Rheumatic lesion of the nervous system, minor chorea. Chorea minor

Sydenham's chorea (Sudenham, 1636) – neurorheumatism (see).

* * *
(named after the English doctor Th. Sydenham, 1624–1689; synonyms - St. Vitus' dance, minor chorea, rheumatic chorea) - a manifestation of rheumatic encephalitis with damage to the cerebellum and its peduncles; in modern clinical practice is extremely rare. Occurs almost exclusively in childhood and adolescence (5–15 years), its appearance at an older age is regarded as central vasculitis nervous system(more often with systemic lupus erythematosus). Associated with the formation of antineuronal antibodies that interact with basal ganglia antigens. Usually occurs several months after acute attack rheumatism, therefore it is often not possible to identify other signs of rheumatism or streptococcal infection. It manifests itself as bilateral or unilateral (hemichorrhea) hyperkinesis, occurring acutely or subacutely, with an increase over 2–4 weeks. When the larynx and tongue are involved, dysarthria and swallowing disorders develop. In mild cases, there may only be grimacing and mannered gestures (a consequence of the patient’s desire to give the appearance of purposeful movements to involuntary movements). In addition, it is characteristic muscle hypotonia(with the so-called soft chorea, it “masks” the chorea), decreased tendon reflexes, “freezing” knee reflex (prolonged choreic contraction of the quadriceps femoris muscle when its tendon is repeatedly tapped). Often identified mental changes(affective lability, anxiety-depressive and obsessive states, decreased attention and memory), autonomic disorders (lability blood pressure, tachycardia). In most cases, hyperkinesis spontaneously regresses within 3–6 months. Relapses of the disease are possible, including during pregnancy, taking oral contraceptives, psychostimulants, levodopa, diphenine. IN long term Some patients who have had Sydenham's chorea exhibit slurred speech, awkwardness of movements, tremors, tics, asthenic, obsessive or anxiety-depressive disorders. Treatment: bed rest in the acute period, small doses of benzodiazepines or barbiturates; in more severe cases, antipsychotics, valproic acid or carbamazepine are used. They use glucocorticoids, plasmapheresis, intravenous immunoglobulin. Those who have had Sydenham's chorea require prophylaxis with benzathine benzylpenicillin for 5 years.

T. Sydenham. Schedula monitoria de novae febris ingressu. Londini, 1686; p. 25–28.

Encyclopedic Dictionary in psychology and pedagogy. 2013.

Notes: the presence of two major criteria, or one major and two minor criteria, in combination with evidence documented of a previous infection with group A streptococci, indicates high probability acute rheumatic fever. Special cases:

1. Isolated chorea - with the exclusion of other causes (including PANDAS*).

2. Late carditis - development of clinical and instrumental symptoms valvulitis - if other causes are excluded.

3. Repeated acute rheumatic fever with or without chronic rheumatic heart disease.

* PANDAS is an acronym English words“Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections” (children’s autoimmune neuropsychiatric disorders associated with streptococcal infection.” This is a condition related in pathogenesis to rheumatic chorea, but differs from it in its normal neurological status. The clinical picture is characterized only by behavioral disorders in the form of obsessive compulsive disorder and/or tic disorder.

Undoubtedly, to the serious achievements of science of the twentieth century. should include the development of prevention of acute rheumatic fever and its relapses. The basis primary prevention acute rheumatic fever consists of timely diagnosis and adequate therapy active chronic infection pharynx (sore throat, pharyngitis). Taking into account the world clinical experience developed adapted to the conditions Russian healthcare recommendations for rational antimicrobial therapy of tonsillitis and pharyngitis.

