ABSTRACT
OBJECTIVE: To present a case of chorea gravidarum and conduct a review of the published literature on the treatment for this condition, and on maternal and fetal prognosis. METHODS: Case presentation of a 16-year-old primiparous patient admitted to a Level III public hospital at 8 weeks of gestation complaining of involuntary head and limb movements and right lower limb hyperreflexia lasting three days. The patient had a history of Sydenham chorea. Treatment with antipsychotics and benzodiazepines was given to manage symptoms, and with benzathine penicillin to address the etiology, achieving control at 14 weeks. Treatment was discontinued at 35 weeks and the patient went on to have normal delivery at 39 weeks. A search was conducted in the Medline via PubMed, UptoDate, Medscape and Google Scholar databases using the terms "Pregnancy and Chorea Gravidarum". The search was limited to case reports and case series or review articles published between 2000 al 2019. RESULTS: Seven case reports and one review of the topic were found. In 4 of the 7 cases, treatment was based on haloperidol, benzodiazepines and chlorpromazine. Penicillin was used in one of two cases with a history of Sydenham chorea. Maternal and fetal prognosis was good in 6 of 7 cases, there was 1 case of intrauterine growth restriction. CONCLUSIONS: Treatment of gestation chorea is primarily expectant and the goal is to reduce symptoms. Maternal and fetal prognosis is good.
TITULO: COREA GRAVÍDICA: REPORTE DE CASO Y REVISIÓN DE LA LITERATURA. OBJETIVO: presentar un caso de corea gravídica y hacer una revisión sistemática de la literatura publicada sobre el tratamiento y pronóstico materno-fetal de la entidad. METODOS: se presenta el caso de una paciente de 16 años, primigesta, que ingresa a un hospital público de tercer nivel de complejidad, con 8 semanas de gestación, con clínica de 3 días de evolución caracterizada por movimientos involuntarios de la cabeza y las extremidades, con hiperreflexia en miembro inferior derecho. Antecedente de Corea de Sydenham. Se da tratamiento con antisicóticos y benzodiacepinas para la sintomatología y etiológico con penicilina benzatínica y control del cuadro a las 14 semanas. Suspendió el tratamiento a las 35 semanas. Parto normal a las 39 semanas. Se realizó una búsqueda en la base de datos de Medline vía PubMed, UptoDate, Medscape y Google Académico empleando los términos: "Pregnancy" and "Chorea Gravidarum". La búsqueda se limitó a reportes y series de casos o artículos de revisión, desde el año 2000 al 2019. RESULTADOS: se encontraron siete reportes de casos y una revisión de tema. El tratamiento se realizó con haloperidol benzodiacepinas y clorpromacina en cuatro de los siete casos. En uno de los dos casos con antecedentes de corea de Sydenham se utilizó penicilina. El pronóstico materno-fetal fue bueno en seis de siete casos, en un caso hubo restricción de crecimiento intrauterino. CONCLUSIONES: el tratamiento de la corea gestacional principalmente es expectante y su finalidad es disminuir la sintomatología, el pronóstico materno-fetal es bueno.
Subject(s)
Antipsychotic Agents/administration & dosage , Benzodiazepines/administration & dosage , Chorea Gravidarum/diagnosis , Penicillin G Benzathine/administration & dosage , Adolescent , Chorea Gravidarum/drug therapy , Female , Humans , Pregnancy , Pregnancy Outcome , PrognosisABSTRACT
Movement disorders such as Parkinson's disease (PD), restless legs syndrome (RLS), chorea, essential tremor, and Tourette syndrome, occur in men and women of all ages. Yet, considerable sex differences in epidemiology, clinical features, and treatment exist in these disorders. In this review, we highlight key differences in the evaluation and management of women with movement disorders, addressing sex-specific complications of treatment and unique challenges surrounding the management of movement disorders during pregnancy. We review the complex relationship between estrogen and movement disorders, including the putative neuroprotective effects of estrogen in PD and the modulatory effects on RLS and chorea associated with autoimmune disease. Further understanding of sex-specific and hormonal effects on clinical features will be important to optimize the management of women with movement disorders in the future.
Subject(s)
Antiphospholipid Syndrome , Chorea Gravidarum , Essential Tremor , Lupus Erythematosus, Systemic , Parkinson Disease , Pregnancy Complications , Restless Legs Syndrome , Tourette Syndrome , Animals , Antiphospholipid Syndrome/drug therapy , Antiphospholipid Syndrome/immunology , Antiphospholipid Syndrome/physiopathology , Chorea Gravidarum/drug therapy , Chorea Gravidarum/immunology , Chorea Gravidarum/physiopathology , Essential Tremor/drug therapy , Essential Tremor/physiopathology , Female , Humans , Lupus Erythematosus, Systemic/drug therapy , Lupus Erythematosus, Systemic/immunology , Lupus Erythematosus, Systemic/physiopathology , Parkinson Disease/drug therapy , Parkinson Disease/physiopathology , Pregnancy , Pregnancy Complications/drug therapy , Pregnancy Complications/immunology , Pregnancy Complications/physiopathology , Restless Legs Syndrome/drug therapy , Restless Legs Syndrome/physiopathology , Tourette Syndrome/drug therapy , Tourette Syndrome/physiopathologySubject(s)
Chorea Gravidarum/diagnosis , Prenatal Diagnosis , Adult , Anti-Dyskinesia Agents/administration & dosage , Anti-Dyskinesia Agents/therapeutic use , Chorea Gravidarum/drug therapy , Chorea Gravidarum/pathology , Diagnosis, Differential , Female , Haloperidol/administration & dosage , Haloperidol/therapeutic use , Humans , PregnancyABSTRACT
Chorea gravidarum is a rare syndrome in pregnancy. The clinical picture is of extrapyramidal symptoms such as involuntary movements, lack of coordination and slurred speech. Neuroleptics or benzodiazepines can be used for treatment. When antiphospholipid antibodies are shown to be present, corticosteroids, and sometimes aspirin, are added to the treatment. Movement disorders can also be associated with an increased central dopamine level. In this report, we present the case of a patient with chorea gravidarum in whom an etiologic factor has not been observed. We treated the symptoms with dopamine-blocking agents such as haloperidol. We believe that, if chorea gravidarum is not accompanied by other etiologic factors (such as antiphospholipid antibodies), there is no elevated risk for the mother and the fetus.
