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

Sidengama chorea (Sudenham, 1636) - neurorheumatism (see).

* * *
(named after the English doctor Th. Sydenham, 1624-1689; synonyms - St. Witt's dance, chorea minor, rheumatic chorea) - a manifestation of rheumatic encephalitis with damage to the cerebellum and its legs; 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 vasculitis of the central nervous system(more often with systemic lupus erythematosus). Associated with the formation of antineuronal antibodies that interact with the antigens of the basal ganglia. Usually occurs several months after acute attack rheumatism, so often in patients it is not possible to identify other signs of rheumatism or streptococcal infection. It is manifested by bilateral or unilateral (hemichorea) hyperkinesia, occurring acutely or subacutely, with an increase over 2–4 weeks. With the involvement of the larynx and tongue, dysarthria and swallowing disorders develop. In mild cases, there can only be grimacing and mannered gestures (a consequence of the patient's desire to give involuntary movements the appearance of purposeful ones). In addition, characteristic muscular hypotension(with the so-called soft chorea, it “masks” the chorea), a decrease in tendon reflexes, a “freezing” knee jerk (prolonged choreic contraction of the quadriceps femoris muscle with repeated tapping on its tendon). Often identified mental changes(affective lability, anxiety-depressive and obsessive states, decreased attention and memory), vegetative disorders (lability blood pressure, tachycardia). In most cases, hyperkinesis spontaneously regresses within 3–6 months. Recurrence of the disease is possible, including during pregnancy, taking oral contraceptives, psychostimulants, drugs levodopa, difenin. AT remote period in some patients who have had Sydenham's chorea, blurred speech, awkwardness of movements, tremors, tics, asthenic, obsessive or anxiety-depressive disorders are detected. Treatment: bed rest in the acute period, small doses of benzodiazepines or barbiturates, in more severe cases, antipsychotics, valproic acid or carbamazepine are used. Use glucocorticoids, plasmapheresis, intravenous immunoglobulin. Those who have had Sydenham's chorea for 5 years need prophylaxis with benzathine benzylpenicillin.

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 to support 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 - extended in time (more than 2 months) development of clinical and instrumental symptoms valvulitis - with the exclusion of other causes.

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

* PANDAS is an abbreviation English words"Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections" (Children's autoimmune neuropsychiatric disorders associated with streptococcal infection". This condition is related in pathogenesis to rheumatic chorea, but differs from it in a 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. basis primary prevention acute rheumatic fever are timely diagnosis and adequate therapy active chronic infection pharynx (tonsillitis, pharyngitis). Taking into account the global clinical experience designed adapted to the conditions Russian healthcare recommendations for rational antimicrobial therapy of tonsillitis and pharyngitis.

Secondary prevention aims to prevent recurrent attacks and disease progression in individuals who have had an acute rheumatic fever, and provides for the regular administration of long-acting penicillin (benzathine penicillin). 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 to the insufficient effectiveness of bicillin prophylaxis in 13-37% of patients. Joint studies performed at the Institute of Rheumatology of the Russian Academy of Medical Sciences and the State scientific center on antibiotics have shown that currently highly effective and safe medicine secondary prevention acute rheumatic chorea is benzathine benzylpenicillin, administered at a dose of 2.4 million units intramuscularly every 3 weeks. Produced by the 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 XXI century. the efforts of scientists will be focused on the creation and improvement of a vaccine containing epitopes of M-proteins of "rheumatogenic" strains that do not cross-react with tissue antigens of the human body.

General information

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

This disease is more pronounced in children, however, there is evidence of the occurrence of the disease in adults.

The reasons

The main causative agent of the disease is group A gemological streptococcus. This streptococcus is well known to all parents, since it is he who is to blame for the occurrence of a sore throat or other infectious diseases of the upper respiratory tract(VDP).

It is believed that the sick child infectious disease URT, immediately goes into the risk group, as a potential patient with a diagnosis of chorea.

