A patient primer from the UF Health Center for Movement Disorders & Neurorestoration
What is chorea?
Chorea refers to involuntary movements characterized by their random, brief, and non-rhythmic character. They are often described as seeming to “flow” from one body part to another unpredictably, though they can also be confined to a single area of the body (such as the mouth area or hands). Choreic movements can often look like restlessness or fidgeting to those not familiar with them. They can usually be reduced to some degree when the affected person concentrates on suppressing them. The movements can also be masked or hidden when they are combined with normal voluntary movements. Patients with chorea will sometimes become clumsy or drop objects repeatedly, and chorea can lead to falling when it affects walking. The characteristic pattern of walking that occurs in chorea is often easily recognizable by movement disorders neurologists.
What causes chorea?
Chorea is a symptom and not a specific disease, similar to the way a fever can happen for many different reasons. Chorea can be caused by a variety of abnormal processes in the body, including metabolic derangements, exposure to certain drugs or toxins, genetic and degenerative diseases of the brain, infections, tumors, and disorders of the immune and inflammatory systems of the body. When these processes affect a specific region of the brain called the basal ganglia and its connections, they can produce chorea.
Is chorea the same thing as Huntington’s disease?
Huntington’s disease is a genetic disease caused by a specific gene mutation. It is the most widely recognized cause of chorea, but it is just one cause, and not even the most common one.
Do patients with Parkinson’s disease get chorea?
In patients who take medications to treat the symptoms of Parkinson’s disease, the medications can cause choreic movements that are more commonly referred to as dyskinesias. These movements occur secondary to the anti-parkinsonian medications and are not caused by Parkinson’s disease directly. Medications that are used to treat Parkinson’s disease can sometimes cause other abnormal movements as well, such as dystonia.
My doctor mentioned athetosis. Is athetosis the same thing as chorea? What is choreoathetosis?
Athetosis is a form of chorea that is slow and writhing in quality. Most movement disorders neurologists consider it a form of chorea, and often athetosis can change over time into chorea and vice versa. When both chorea and athetosis occur at the same time, it is sometimes referred to as choreoathetosis. Athetosis and choreoathetosis can sometimes be mistaken for another involuntary movement called dystonia.
Who does chorea affect?
Since many different types of diseases and disorders can cause chorea, it can affect almost anyone from infants and children to the elderly, and it can occur in both males and females. The number of people affected with specific diseases that cause chorea is known and the number of people who have chorea or develop it every year is difficult to study.
How is chorea diagnosed?
Chorea is diagnosed clinically, meaning that it is based on the examination of an experienced physician. There is currently no objective test that differentiates chorea from other types of involuntary movements. The clinical evaluation includes a detailed history of other medical problems, prior surgeries, previous infections you may have had, exposures to medications and toxins (including alcohol and illegal drugs), and a family history of diseases that occurred in your relatives. You should be ready to answer questions such as when the movements started, whether it was a quick or gradual onset, and any associated symptoms. It can be helpful to try to obtain a list of all the medications you have been prescribed within a year of onset of involuntary movements from your pharmacy. Once the clinical diagnosis of chorea is made, your physician will likely need to order additional tests to try to identify the underlying cause of the movements. This usually includes blood tests and imaging studies of the brain such as magnetic resonance imaging (MRI), and can sometimes include more specialized tests. Determining the cause of chorea can sometimes be challenging even for movement disorders specialists, and in some patients with chorea the cause cannot be identified.
How is chorea treated?
The treatment of chorea is first directed at treating the underlying cause of the movements if possible. This may include discontinuing a medication, correcting a metabolic abnormality, or medically treating an autoimmune, infectious, rheumatologic, or endocrinologic cause of chorea. In some cases in which chorea is due to prior damage to the brain or an ongoing degenerative process, there may not be a treatment available to influence the underlying disease process. The choreic movements themselves can be treated with medications that can help to suppress them. In very specific cases neurosurgical procedures can sometimes be considered.
Where do I find more information on Chorea?
Please feel free to contact me, Dr. Christopher Hess, at the UF Health Center for Movement Disorders and Neurorestoration (Contact Us Form) for further information. Other sites online tend to be disease-specific, and are most helpful once a diagnosis is made.