Secondary prevention is aimed at preventing recurrent attacks and progression of the disease in people who have had an acute rheumatic fever, and involves regular administration of long-acting penicillin (penicillin benzathine). Application this drug in the form of bicillin-5 made it possible to significantly (4-12 times) reduce the frequency of repeated rheumatic attacks and, consequently, increase the life expectancy of patients with RPS. At the same time, a number of authors pointed out the insufficient effectiveness of bicillin prophylaxis in 13-37% of patients. Joint research carried out at the Institute of Rheumatology of the Russian Academy of Medical Sciences and the State scientific center on antibiotics have shown that they are currently highly effective and safe medicine secondary prevention acute rheumatic chorea is benzathine benzylpenicillin, prescribed at a dose of 2.4 million units intramuscularly every 3 weeks. Produced by domestic industry, prolonged dosage form penicillin - bicillin-5 - is currently not acceptable for secondary prevention of ARF, since it does not meet the pharmacokinetic requirements for preventive drugs. In the coming 21st century. Scientists' efforts will be focused on creating and improving a vaccine containing epitopes of M-proteins from “rheumatogenic” strains that do not cross-react with tissue antigens of the human body.

General information

So, what is minor chorea? Lesser chorea is rheumatic disease neurological nature, which is manifested by excessive motor activity of the patient’s limbs. This disease is known as rheumatic chorea and Sydenham's chorea, after the scientist who discovered this disease in 1686 and described its symptoms.

This disease manifests itself to a greater extent in children, however, there is evidence of the occurrence of the disease in adults.

Reasons

The main causative agent of the disease is group A hemological streptococcus. This streptococcus is well known to all parents, since it is precisely it that is to blame for the child’s sore throat or other infectious ailments of the upper respiratory tract(VDP).

It is believed that a child who is ill infectious disease VDP immediately goes into the risk group, as a potential patient diagnosed with chorea.

However, despite the fact that this reason is one of the main ones, there are a number of factors that can trigger the development of this disease, including:

• heredity;
• rheumatic diseases in the body;
• disruptions in the functioning of the endocrine system;
• the presence of carious formations on the teeth;
• decreased immunity;
• taking certain medications;
• cerebral palsy;
• insufficient blood supply to the brain

This is far from full list reasons that can provoke chorea. You should know that you are most susceptible this disease children aged 5 to 15 years due to what is happening in their body hormonal changes. Girls especially suffer from the disease, since their concentration of hormonal surges is several times higher.

Symptoms

The main symptoms of minor chorea are the formation of hyperkinesis of varying intensity in the patient.

Hyperkinesis - involuntary movements or muscle contractions

Since the nervous system is affected, in addition to hyperkinesis, little patient the following are diagnosed clinical manifestations diseases:

• uncontrolled movements of the limbs (especially evident during writing or drawing);
• grimacing;
• regular and uncontrollable scratching of the baby, the inability to sit quietly in one place, the need to touch something on the body, etc.;
• slurred speech (in especially severe cases it can manifest as complete loss of speech);
• shouting some words or sounds;
• moodiness;
• touchiness;
• anxiety;
• decreased muscle tone;
• when lifting the baby by the shoulders, the head seems to sink into the shoulders (a kind of pressing of the head into the neck occurs);
• inability to raise their arms up with their palms facing inward (the child raises them with their palms facing outward);
• inability to stick out tongue with eyes closed;
• blueness of the feet and hands;
• cold extremities;
• low blood pressure.

In adults who are childhood Having suffered this disease, a heart defect can be diagnosed.

Diagnostics

This disease is diagnosed using integrated approach to its study.

At the very beginning, the doctor will receive primary data about the patient’s condition, symptoms and thus compile an anamnesis.

To immediate diagnostic measures can be attributed:

• clinical blood test;
• neurological tests (checking the body's response using neurological methods);
• electromyography;
• computed tomography;
• magnetic resonance imaging;
• electroencephalography.

An integrated approach to the study of the disease will allow you to make a timely and accurate diagnosis and prescribe effective treatment.

Treatment

Therapy for chorea minor consists, first of all, in eliminating the cause of the disease, which in most cases is an infectious disease.

The basis of treatment is antibiotic therapy. Penicillin and cephalosporin, as well as drugs based on them, are used as the main antibiotics for the treatment of Sydenham's chorea.