Nevertheless, despite the fact that given reason is one of the main ones, there are a number of other factors that can provoke the development of this disease, including:

heredity;
rheumatic diseases in the body;
malfunctions of the endocrine system;
the presence of carious formations on the teeth;
reduced immunity;
taking certain medicines;
cerebral palsy;
insufficient blood supply to the brain

This is far from complete list causes that can provoke chorea. Know what is most susceptible this disease children aged 5 to 15 years due to what is happening in their body hormonal changes. Girls are especially affected by the disease, as their concentration of hormonal surges is exceeded several times.

Symptoms

The main symptoms of chorea minor 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 in little patient the following are diagnosed clinical manifestations diseases:

uncontrolled movements of the limbs (especially manifested during writing or drawing);
grimacing;
regular and uncontrolled 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 may manifest as a complete loss of speech);
shouting out some words or sounds;
capriciousness;
touchiness;
anxiety state;
decreased muscle tone;
when lifting the baby by the shoulders, the head seems to sink into the shoulders (a kind of pressing the head into the neck occurs);
the inability to raise their hands up with their palms inward (the child raises them with their palms outward);
inability to stick out the tongue with closed eyes;
blueness of the feet and hands;
cold extremities;
low pressure.

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

Diagnostics

This disease is diagnosed using integrated approach to its study.

At the very beginning, the doctor will receive primary data on the patient's condition, symptoms, and thus, make an anamnesis.

to immediate diagnostic measures can be attributed:

clinical blood test;
neurological tests (checking the body's response using neurological methods);
electromyography;
CT scan;
Magnetic resonance imaging;
electroencephalography.

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

Treatment

Therapy for chorea is, first of all, to eliminate the cause of the development of the disease, and this is in most cases 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 microflora of the stomach, the doctor prescribes a course of bifidobacteria preparations (Linex, Baxet). This therapy especially necessary for young children, since their fragile body is not able to independently cope with such disorders in the stomach.

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

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

In severe cases, the patient without fail bed rest is shown, with a restriction on the entry of bright light and loud sounds into the room.

The whole 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.

Forecast and prevention for minor chorea

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

Naturally, in the case reinfection a child with streptococcal infection or rheumatism may relapse.

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

Heart disease.
aortic insufficiency.
mitral stenosis.

Despite the fact that the disease is not among the deadly, there have been cases of a fatal outcome, with sudden failures 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, chorea is not fatal, but unpleasant disease with the presence of complications, so a timely appeal to a specialist will avoid problems in the future for you and your baby. Take care of your children and get treated right!

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

Types of chorea

The disease can take the following forms:

Chorea minor (in children);
Chorea of Huntington;
Chorea of pregnancy.

The disease is also rheumatic and non-rheumatic, rheumatic chorea occurs in children and pregnant women.

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

The disease in pregnant women develops in the first trimester. In this case, the symptoms of chorea are the result of a small 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, "chorea" means "dance", 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 physical activity decreases, in a dream it is absent, but at the slightest irritation it intensifies again. The disease is also characterized by a decrease muscle tone.

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

Chorea in children (small)

The disease develops against the background of rheumatism. Patients note diffuse changes in the cerebral hemispheres, cortex, trunk, membranes and subcortical nodes of the brain. Often these lesions occur simultaneously with cardiac disorders. The risk group includes children aged 5 to 14 years.

The symptoms of chorea are as follows:

Increase in body temperature up to 38 degrees;
Inaccuracy of movements;
violation of coordination;
Change 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.

The symptoms of chorea in children tend to get worse over time. Often, parents do not pay attention to some moments in the behavior of the child, because they may look like innocent pranks. But soon the syndrome acquires pronounced features, which perplexes moms and dads.

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

Sometimes the disease is manifested by pathological reflexes, impaired sensitivity, pain syndromes. Also, the child may experience a violation of speech, increased sweating.

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

Huntington's chorea

This type of disease is hereditary. The first symptoms make themselves felt, as a rule, between 25 and 50 years. The manifestations of the disease are:

Choreic hyperkinesis of a relatively slow pace (non-rhythmic and sharp twitching of the limbs or trunk);
Progressive decline in intelligence;
Emotional instability.

In the case of Huntington's disease, the prognosis is unfavorable, that is, it is impossible to cure the disease.

