies, as well as a number of pathologies that you can use to create pathologies for your own body. , systemic lupus erythematosus, multiple sclerosis). Among the reasons that provoke the occurrence of the disease, doctors also refer to damage to the brain structure. These include tumor formations, hypoxic encephalopathy, traumatic brain injuries, strokes.
Chorea is a disease that manifests itselfrandom, chaotic, short-term bodily movements. In some cases, these movements can be taken as normal, adequate, characteristic of a healthy person, with something alarmed. In others, they resemble an emotional, uncontrolled dance. Push-jerking may be one- or two-sided, but they lack at least some kind of synchronicity.
Depending on which form is detectedpathology, there are manifestations of chorea. If a person has a slightly pronounced choreic hyperkinesis, then in his behavior there is a motor slight anxiety, accompanied by motor disinhibition, heightened emotionality, certain grimaces, fussy movements, inadequate gestures.
Clearly expressed forms of chorea appear aspeculiar movements "devil on a thread." The pronounced form of choreic hyperkinesis distorts movement when walking, speech and facial expressions. The gait of the patient is not only strange, but also to some extent “clown”. Chorea, the symptoms of which are extremely severe, does not allow for any movements at all. Patients with a severe form of pathology are dependent on their surroundings, since they cannot move around and serve themselves fully in everyday life.
This pathology in most casesappears in age from 35 to 45 years. Chorea, the symptoms of which, in addition to the typical hyperkinesis, still carry personality disorders and dementia (reduced intelligence), develops gradually, sometimes even difficult to trace the moment when it began to manifest. The first violent movements usually occur on the face. They can be confused with random motor automatisms (this is tongue sticking out, frowning, lips licking, mouth opening). The progression of the disease is manifested in the development of hyperkinesis in the trunk and extremities. The severe form is characterized by impairment of speech, memory, swallowing processes, self-care level and ends with dementia. The starting point for Huntington's chorea is mental disorders in the form of hallucinatory-paranoid, affective and behavioral disorders.
Patients with neuroacantocytosis suffer not onlychoreic hyperkinesis, but also acanthocytosis (the form of erythrocytes changes). A distinctive feature in this pathology is atrophy (weakness in the muscles of the upper and lower extremities). Other characteristics of the disease include: oral hyperkinesis with chewing movements, lip twitching, tongue sticking out and other grimaces. In neuroacantocytosis, the patient involuntarily tempers his tongue, lips and inner surface of the cheeks to blood. Complicating factors in this disease are dementia and epileptic seizures.
Congenital diseases of the nervous system interfereman live a full life. Such pathologies include Lesch-Nyhan disease. The main cause of the development of pathology is a hereditary deficiency of hypoxanthine-guanine phosphoribosyltransferase. This chorea in children is accompanied by severe disturbances in the functioning of the nervous system. Also pathology provoked increased production of uric acid.
From the first months of life the child is noticeddevelopmental delay. Rigidity of the limbs appears from the third month. From the second year of life, the baby has facial grimaces that are accompanied by signs of lesions of the pyramidal tract and mental retardation. The baby can harm itself physically by biting its lips or fingers.
Benign chorea in children is manifested inchest or early childhood. Treats pathology to hereditary diseases. Generalized hyperkinesis in this disease recedes only when the child is sleeping. This type of pathology differs from Huntington's chorea by a non-progressive course and normal development of the intellect. In older age with benign trochaic, you can reduce hyperkinesis, if you go to a medical institution in time.
The most common secondary forms of pathology are two: small chorea and chorea of pregnant women.
The first is also called the chorea of Sydengam.Exacerbation of streptococcal infection or rheumatism can provoke its occurrence. Light form is characterized by exaggerated grimaces, expressive gestures, disinhibited movements. More complex forms of choreic hyperkinesis are manifested in the fact that it is difficult for the patient to move, speak normally, even breathe. With the disease, there are also "tonic" knee and "freezing" reflexes, emotional and affective disorders, muscular hypertension.
In pregnant women, chorea is a disease thatreturns from childhood. That is, those women who have had little chorea in their childhood are in the risk zone. Pathology can manifest itself during the first pregnancy at 2-5 months. The subsequent course of the “interesting” position can also cause chorea. Treatment in such cases is rare, since the disease disappears by itself after the termination of pregnancy or after childbirth.
Возникновение болезни происходит на фоне aggravated rheumatism or endocarditis, which is accompanied by valvular heart disease. Many cases of the disease are not associated with this factor, and the disease manifests itself independently.
Ревматическая хорея чаще всего поражает детей в age from 6 to 15 years. In girls, pathology is more common. In the first stage, the disease may not cause concern, as the symptoms are limited to grimaces, and parents take it as a joke. The process continues with small involuntary movements of the limbs, starting from the tips of the fingers and spreading gradually throughout the body. After a week, a period of manifestation begins, when the movements of the child become fast and sweeping. This state prevents the baby from continuing normally his activities, that is, to eat, walk, write.
Rheumatic chorea distorts the face of a childthousands of grimaces. Severe forms of the disease prevent the patient from standing on his feet, swallowing, talking, while the body is constantly moving. If chorea is diagnosed, treatment should be carried out carefully and urgently.
Suspicions of chorea occur because of strangehuman behavior. During the preliminary examination, the doctor should talk with the patient or his relatives. In particular, it is important to find out if someone else in the family was sick with this disease, how long the symptoms of chorea appeared, if the patient was on medication, if he had any inflammatory diseases. Next, the specialist must give an assessment of involuntary movements. It is also necessary to diagnose and describe diseases that may accompany chorea, cause serious intellectual deviations. Symptoms of such diseases do not always appear. Sometimes in order to detect a similar pathology at an early stage, they conduct a whole range of examinations. A blood test will show the level of copper in the blood and the presence or absence of signs of inflammatory reactions. In addition, computed tomography, magnetic resonance imaging, electroencephalography are performed.
Chorea is a pathology that does not allowthe patient should lead a normal, full-fledged lifestyle, so her treatment should be timely and comprehensive. Tactics of treatment depends on the causes of the disease. For example, in case of Wilson-Konovalov disease, patients are prescribed diets with a minimum copper content and drugs that are aimed at reducing its absorption.
In chorea, Huntington is prescribed antipsychotics andbenzodiazepine tranquilizers. If chorea is caused by chronic insufficiency of blood supply to the brain, then drugs are needed to lower blood pressure. When vasculitis spend hormonal treatment. If very generalized symptoms occur, treatment should be comprehensive.
Reduce the intensity of involuntary movementsIt is possible with the help of a surgical intervention when the ventrolateral nuclei of the thalamus are destroyed. When trochee you need to take drugs that improve the work and nutrition of the brain, as well as vitamins of group B.