Naturally, as a maintenance therapy for the gastric microflora, the doctor prescribes a course of bifidobacterial drugs (Linex, Bakset). This therapy It is especially necessary for young children, since their fragile bodies are not able to cope with such stomach disorders on their own.

In addition, for the treatment of chorea minor, sedative and tranquilizing drugs may be required, which are prescribed in case of negative reactions from the outside psycho-emotional state child.

In addition, in most cases, it is possible to prescribe anti-inflammatory drugs to reduce inflammation in the diseased body.

In particularly severe cases, the patient in mandatory Bed rest is indicated, limiting the entry of bright light and loud sounds into the room.

The entire complex of treatment must be carried out under the supervision of a specialist - a neurologist. Any self-treatment, especially those prescribed based on the results of studying information via the Internet are strictly contraindicated.

Prognosis and prevention for chorea minor

Sydenham's chorea is not fatal disease and with proper treatment goes away in 5-6 weeks.

Naturally, in case reinfection child with streptococcal infection or rheumatism, relapse is possible.

Among the most unpleasant complications, past illness can be attributed:

1. Heart defect.
2. Aortic insufficiency.
3. Mitrine stenosis.

Despite the fact that the disease is not considered fatal, there have been cases of death due to sudden disruptions of the cardiovascular system.

As preventive measures The following should be noted:

• timely treatment of infectious diseases and rheumatic diseases;
• full and harmonious physical development of the baby;
• complete and balanced nutrition;
• strengthening the child's immunity.

So, minor chorea is not fatal, but unpleasant disease with the presence of complications, so timely contact with a specialist will avoid problems in the future for both you and your baby. Take care of your children and get treatment correctly!

Chorea is a disease of the nervous system, which is characterized by damage to the subcortical nodes of the brain and is manifested by rapid, uncontrolled, involuntary and jerking movements in the torso and limbs.

Types of chorea

The disease can take the following forms:

• Minor chorea (in children);
• Huntington's chorea;
• Chorea of ​​pregnancy.

The disease can also be rheumatic and non-rheumatic; rheumatic chorea occurs in children and pregnant women.

Minor chorea is observed in childhood and adolescence in the presence of rheumatism. At timely treatment the disease goes away completely. The causes of rheumatic chorea lie in vascular, degenerative and inflammatory changes in the nervous tissue.

The disease develops in pregnant women in the first trimester. In this case, the symptoms of chorea are the result of minor chorea suffered in childhood. Most often, the disease affects young women.

Huntington's chorea is genetic disease, which occurs in adults and is accompanied by increasing dementia over time.

Translated from Greek, “trochea” means “dancing”, which, in fact, clearly corresponds to the manifestations of the syndrome: the patient performs sweeping, fast and irregular actions, and this process resembles dancing.

Chorea is one of the most common types hyperkinesis (pathological uncontrolled muscle movement). In a state of mental or physical rest motor activity decreases, is absent during sleep, but at the slightest irritation it intensifies again. The disease is also characterized by a decrease muscle tone.

Symptoms of chorea may also indicate serious illnesses brain, in particular for encephalitis, various tumors and for other pathologies. In most cases, rheumatic chorea occurs in children.

Chorea in children (minor)

The disease develops against the background of rheumatism. Patients note diffuse changes in the cerebral hemispheres, cortex, brainstem, meninges and subcortical nodes of the brain. Often these lesions occur simultaneously with cardiac dysfunction. Children aged 5 to 14 years are at risk.

The symptoms of chorea are as follows:

• Increase in body temperature to 38 degrees;
• Inaccuracy of movements;
• Loss of coordination;
• Changes in the child’s behavior (begins to grimace, frown, stick out his tongue, write poorly, twitch his shoulders);
• Bouncing gait;
• Tearfulness, irritability, rapid exhaustion and fatigue.

Symptoms of chorea in children tend to worsen over time. Often, parents do not pay attention to some aspects of their child’s behavior, since they may look like innocent pranks. But soon the syndrome acquires pronounced features, which leaves moms and dads bewildered.