Chorea treatment

Treatment of chorea of a small type is carried out in a hospital. The patient is strictly shown bed rest, rest and careful care for him. The medical arsenal includes:

Antibiotics (novocillin, penicillin, bicillin, ecmonovocillin);
Salicylates ( acetylsalicylic acid, salicylic sodium, butadiene, amidopyrine);
Hormones of the glucocorticoid series (prednisolone and cortisone);
Vitamins and trace elements (preparations containing calcium, multivitamins, vitamin C, vitamins of group B);
Heart remedies.

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

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

In order to prevent chorea minor, 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.

Adult people suffering from Huntington's disease are advised to refrain from procreation - conception and the birth of children.

Chorea minor is a rheumatic anomaly. It is expressed in vivid uncontrolled movement disorders. The nature of this nervous pathology more than once baffled doctors. 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 the recurrence of scarlet fever or tonsillitis.

Disease development factors

It is noteworthy that girls are more at risk of developing chorea minor than boys. Reasons for the development of this disease long time were a real mystery to doctors. Now doctors have come to the conclusion that the root cause of the development of chorea 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 into the connective tissue.

If a infectious agent enters the CNS natural cause this is a malfunction of the GM. This leads to impaired coordination of movements and muscle tone.

The duration of the anomaly is 3-6 weeks.

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

How does pathology manifest itself?

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

Chorea minor, being a "juvenile" anomaly, develops extremely rarely after the onset of puberty. At risk, again, are girls. Chorea minor in adult young ladies is almost never found. the exception is persons prone to relapse during gestation.

Main features

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

According to some researchers of this pathology, against the background of a small chorea, rheumatic cardiac anomalies may develop.

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

Clinical signs

Subsequently, the symptoms of chorea minor appear in:

Muscle weakness.
Violation of motor coordination.
The presence of choreic hyperkinesis.

A sick child moves quickly, but by no means rhythmically. Movement passages are distinguished by rudeness, awkwardness and random distribution. From the outside, it seems that the movements are very “ragged”.

Hyperkinesis can be both symmetrical and 1-sided. They are expressed in facial expressions, feet, and hands. Hyperkinesis of the larynx is very common. Against this background, a person suffers slurred speech, swallowing is impaired.

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

Diagnosis of the disease

Chorea minor can be pre-diagnosed immediately. To clarify the diagnosis, the specialist is obliged to collect an anamnesis of the patient's life. For this, they are used special methods research. In addition, in a person suffering from this disease in laboratory conditions blood is taken for analysis. It is in the blood test that the number of markers is detected rheumatoid factor, as well as reactive protein and streptococcal infection.

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

To discover focal changes The GM is assigned a CT scan.

Features of helping the patient

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

All prescriptions and wishes of the specialist must be strictly followed. In some cases, the doctor recommends surgery to remove the tonsils. It is better to do so, because otherwise the child will have a sore throat very often.

Impulsive uncontrolled actions are stopped by taking antipsychotics.

Important to consider

Chorea minor is characterized by a paroxysmal manifestation. Average duration 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 (drowsiness is most often observed);
hallucinations.

Far from always the “strange” behavior of a child is pampering.

If a child suddenly begins to wrinkle his forehead, spill the contents of a spoon without sitting down to bring it to his mouth, tip a plate over himself and make a face, you should not rush to either punish him or take him to a psychologist or priest. It is these signs that are the first swallows in the development of chorea minor.

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

Conclusion

The prognosis of chorea minor, unfortunately, is not very encouraging. Often patients die from dementia or cachesia.

Disease prevention is possible. To do this, it is necessary to treat catarrhal pathologies in a timely manner, and even better - to 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 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 predominantly in childhood.

The disease requires immediate therapy, 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 revealed that children from five to fifteen years old are susceptible to the development of small chorea, and the incidence among girls is somewhat more common than among boys. This is due hormonal features female body.

CNS lesions 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 often manifested in girls, and the peak incidence is in the autumn and winter.

The duration of the disease averages three to four months. In some cases, after prolonged absence symptoms may flare up, most often during pregnancy.

