Parkinsonian signs and symptoms in adults with a history of Sydenham's chorea

BackgroundSydenham’s chorea is associated with dysfunction of fronto-striatal circuits induced by cross-reactive antibodies to group A β-hemolytic streptococcus. High susceptibility of extrapyramidal effects of neuroleptics in patients with Sydenham’s chorea suggests underlying nigro-striatal dysfunction.ObjectiveTo study the presence of parkinsonism in patients with a history of Sydenham’s Chorea.MethodsWe used the UFMG Sydenham’s Chorea Rating Scale (USCRS) and the Unified Parkinson’s Disease Rating Scale (UPDRS) part III, respectively, to determine the presence of chorea and parkinsonian symptoms and signs in 25 adults with a history of previous Sydenham’s Chorea currently without chorea or use of anti-choreic drugs.ResultsBradykinesia was found in 64% of subjects. There was a statistically significant correlation between bradykinesia and hemichorea (?0.412; p = 0.036) and bradykinesia and generalized chorea (0.412; p = 0.036). There was no correlation between bradykinesia and use of anti-choreic drugs.ConclusionsBradykinesia is common in patients with Sydenham’s Chorea in remission. This finding suggests an immune-mediated dysfunction of the nigro-striatal system.