The psychological symptoms of 11 children with Sydenham’s chorea (8 girls and 3 boys, mean age 8.4 years) were evaluated at the National Institute of Mental Health, Bethesda, MD. Subjects had a recent onset of chorea and rheumatic fever. Seven had rheumatic carditis and 3 had arthritis. All were receiving penicillin, and 8 had been treated with haloperidol, without lasting benefit. All had an elevated antistreptolysin O (ASO) titer, greater than 480 Todd units, and 10 had positive antineuronal antibody titers. Psychological symptoms included nightmares, decreased attention, hyperactivity, distractibility, emotional lability, and an acute onset of obsessive-compulsive disorder. The OCD started shortly before the onset of involuntary movements, peaked with the chorea, and disappeared before movements ceased. The mean total duration of chorea symtoms was 7 months. [1]
COMMENT. Of 9 children exhibiting obsessive-compulsive symtoms, 4 met DSM-III-R diagnostic criteria for OCD. The authors hypothesize that certain acute-onset cases of OCD acquired during childhood may represent an autoimmune cerebral disorder similar to Sydenham’s chorea, and affecting the basal ganglia. A trial of intravenous immunoglobulin in children with Sydenham’s chorea is in progress at the NIH.