When diagnosed, patients note a decrease in muscle tone, especially in those muscles that are subject to chaotic twitching. The presence of the disease is also checked in this way: the knee is hit with a medical hammer, as a result of which the leg freezes in the extension position - a clear sign chorea.

Sometimes the disease manifests itself as pathological reflexes, sensory disturbances, pain syndromes. The child may also experience speech impairment and increased sweating.

If chorea is detected in time and a series of therapeutic measures are carried out, then after 2-3 weeks the symptoms will disappear, but there is a possibility of relapses.

Huntington's chorea

This type of disease is hereditary. The first symptoms appear, as a rule, between 25 and 50 years. Manifestations of the disease are:

• Choreic hyperkinesis of a relatively slow pace (irregular and sharp twitching of the limbs or torso);
• Progressive decline in intelligence;
• Emotional instability.

In the case of Huntington's disease, the prognosis is unfavorable, that is, the disease cannot be cured.

Treatment of chorea

Treatment of minor chorea is carried out in a hospital setting. The patient is strictly prescribed bed rest, rest and careful care. The medical arsenal includes:

• Antibiotics (novocillin, penicillin, bicillin, ecmonovcillin);
• Salicylates ( acetylsalicylic acid, salicylic sodium, butadiene, amidopyrine);
• Glucocorticoid hormones (prednisolone and cortisone);
• Vitamins and microelements (calcium supplements, multivitamins, ascorbic acid, B vitamins);
• Heart remedies.

Physiotherapy is also indicated for the treatment of chorea, including:

• Pine baths;
• Galvanic collar according to Shcherbak with calcium chloride;
• Electrosleep.

In order to prevent minor chorea, it is possible to recommend sanitation of the nasopharynx and oral cavity, timely diagnosis and treatment various forms rheumatism, as well as hardening of children.

Adults suffering from Huntington's disease are advised to refrain from procreation - conceiving and having children.

Chorea minor is a rheumatic abnormality. It is expressed in pronounced uncontrollable movement disorders. The nature of this nervous pathology I have baffled doctors more than once. Today, doctors have come to the conclusion that the anomaly develops against a rheumatic background.

The main root cause of the development of this anomaly is a relapse of scarlet fever or tonsillitis.

Factors in the development of the disease

It is noteworthy that girls are at greater risk of developing chorea minor than boys. Reasons for the development of this disease long time were a real mystery for doctors. Now doctors have come to the conclusion that the root cause of the development of chorea minor is the penetration of streptococcal bacteria from group A into the body. The disease can begin to progress even against the background of tonsillitis, when bacteria, traveling through the blood, penetrate the connective tissue.

If infectious agent penetrates the central nervous system, then natural cause This is a disruption of the functioning of the GM. This leads to impaired coordination of movements and muscle tone.

The duration of the anomaly is 3−6 weeks.

Death is quite rare. The reason for this is damage to the cardiovascular system.

How does the pathology manifest itself?

The symptoms of chorea minor are quite specific and the disease can be diagnosed already at the dawn of its development.

Lesser chorea, being a “juvenile” anomaly, develops extremely rarely after puberty. Girls are again at risk. Minor chorea almost never occurs in adult young ladies. The exception is individuals who are prone to relapses during pregnancy.

Main signs

The main symptoms of minor chorea include uncontrolled motor passages. They are expressed in nervous twitching of the upper and lower limbs, which is called in medicine choreic hyperkinesis.

According to some researchers of this pathology, rheumatic cardiac anomalies can develop against the background of minor chorea.

The fact that girls are more susceptible to this disease is explained by the influence of female hormones.

Clinical signs

Subsequently, the symptoms of minor chorea manifest themselves in:

1. Muscle weakness.
2. Impaired motor coordination.
3. The presence of choreic hyperkinesis.

A sick child moves quickly, but not rhythmically. Motor passages are characterized by rudeness, awkwardness and random distribution. From the outside it seems that the movements are very “ragged”.

