The Drug of Choice for Sydenham chorea is
(D) Sodium Valproate[?]SYDENHAM'S CHOREA:oSydenham's chorea (SC)/Chorea minor/Rheumatic chorea (RC)/St Vitus' s Dance:-Major diagnostic criteria for rheumatic disease-Most common acquired chorea during childhood-Characterized by rapid, uncoordinated jerking movements primarily affecting the face, hands and feet.[?]Treatment of Chorea:oMay be difficult to treat.oTaper or discontinue any medications that can cause or worsen chorea.oIn adults, the mainstay of treatment in adults is Neuroleptics, including Haloperidol & Pimozide.oIn children the incidence of side effects in children is high.oTherefore, treatment is usually:-Benzodiazepine, particularly Clonazepam, Diazepam or Clobazam.-Valproate Is the drug of choiceoSydenham chorea generally responds to dopamine-blocking agents - Valproic acid & carbamazepine.oBenzodiazepines facilitate the action of GABA and valproate enhances the action on GABA, hence these agents are used to treat choreaoBut it is self limited, and treatment generally restricted to those with severe chorea.oSydenham chorea with recurrence in lateral life as pregnancy (Chorea gravidarum) or treatment with sex hormones.[?]Treatment Hyperkinetic Movement Disorders:oDystonia:-Anticholinergic, baclofen, botulinum toxin, globus pallidus internus DBS.oHemifacial spasm:-Botulinum toxinoEssential tremor:-Propranolol, primidone, topiramate, botulinum toxin, ventral intermediate nucleus DBS.oTics (Tourette's syndrome):-Fluphenazine, risperidone, botulinum toxin.oChorea (huntington's Disease):-TetrabenazineoMyoclonus:-Clonazepam, levetiracetam, piracetam, sodium valproate.oTardive dyskinesia:-Withdrawal of the causative treatment, tetrabenazine (for tardive stereotypy, chorea, tremor), botulinum toxin (for tardive dystonia).GENETIC & NON-GENETIC CAUSES OF CHOREAGenetic causesNon-genetic causes* Huntington's Disease* Sydenham's chorea* Neuroacanthocytosis* Metabolic causes* Benign hereditary chorea* Chorea gravidarum* Wilson's disease* Drug induced chorea* Dentatorubropallidolusian atrophy* Senile chorea* Spinocerebellar ataxia type 2* Vascular chorea* McLeod Syndrome* Infective causes[?]CAUSES OF CHOREA:oDrugs:-Levodopa in Parkinson's patients-Oral contraceptive pills-Many psychiatric drugsoVascular disease of the basal ganglia:-Atheroma-Systemic lupus erythematosusoDegeneartive disease:-Huntington's diseaseoPost-infectious:-Sydenham's choreaoOther causes: Thyrotoxicosis
Haloperidol
Sodium valproate
Diazepam
Prednisolone
C.N.S.