The relationship between cardiac and neurologic findings and long-term prognosis of 40 patients with Sydenham chorea were investigated at Istanbul University, Turkey. Patients were predominantly female (70%), and mean age was 11.3 +/- 2.5 years (range 4-16 yrs). Of 304 patients with rheumatic fever, 45 (14.8%) had chorea during the first attack. Duration of chorea was 5.3 +/- 3.1 months (range 1-12 months). Chorea was mild in 30 (75%), moderate in 9 (22%), and severe in 1 patient (2.5%). Echocardiograms showed evidence of carditis in 28 cases (70%); the mitral valve was affected most often (35%). EEG performed in 20 patients showed nonspecific abnormalities in 2. Cranial MRI in 21 patients showed no abnormality. Benzathine penicillin prophylaxis was given to all patients, and haloperidol for chorea. At a mean of 54 +/- 18 month follow-up for 32 patients, 28 with carditis, 2 (6%) had a recurrence of chorea. [1]
COMMENT. No MRI or significant EEG abnormalties were reported in this series of patients with Sydenham's chorea. Abnormalties in the caudate nucleus have been described in 16% of relapsing cases [2]; and the caudate, putamen, and globus pallidus were increased in volume in 24 patients compared to controls studied at the NIH [3].
EEG in Sydenham's chorea. Several studies have found abnormalities. Of 31 patients with EEGs at the Mayo Clinic, 55% had abnormal records [4]. The most prominent abnormality in our study consisted of short trains of bisynchronous waves of 2-3 cycles/sec in posterior head regions following eye closure. The changes were not considered pathognomonic for Sydenham's chorea but may be helpful in differential diagnosis of choreiform movement disorders.