Chorea

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  1. Irregular, unpredictable, brief, jerky movements that move from one body part to another in a random sequence; derived from Greek word meaning ‘dance’
    1. often seen in Huntington’s disease and Syndenham chorea; in Huntington’s disease it is accompanied by dementia and psychiatric symptoms
      1. Syndenham’s chorea is an autoimmune disorder resulting from a group A beta-hemolytic streptococcal infection (rheumatic fever) in childhood; there is no known treatment; it is the most common cause of chorea
    2. probably due to atrophy of the caudate – get loss of GABAergic striatal output neurons although patients with vascular strokes of this area do not have chorea
    3. autosomal dominant inheritence with mutation of triplet repeat on chromosome 4
    4. treatment: no cure, provide plenty of calories, treat depression, supportive care; Huntington’s patients who are given L-dopa will have worsening writhing and jerking movements of the limbs
  2. Other movement disorder definitions:
    1. dyskinesias – abnormal, involuntary movements
    2. tremor – rhythmical oscillation of a body part; greater at the end point of movement (intention tremor)
    3. athetosis – slow distal twisting movements
    4. ballism – wide amplitude flinging movements (usually proximal limb); if involving only one side of body then it is hemiballismus ); due to damage of the subthalamic nucleus of Luys or its connection with the pallidum
    5. dystonia – sustained muscle contractions causing twisting and repetitive movements or abnormal postures
    6. tics – abrupt transient stereotypic, coordinated movements that vary in intensity and are repeated at irregular intervals
    7. myoclonus – sudden, brief, shock-like involuntary movements – different from chorea because they occur at a greater speed
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