Korn-Lubetzki Isabelle, Brand Abraham, Steiner Israel
Neurological Service, Bikur Cholim Hospital, Jerusalem, Israel.
Arch Neurol. 2004 Aug;61(8):1261-4. doi: 10.1001/archneur.61.8.1261.
Sydenham chorea (SC), a major sign of rheumatic fever (RF), is related to systemic streptococcal infection and is treated with antibiotics. Recurrence usually occurs within a short interval following the initial event and is considered part of RF.
To evaluate the rate, nature, and course of recurrent SC during an extended follow-up period.
Prospective assessment of a cohort of patients with SC who were admitted between 1985 and 2002.
General community hospital.
Diagnosis of RF was based on the revised Jones criteria. Other causes of chorea were excluded. Recurrence was defined as the development of new signs, lasting more than 24 hours and separated by a minimum of 2 months from the previous episode. Patients were observed from 1 to 14 years following the initial SC episode and for at least 1 year after recurrence. At recurrence, patients were assessed for RF clinical and laboratory activity, including change in cardiac involvement.
Twenty-four patients had SC. In 19 patients (79%), the chorea was associated with other RF signs, and 5 suffered from pure chorea. Ten patients (42%, 7 women) developed 11 recurrent episodes of chorea 3 months to 10 years after the initial episode. Association of recurrent chorea with RF could be suspected in only 6 episodes: cessation of prophylactic antibiotic treatment or poor compliance in 4 patients and rise in antistreptolysin O titers in 2. In an 18-year-old woman, chorea recurred during her first pregnancy. At recurrence, chorea was the sole rheumatic sign in all 9 patients who had 1 recurrent episode. In the patient with 2 recurrent episodes, mitral regurgitation developed into mitral stenosis. No statistical differences in previous RF activity and rheumatic cardiac involvement between patients with recurrent SC and patients with a single episode could be found.
In a significant subgroup of patients, SC recurrence might not be a true relapse of rheumatic fever. It might represent either a primary underlying abnormality that renders patients susceptible to developing such a movement disorder or the outcome of permanent subclinical damage to the basal ganglia following the initial SC episode.
Sydenham舞蹈病（SC）是风湿热（RF）的主要体征之一，与全身性链球菌感染有关，采用抗生素治疗。复发通常在初次发病后的短时间内发生，被认为是RF的一部分。
评估在延长的随访期内SC复发的发生率、性质和病程。
对1985年至2002年间收治的一组SC患者进行前瞻性评估。
综合社区医院。
RF的诊断基于修订的Jones标准。排除舞蹈病的其他病因。复发定义为出现新的体征，持续超过24小时，且与上一次发作间隔至少2个月。患者在初次SC发作后观察1至14年，复发后至少观察1年。复发时，对患者进行RF临床和实验室活动评估，包括心脏受累情况的变化。
24例患者患有SC。19例患者（79%）的舞蹈病与其他RF体征相关，5例患有单纯舞蹈病。10例患者（42%，7例女性）在初次发作后3个月至10年出现了11次舞蹈病复发。仅在6次发作中可怀疑复发的舞蹈病与RF有关：4例患者预防性抗生素治疗停止或依从性差，2例抗链球菌溶血素O滴度升高。在一名18岁女性中，舞蹈病在其首次怀孕期间复发。复发时，在所有9例有1次复发的患者中，舞蹈病是唯一的风湿体征。在有2次复发的患者中，二尖瓣反流发展为二尖瓣狭窄。复发SC患者与单次发作患者在既往RF活动和风湿性心脏受累方面无统计学差异。
在相当一部分患者中，SC复发可能并非风湿热的真正复发。它可能代表使患者易患这种运动障碍的原发性潜在异常，或者是初次SC发作后基底节永久性亚临床损伤的结果。