Hyperkinesis can be either symmetrical or unilateral. They are expressed in facial expressions, feet, and hands. Laryngeal hyperkinesis is very common. Against this background, a person suffers slurred speech, swallowing is impaired.

The muscles of the trunk are rarely involved in hyperkinesis. In this case, rapid, almost interrupted breathing is observed. The severity of abnormal manifestations may vary. In some cases, there is a slight grimacing. Sometimes the patient suffers from violent pathological motor passages.

Diagnosis of the disease

You can pre-diagnose minor chorea immediately. To clarify the diagnosis, the specialist must collect an anamnesis of the patient’s life. For this purpose they are used special methods research. In addition, a person suffering from this disease laboratory conditions blood is taken for analysis. It is in the blood test that the number of markers is revealed rheumatoid factor, as well as reactive protein and streptococcal infections.

The key research method is the electroencephalogram. This procedure assumes that GM activity is examined using waves. Then, for research skeletal muscles The doctor prescribes electromyography to the patient.

For detection focal changes GM is prescribed CT.

Features of helping the patient

Treatment of minor chorea should be timely and correct. It is assumed that a person at risk is registered with the attending physician even before the occurrence of specific disorders.

All instructions and wishes of the specialist must be strictly followed. In some cases, the doctor recommends surgery to remove the tonsils. It’s better to do this, because otherwise the child will get a sore throat very often.

Impulsive uncontrolled actions are stopped by taking antipsychotics.

Important to consider

Minor chorea is characterized by paroxysmal manifestations. Average duration the abnormal process is twelve weeks. In some cases pathological period lasts twelve months.

Against this background, a sick child often complains of:

• lethargy and apathy;
• hyperfatigue;
• sleep disturbances (most often drowsiness is observed);
• hallucinations.

A child’s “strange” behavior is not always mischief.

If a child suddenly begins to wrinkle his forehead, spill the contents of a spoon before reaching his mouth, knock over the plate on himself and grimace, there is no need to rush to punish him or take him to a psychologist or priest. It is these signs that are the first signs in the development of chorea minor.

Therefore, if a child suffers from private sore throats, it is recommended to immediately consult a good pediatric doctor.

Conclusion

The prognosis for minor chorea, unfortunately, is not very encouraging. Patients often die from dementia or cachexia.

Prevention of the disease is possible. To do this, you need to promptly treat colds, and even better, prevent their occurrence.

Chorea minor is a rather rare neurological pathology, the main manifestations of which are motor disorders and erratic muscle contractions.

This disease affects children and adolescents, but relapses can also occur at a young age.

Otherwise, the disease is called Sydenham's chorea, rheumatic or infectious. This is the most common form of acquired chorea, occurring mainly in childhood.

The disease requires immediate treatment, otherwise serious complications may develop.

Causes and features of failures

The symptoms of the disease were first described in 1686 English doctor- Thomas Sydenham. It was he who discovered that children from five to fifteen years of age are susceptible to the development of minor chorea, and the incidence among girls is somewhat more common than among boys. This is due hormonal characteristics female body.

Lesions of the central nervous system in chorea minor are localized in the cerebral cortex. But after the discovery of antibacterial drugs, chorea Sydenham accounts for only ten percent of all neurological pathologies in children.

As already mentioned, the symptoms of the disease are more common in girls, and the peak incidence is in the autumn and winter.

The average duration of the disease is three to four months. In some cases after long absence Symptoms may worsen, most often during pregnancy.

The disease, as a rule, is not fatal, but pathological changes in rheumatism that occur in the cardiovascular system can still cause death.

As for the reasons for the development of the disorder, the leading one is past infection beta-hemolytic streptococcus group A, which is why the disease, in addition to its neurological nature, is also infectious.

