Sydenham's chorea (SC) is a disorder of the central nervous system (CNS) characterized by sudden, involuntary, arrhythmic, clonic, and purposeless movements. These are associated with hypotonia, motor failure, and psychological symptoms, as well as difficulties of speech and gait. SC commences in infancy or puberty and has a tendency to relapse.

The term chorea derives from the Greek word for dancing, and has been used to describe the abnormal movements seen in SC, as well as the disorder itself. This has led to a certain confusion in the literature. Three important points in time can be highlighted in the history of SC: its initial description in 1686; its proposed link with rheumatic fever (RF) in the 1860s<sup>12 Chapman A.H., Pilkey L., Gibbons M.J. A psychosomatic study of eight children with Sydenham's chorea Pediatrics 1958 ;  21 : 582-595

Haga clic aquí para ir a la sección de Referencias</sup>; and the recent developments, since the 1980s, emphasizing its relationship with other psychiatric disorders.

SC was first described by Thomas Sydenham, in his Schedula Monitoria in 1686. He named this new disease “St. Vitus' Dance” to differentiated it from “dancing mania,” a practice seen in the religious ceremonies of the day by those who danced to exorcise prevalent epidemic illnesses.<sup>8 Brett W.R. Some paediatric eponyms: IV. Sydenham's chorea Br J Child Dis 1932 ;  29 : 283

Haga clic aquí para ir a la sección de Referencias</sup> Sydenham's clinical description was fairly complete, but at that time he attributed the illness to physical trauma and emotional shock.

In 1780, Stoll described two cases that seemed to suggest an association between arthritis and chorea. This relationship was better established by Roger, in his articles of 1866 and 1868.<sup>12 Chapman A.H., Pilkey L., Gibbons M.J. A psychosomatic study of eight children with Sydenham's chorea Pediatrics 1958 ;  21 : 582-595

Haga clic aquí para ir a la sección de Referencias</sup> Although the North American literature began to discuss the association between SC and RF at the beginning of this century,<sup>18 Ebaugh F.G. Neuropsychiatric aspects of chorea in children JAMA 1926 ;  87 : 1083-1088

Haga clic aquí para ir a la sección de Referencias</sup> it seemed to take much longer for these concepts to be accepted in other countries. For example, SC was discussed more phenomenologically than causally in the French literature during the 1920s.<sup>56 Roxo H. Chorèa Manual de Psychiatria Sao Paulo: Livraria Francisco Alves (1921).  567-579

Haga clic aquí para ir a la sección de Referencias</sup> Even in the 1970s, however, doubts were being expressed about its links with RF, particularly in the absence of rheumatic symptoms, such as arthritis, carditis, or elevated erythrocyte sedimentation rate.<sup>2 Ajuriaguerra J. Afecá es cerebrais conhecidas Manual de Psiquiatria Infantil Spain: Masson (1993).  520-521

Haga clic aquí para ir a la sección de Referencias</sup> Nevertheless, the increasing evidence of an association with RF has led to SC also being called rheumatic chorea or chorea minor.<sup>52 Osler W. The cardiac relations of chorea Am J Med Sci 1887 ;  188 : 371

Haga clic aquí para ir a la sección de Referencias, 59 Sèe G. De la chorèe Mèmoires de l'Acadèmie de Mèdicine 1850 ;  15 : 373

Haga clic aquí para ir a la sección de Referencias</sup> During the second half of this century, SC and RF have been associated with the occurrence of an antecedent group A β-streptococcal infection.<sup>58 Schwartzman J. Chorea minor: Review of 175 cases with reference to etiology, treatment and sequelae Rheumatology 1950 ;  6 : 89

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SC more recently has been linked to the obsessive-compulsive disorder (OCD) spectrum. Informal descriptions had suggested that postchoreic tic, coprolalia, and impulsive behavior were sequelae of SC.<sup>5 Aron A.M., Freeman J.M., Carter S. The natural history of Sydenham's chorea: Review of literature and long-term evaluation with emphasis on cardiac sequelae Am J Med 1965 ;  38 : 83-95  [cross-ref]

Haga clic aquí para ir a la sección de Referencias</sup> More systematic studies began to demonstrate a high incidence of obsessive-compulsive symptoms (OCS), as well as OCD in SC children.<sup>64 Swedo S.E., Rappoport J.L., Cheslow D.L. , y al. High prevalence of obsessive-compulsive symptoms in patientes with Sydenham's chorea Am J Psychiatry 1989 ;  146 : 246-249

Haga clic aquí para ir a la sección de Referencias</sup> Although some investigators attempted to associate SC with other psychiatric disorders such as schizophrenia,<sup>21 Freeman J.M., Aron A.M., Collard J.E. , y al. The emotional correlates of Sydenham's chorea Pediatrics 1965 ;  35 : 42-49

Haga clic aquí para ir a la sección de Referencias, 39 Lewis A., Minski L. Chorea and psychosis Lancet 1935 ;  1 : 536

Haga clic aquí para ir a la sección de Referencias</sup> these efforts have been less successful.

The purpose of this article is to provide an overview of the clinical picture, causes, course, and treatment of SC, as well as to examine some pathophysiologic hypotheses, and its relationship to psychiatric disorders.