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

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

This type of streptococcus in most cases affects the upper respiratory tract (URT). It is enough to get sick with tonsillitis 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-over 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 response manifested by hyperkinesis.

This happens far from always, otherwise every second child would get sick chorea minor. It is believed that the disease can develop due to:

the presence of a rheumatic disease;
genetic predisposition;
failures in the functioning of the endocrine system;
chronic infectious processes of the upper respiratory tract;
caries not cured in a timely manner;
decrease in immunity;
increased emotionality;
the use of certain medications, for example, for nausea;
chronic insufficiency of blood supply to the brain;
the presence of cerebral palsy - cerebral palsy.

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

Varieties of rheumatic chorea

Apart from classic version chorea minor is also noted atypical course. There are the following types of pathology:

erased (sluggish, oligosymptomatic);
paralytic;
pseudo-hysterical.

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

Clinical manifestations

The general symptoms of the disease are quite bright. The manifestation of the disease can be different in each individual case. The main symptoms of chorea minor disease include hyperkinesis (involuntary movements).

The appearance of chaotic muscle contractions that occur randomly and which the child is not able to control is noted.

At the beginning of the disease, hyperkinesis is hardly noticeable. Grimacing, clumsiness of hands, unsteadiness of gait, parents do not perceive as a reason to seek the help of a specialist.

Over time, hyperkinesis becomes more noticeable. They usually occur during agitation. By ignoring the manifestations of the violation, movement disorders are complicated. They become pronounced, up to a choreic storm - a paroxysmal occurrence of uncontrolled movements throughout the body.

What is worth paying special attention to?

Handwriting of a child diagnosed with chorea

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

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.
Uncontrolled frequent antics.
restlessness. The baby is unable to sit in one place, he constantly scratches himself and twitches different parts body.
involuntary shouting out different sounds (due to involuntary contraction of the muscles of the larynx).
Slurring, confusion of 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, capriciousness, touchiness, tearfulness).

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

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

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

Diagnostic approach

In addition to a physical examination, history taking, and blood sampling, the following may be done:

computed tomography;
electroencephalography;

All this will contribute to the identification of pathological foci in the brain, the assessment of muscle function, the identification of 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, antibiotics of the penicillin and cephalosporin series are prescribed.

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

Since the disease is characterized psychoemotional disorders, without fail, prescribe the use of sedatives and tranquilizers. If necessary, neuroleptics are used. Often, medications are prescribed to improve the functioning of the brain, as well as B vitamins.

Chorea minor can only be treated by a neurologist. Dosages of drugs are selected individually for each individual case.

In the acute period, it is recommended to comply bed rest. At this time, it is important to create the right conditions, with no or minimal exposure to irritants - this also applies to light and sound. The nutrition of the child should be balanced and fortified.

What is the prognosis?

With timely treatment, the prognosis is positive, the disease ends in recovery. However, the occurrence of relapses is not excluded. Exacerbations of the disease may be due to repeated sore throat or rheumatic process.

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

The disease is not fatal and proper treatment does not pose a threat to the life of the patient. A fatal outcome is possible in the event of a sharp failure in the functioning of the CCC, incompatible with life.

Preventive actions

In addition, care must be taken to physical development child, rational nutrition, anti-relapse therapy, strengthening immune system, as well as the disposal of chronic foci of infection.

Usually, when a child gets sick, the mother sees it right away. But there is a disease that is so easy to distinguish from simple pampering or indiscipline will not work. This exceptional disease is called "chorea" - children are more often punished for it than they are shown to a doctor.

Chorea: what is it?:

Chorea (small chorea, Witt's dance, rheumatic or infectious chorea, Sydenham's chorea) is a neurological course of rheumatic disease. Accompanied by the disease movement 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 angina. The body begins the fight against infection by producing antibodies to streptococcus to fight it. Some people have a cross immune response, ie. antibodies begin to attack their own body cells - 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 is manifested by specific symptoms.

The development of streptococcal infection with brain damage is not manifested in everyone. The main predisposing factors are:

Heredity;
- violations hormonal background;
- chronic diseases upper respiratory tract;
- carious teeth;
- violations in the work of immunity;
- natural increased nervous excitability and emotionality;
- asthenic body type.