This type of streptococcus in most cases affects the upper respiratory tract (upper respiratory tract). It is enough to get a sore throat and tonsillitis and the child automatically falls into the risk group. With the development of such diseases children's body starts to lead active struggle with the pathogen, it produces antibodies against it.

Quite often, antibodies can be produced to basal ganglia brain Cross autoimmune response - that’s what it’s called this phenomenon. Antibodies begin to attack the nerve cells of the ganglia, and as a result, inflammatory reaction, manifested by hyperkinesis.

This does not always happen, otherwise every second child would get sick minor chorea. It is believed that the disease can develop due to:

• presence of rheumatic disease;
• genetic predisposition;
• disruptions in the functioning of the endocrine system;
• chronic infectious processes of the upper respiratory tract;
• untreated caries;
• decreased immunity;
• increased emotionality;
• taking certain medications, for example, for nausea;
• chronic insufficiency of blood supply to the brain;
• presence of cerebral palsy - cerebral palsy.

Since beta-hemolytic streptococcus provokes the production of antibodies to other organs and systems and becomes the cause of rheumatic lesions, then this pathology is considered as one of the variants of the active rheumatic process.

Varieties of rheumatic chorea

Besides classic version minor chorea is also noted atypical course. The following types of pathology are distinguished:

• erased (sluggish, low-symptomatic);
• paralytic;
• pseudo-hysterical.

Along the course, the disease can be latent, subacute, acute and recurrent.

Clinical manifestations

The general symptoms of the disease are quite clear. The disease can manifest itself differently in each individual case. The main symptoms of minor chorea disease include hyperkinesis (involuntary movements).

There is the appearance of chaotic muscle contractions that occur randomly and which the child is unable to control.

At the beginning of the disease, hyperkinesis is hardly noticeable. Parents do not perceive grimacing, awkwardness of hands, or unsteadiness of gait as a reason to seek the help of a specialist.

Over time, hyperkinesis becomes more noticeable. They usually occur during excitement. If you ignore manifestations of a violation, movement disorders become more complicated. They become pronounced, up to a choreic storm - a paroxysmal occurrence of uncontrolled movements in the entire body.

What is especially worth paying attention to?

Handwriting of a child diagnosed with chorea minor

There are a number of symptoms that should be alarming. Initial manifestations illnesses are perceived by many parents as banal antics. But timely detection pathology is the basis successful therapy. The main warning signs of minor chorea include:

1. Awkward movements while drawing or writing. The child is not able to hold a pencil; if he writes, then only clumsy, disproportionate letters are obtained.
2. Uncontrolled frequent grimacing.
3. Restlessness. The baby is unable to sit in one place, he constantly scratches himself and twitches in different parts bodies.
4. Involuntary shouting different sounds (due to involuntary contraction of the muscles of the larynx).
5. Blurred, confused speech. In some cases, tongue hyperkinesis provokes the appearance of choreic mutism ( complete absence speech).

In addition, the disease is characterized by:

• decreased muscle tone;
• psycho-emotional disorders(anxiety, moodiness, touchiness, tearfulness).

There are several neurological manifestations, characteristic only for this disease, which a neurologist will definitely pay attention to during examination:

In almost all cases, the pathology is characterized by vegetative disorders: cyanosis of the feet and hands, coldness of the extremities, marbled coloration skin, irregular pulse, tendency to low blood pressure.

Moreover, a third of children who have had the disease may subsequently develop heart defects.

Diagnostic approach

In addition to a physical examination, history taking and blood sampling, the following is prescribed:

• computed tomography;
• electroencephalography;

All this will help identify pathological foci in the brain, assess muscle function, and identify markers of streptococcal infection and C-reactive protein.

Therapy: goals, methods

The basis of treatment is the fight against infection, namely group A hemolytic streptococcus. In this case, the use of penicillin and cephalosporin antibiotics is prescribed.

In order to reduce inflammatory process in the kidneys, anti-inflammatory drugs from the NSAID group are prescribed.

