SYDENHAM'S CHOREA

Sydenham’s Chorea and PANS/PANDAS have many similarities.  Here we will try to explain the difference.

There are a lot of similarities with Sydenham's Chorea, but it is important to distinguish them.  To get a diagnosis of PANS or PANDAS, other possible diseases including Sydenham’s chorea need to be ruled out.   

  • You may see similar symptoms of involuntary movements, tics, changes in mood and behaviour.  

  • You see the same pattern of sudden onset of symptoms, gradually getting better but then sometimes coming back again, months or even years later. 

  • For both Sydenham’s chorea and PANDAS, there must be evidence of a preceding streptococcal infection (although the initial streptococcal infection may have been mild and you may not even have recognised it as a bacterial infection at the time).    

  • There is some research evidence showing the same antibodies (targeting the brain) can be found in both Sydenham’s Chorea and PANDAS. Unfortunately, these tests are not available to NHS patients in the UK.

  • Some of the treatments used for patients with Sydenham's Chorea have been tried successfully in patients with PANDAS.  

  • There are gaps in understanding of both Sydenham's Chorea and PANDAS.

  • Both conditions are considered rare and doctors (GPs or paediatricians) do not always recognise them when they first present. Tests may be necessary to look for other diseases.

The reason it is important to work out whether you have Sydenham’s Chorea or PANDAS (if possible) is as follows:

  • There is a risk of chronic heart disease in Sydenham’s Chorea, even after the other problems have gone away.  This is because Sydenham’s Chorea is related to rheumatic fever.  Long term antibiotic treatment is recommended to prevent both Sydenham’s chorea symptoms and further heart damage.

  • In PANS and PANDAS, long term antibiotics may be tried to reduce or prevent symptoms (and there are increasing reports of these medications helping reduce or completely cure symptoms) but there is only limited research evidence that these help.  

  • There is evidence for using anti-inflammatory medicines in Sydenham’s Chorea, including steroids and intravenous immunoglobulin, although since symptoms settle by themselves in most cases, it isn’t essential to use these.

  • In PANS and PANDAS, anti-inflammatory medicines may be tried (and there are increasing reports of these medications helping reduce or completely cure symptoms) but there is only limited research evidence that these help.

If there is doubt about whether it is Sydenham’s Chorea or PANDAS causing symptoms, it seems sensible to get a heart scan (even if there isn’t any obvious sign of a heart problem), and seek advice from a doctor familiar with what chorea looks like. 

 

Further support is available from The Sydenham's Chorea Association

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