Chorea is an irregular, rapid, uncontrolled, involuntary, excessive movement that seems to flow randomly from one part of the body to another.
The affected child often appears fidgety or restless and unable to sit still. The word "chorea" comes from the Greek word for dance. The jerky movements of the feet or hands are often similar to dancing or piano playing. When chorea is severe, the movements may cause flailing motions of the arms or legs that results in throwing whatever is in the hand or falling to the ground. This form of severe chorea is referred to as "ballism." Walking may become bizarre, with inserted excessive postures and leg movements. Unlike parkinsonism, which is an inability to make voluntary movements, or ataxia and dystonia, which affect the quality of voluntary movements, the movements of chorea and ballism occur by themselves, without conscious attempts at movement. In some cases, attempts to move may make the symptoms worse.
Athetosis is a slower writhing and twisting movement. Choreoathetosis is a movement of intermediate speed, between the quick, flitting movements of chorea and the slower, writhing movements of athetosis. Choreoathetosis is the most common form in children. Choreoathetosis tends to worsen with attempts at movement and often occurs only while the child is attempting to move. It therefore shares features with dystonia; it is not clear whether or not choreoathetosis may be a form of "hyperkinetic" dystonia, in which there is too much movement due to involuntary overflow of activity into muscles the child was not intending to activate. It is possible that some children with choreoathetosis have symptoms of both chorea and dystonia, but finding the best method to sort this out in any particular child will require future scientific research.
Chorea may affect the hands, feet, trunk, neck, and face. In the face, they often lead to nose wrinkling, continual flitting eye movements, and mouth or tongue movements. These disorders may be distinguished from tics, as tics tend to repeat the same set of movements. In addition, the child often describes a "build-up" in the need to make the tic, with a sense of release afterwards. There is no such sense of release following chorea; the movements are continually changing and flowing from one body part to another.
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Section Author: Terence Sanger, MD PhD
Scientific Reviewers: Leon Dure, MD, Associate Professor of Pediatrics and Neurology, The University of Alabama at Birmingham; Marjorie A Garvey, MD, Pediatrics and Developmental Neuropsychiatry Branch, NIMH, Human Motor Control Section, NINDS; Jonathan W. Mink, MD PhD, Associate Professor of Neurology, Neurobiology & Anatomy, and Pediatrics Chief, Child Neurology, University of Rochester Medical Center, Rochester, New York
Editor: Joy B. Leffler, NASW, AMIA