Since the disease is characterized psychoemotional disorders, it is mandatory to prescribe sedatives and tranquilizers. If necessary, antipsychotics are used. Medicines that help improve brain functioning, as well as B vitamins, are often prescribed.

Only a neurologist can treat minor chorea. Dosages of drugs are selected individually for each individual case.

In the acute period, it is recommended to follow bed rest. At this time, it is important to create the proper conditions, without or with minimal exposure to the stimulus - this applies to both light and sound. The child's diet should be balanced and fortified.

What's the prognosis?

With timely treatment, the prognosis is positive and the disease ends in recovery. However, relapses cannot be ruled out. Exacerbations of the disease may be due to recurrent sore throat or rheumatic process.

After past illness Asthenia may persist for a fairly long period. The main complications of the pathology include heart disease, aortic insufficiency, mitral stenosis.

The disease is not fatal and proper treatment does not pose a threat to the patient's life. Death is possible in the event of a sudden failure in the functioning of the cardiovascular system, incompatible with life.

Preventive measures

In addition, it is necessary to take care of the correct physical development child, rational nutrition, anti-relapse therapy, strengthening immune system, as well as getting rid of chronic foci of infection.

Usually, when a child gets sick, the mother sees it immediately. But there are diseases that cannot be easily distinguished from simple self-indulgence or indiscipline. This exceptional disease is called "chorea" - for which children are more often punished than shown to a doctor.

Chorea: what is it?:

Chorea (minor chorea, Witt's dance, rheumatic or infectious chorea, Sydenham's chorea) is a neurological course of rheumatic disease. Accompanied by disease motor disorders, uncontrolled muscle contractions and psycho-emotional deviations.

It is now 100% known that the disease is caused by group A β-hemolytic streptococcus. This microorganism affects upper section respiratory system, causing tonsillitis with sore throat. The body begins to fight the infection by producing antibodies to streptococcus to fight it. Some people experience a cross-immune response, i.e. antibodies begin to attack their own body cells - the brain ganglia in the head, joints, heart muscle, kidneys, etc. A rheumatic infection in the organs and inflammation of the subcortical layer of the brain begins to develop, which manifests itself in specific symptoms.

The development of streptococcal infection with brain damage does not occur in everyone. The main predisposition factors are:

Heredity;
- violations hormonal levels;
- chronic diseases upper respiratory tract;
- carious teeth;
- disturbances in the functioning of the immune system;
- natural increased nervous excitability and emotionality;
- asthenic body type.

Chorea affects children of preschool and school age. Under the age of 3 and after 15 years, the disease practically does not occur. There is also a greater propensity for the disease in girls than in boys.

The course of chorea and its symptoms:

Chorea develops gradually after tonsillitis, scarlet fever, tonsillitis or flu. All main signs can be classified into 4 groups:

1. hyperkinesis (involuntary and uncontrolled muscle movements);

2. lack of coordination (impaired coordination of movements);

3. hypotension (muscle weakness);

4. sudden change of mood.

First of all, the child is overwhelmed by absent-mindedness, tearfulness and resentment. Clarity and coordination are lost in movements. Handwriting deteriorates in school-aged children, preschool age– drawings lose clarity. The child begins to eat sloppily, difficulties arise with holding objects, and grimaces are seen on the face. The more attentive parents or teachers are at school, the sooner they will be able to understand that the child is not playing around, and his entire condition is explained by a specific disease.

Rheumatic lesions internal organs after chorea can appear after a very long time, up to several years.

Impaired movement of the limbs manifests itself in erratic tremors due to muscle damage. The movements are completely involuntary, but intensify with additional stimuli and stop when the child falls asleep. The twitching progresses quite quickly, and at the peak of the disease it seems that the child is in constant motion. Legs, arms, shoulders - everything is covered in meaningless and unnecessary contractions. The child cannot walk or stand normally, and his speech is impaired. Conscious movements are fleeting and practically imperceptible (squeezing the hand, holding objects, etc.). In parallel with twitching, muscle hypotonia is noted, i.e. when lifting the patient lying down, holding the armpits, the shoulders involuntarily fall back, becoming limp.