Chorea affects children of preschool and school age. At the age of up to 3 and after 15 years, the disease practically does not occur. Girls are also more prone to the disease than boys.

The course of chorea and its symptoms:

Chorea develops gradually after suffering tonsillitis, scarlet fever, tonsillitis or influenza. All the main features can be classified into 4 groups:

1. hyperkinesis (involuntary and uncontrolled muscle movements);

2. discoordination (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. In movements, clarity and coordination are lost. Handwriting deteriorates in school-age children preschool age- Drawings lose clarity. The child begins to eat inaccurately, there are difficulties with holding objects, grimaces on the face are caught. The more attentive parents or teachers at school, the sooner they will be able to understand that the child is not indulging, and his whole condition is explained by a specific disease.

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

Limb movement disorder manifests itself in erratic shudders due to muscle damage. The movements are absolutely involuntary, but increase with additional stimuli and stop when the child falls asleep. Twitching progresses quickly enough, and at the peak of the disease it seems that the child is in constant motion. Legs, arms, shoulders - everything is covered by meaningless and unnecessary contractions. The child cannot walk normally, stand, his speech is disturbed. Conscious movements are fleeting and almost imperceptible (squeezing the hand, holding objects, etc.). In parallel with twitching, muscle hypotension is noted, i.e. when lifting the patient lying down, taking the armpits, the shoulders involuntarily lean back, 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. Uncontrolled mood swings for no reason are also noted: the child becomes easily vulnerable, laughter is quickly replaced by crying or irritability.

If the diaphragm is affected during the course of the disease, then Czerny's symptom or "paradoxical breathing" is noted. It manifests itself by pulling abdominal wall on inspiration, instead of a normal protrusion.

As a rule, the disease proceeds without an increase in the overall body temperature. Possible fever with exacerbation of rheumatic inflammation of the internal organs.

The disease lasts about 7-10 weeks, but can be delayed up to 4 months. Relapses are not uncommon, as well as a regular change of remissions with a deterioration in health.

The prognosis is usually favorable and the patient usually recovers. There is some dependence on the rate 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 noted after angina and rheumatic exacerbations.

How to diagnose?:

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

With this disease, they turn to a pediatric neurologist (or a pediatrician sends him). The doctor carefully studies the history, examines the child and conducts a series of diagnostic manipulations (blood test 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;

Analysis of cerebrospinal fluid;

Electromyography to determine skeletal muscle disorders.

Be sure to differentiate chorea from dysmetabolic encephalopathies, classic tics and viral encephalitis.

Necessarily when making a diagnosis, the doctor must conduct the following neurological tests:

-"eyes and tongue of Filatov" or "language of a chameleon"(the patient cannot hold his tongue out with eyes closed);

- Gordon phenomenon(during the knee-jerk test, the shin drops after lifting after only a few seconds, freezing in the air and making a few swings before stopping);

- symptom of "pronator"(when lifting the palms above the head, forming a semicircle with the hands and brushes a candle, an involuntary turning of the palms outward is noted);

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

- flabby shoulder syndrome(when lifting the patient's armpit, 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, which can last up to 12 months.

The child needs rest and a long sleep, for which “sleep wards” are organized in the hospital 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, hyperkinesias are completely eliminated, and the child at this time can be completely at rest.

Showed their effectiveness physiotherapy, physiotherapy, and creative pursuits where you need to work with your fingers (embroidery, modeling, knitting, drawing, cutting, etc.).

As drug therapy are prescribed:

Antirheumatic drugs;

antibiotics;

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

Hormonal agents;

B group vitamins.

With insufficient efficiency medicines a psychologist helps to deal with psycho-emotional changes.

Conclusions:

Chorea minor in children does not directly threaten the life of the child (the 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 preventive measure from illness. It is also important to remember a few important rules:

1. Chorea often manifests itself after scarlet fever, influenza and tonsillitis, so children after illness should be under their mother's close supervision.

2. Seek immediate medical advice if mood swings, muscle twitching, or uncoordinated movements are noticed.

3. When making a diagnosis, the prescriptions of doctors must be strictly observed.