Feinstein Erin, Walker Ruth
Department of Neurology, Rutgers New Jersey Medical School, 90 Bergen St, suite 5200, Newark, NJ, 07103, USA.
Veterans Affairs Medical Center, Department of Neurology, Bronx Mount Sinai School of Medicine, New York, NY, 10029, USA.
Curr Treat Options Neurol. 2018 Sep 25;20(10):44. doi: 10.1007/s11940-018-0529-y.
There are many causes for chorea, including genetic, autoimmune, pharmacological, and structural lesions. Where appropriate, treatment is based on reversing the underlying cause of chorea; many cases are self-limited, resolving when the primary disorder is treated. This review focuses on the management of chorea due to untreatable causes.
There are a limited number of double-blind randomized control trials assessing the efficacy of specific chorea treatments. Most therapeutic recommendations are based on small open-label studies, case reports, and expert opinion. This is in part due to the heterogeneity of chorea and chorea-associated syndromes and the variety of neurodegenerative phenotypes with variable progression rates. Chorea can be treated with a variety of medications ranging from antiepileptics to antipsychotics. The recent development of selective vesicular monoamine transporter blocking agents has allowed for targeted chorea management with minimal side effects. Neurosurgical interventions such as deep brain surgery (DBS) and pallidotomy are reserved for medication-refractory chorea. As a symptom of neurodegenerative disease, chorea is only one aspect of the basal ganglia syndromes, and often, a multidisciplinary approach tailored to individual patient needs provides the best management.
舞蹈症有多种病因，包括遗传、自身免疫、药物性及结构性病变。在适当情况下，治疗基于逆转舞蹈症的潜在病因；许多病例为自限性，在原发性疾病得到治疗时可自行缓解。本综述聚焦于因无法治疗的病因导致的舞蹈症的管理。
评估特定舞蹈症治疗疗效的双盲随机对照试验数量有限。大多数治疗建议基于小型开放标签研究、病例报告及专家意见。部分原因在于舞蹈症及舞蹈症相关综合征的异质性，以及具有不同进展速度的多种神经退行性表型。舞蹈症可用从抗癫痫药到抗精神病药等多种药物治疗。选择性囊泡单胺转运体阻断剂的最新进展使得能够以最小的副作用进行针对性的舞蹈症管理。神经外科干预措施，如深部脑刺激术（DBS）和苍白球切开术，仅用于药物难治性舞蹈症。作为神经退行性疾病的一种症状，舞蹈症只是基底神经节综合征的一个方面，通常，根据个体患者需求制定的多学科方法可提供最佳管理。