With the development of chorea in mild form, the main symptom is not a movement disorder, but hypotension, which is immediately perceived as paresis. There is also an uncontrollable change in mood for no reason: the child becomes easily vulnerable, laughter quickly gives way to crying or irritability.

If the diaphragm is affected during the disease, Czerny's symptom or “paradoxical breathing” is noted. This is manifested by retraction abdominal wall on inspiration, instead of normal protrusion.

As a rule, the disease proceeds without an increase in general body temperature. Fever is possible with exacerbation of rheumatic inflammation of internal organs.

The disease lasts about 7-10 weeks, but can drag on for up to 4 months. Relapses are common, as well as regular changes from remission to worsening health conditions.

The prognosis is usually favorable and the patient usually recovers. There is some dependence on the speed of development of clinical signs: the slower the symptoms of the disease appear and the deeper the muscle damage, the longer the recovery will take. Relapses are observed after tonsillitis and rheumatic exacerbations.

How to diagnose?:

As already noted, it is difficult to immediately determine the disease based on clinical signs alone, especially at the beginning of its appearance. As the disease progresses, an experienced pediatrician makes a diagnosis quickly and accurately.

With this disease, they turn to a pediatric neurologist (or the pediatrician sends them to him). The doctor carefully examines the medical history, examines the child and performs a number of diagnostic procedures (blood tests and neurological tests). A blood test determines the presence of streptococcal infection and potential rheumatic damage to the body.

Can be assigned:

Electroencephalogram, computer or magnetic resonance imaging to analyze the functioning of the brain;

Cerebrospinal fluid analysis;

Electromyography to determine skeletal muscle dysfunction.

Chorea must be differentiated from dysmetabolic encephalopathies, classic tics and viral encephalitis.

When making a diagnosis, the doctor must perform the following neurological tests:

-“Filatov’s eyes and tongue” or “chameleon tongue”(the patient cannot hold his tongue out eyes closed);

- Gordon phenomenon(during the knee reflex test, the lower leg lowers after rising only a few seconds later, freezing in the air and making several swings before stopping);

- pronator sign(when you raise your palms above your head, forming a semicircle with your hands and a candle with your hands, an involuntary turning of the palms outward is noted);

- "trochaic brush"(extended hands are bent at the radial and wrist joints with the fingers extended and pressed to the palm thumb);

- flabby shoulder syndrome(when lifting the patient's armpits, there is some sinking of the head into the shoulders).

Treatment of chorea in children:

Acute course chorea is cured an order of magnitude faster than sluggish disease, which can last up to 12 months.

The child needs peace and long sleep, for which purpose in the hospital they organize “sleeping wards” with a ticking clock or, for example, a ticking chronometer, as well as with windows open to the sun. This is done due to the fact that during sleep hyperkinesis is completely eliminated, and the child can be completely at rest at this time.

Shown their effectiveness physical therapy, physiotherapy, and creative activities where you need to work with your fingers (embroidery, modeling, knitting, drawing, cutting, etc.).

The following are prescribed as drug therapy:

Antirheumatic drugs;

Antibiotics;

Drugs that inhibit nervous excitability (neuroleptics, antidepressants and sleeping pills);

Hormonal agents;

B vitamins.

In case of insufficient efficiency medicines A psychologist helps to combat psycho-emotional changes.

Conclusions:

Minor chorea in children does not directly threaten the child’s life (frequency of deaths from rheumatic complications is up to 1%), and when quality treatment may go into long-term remission or be cured completely. Walkthrough full course antibiotic therapy against streptococci - the main preventative measure from illness. It is also important to remember a few important rules:

1. Chorea often appears after scarlet fever, flu and sore throat, so children after illness should be under their mother’s close supervision.

2. You should immediately seek medical advice if you notice mood swings, muscle twitching or uncoordinated movements.

3. When making a diagnosis, doctors' instructions must be strictly followed.