Children With Sydenham Chorea and Psychiatric Disorders Had Variable Long-Term Outcomes and Required Multidisciplinary Management

Abstract

Aim: Sydenham chorea (SC) is a globally significant, post-streptococcal, childhood neuropsychiatric condition that is rare in western Europe. This retrospective single-centre study focused on children with neuropsychiatric features of SC.

Methods: Participants were recruited from neuropsychiatry referrals to a regional paediatric neurology department in Glasgow, Scotland, from 2009 to 2012. Interviews established the course of SC and the children's medical and family histories. Semi-structured psychiatric interviews explored current and past episodes of psychopathology.

Results: We studied 12 children (seven girls) with a mean age of 13 (range 10-15) years, and an average of six (range 4-10) years after their SC symptoms began. Before they displayed symptoms, seven children had been suspected or diagnosed neurodevelopmental problems and four had separation anxiety. Their physical symptoms were often debilitating. Psychopathology was most severe during their first episode and SC diagnoses were sometimes delayed. Educational problems were frequent. Multiple psychiatric conditions were diagnosed in 11 children and anxiety and attention deficit hyperactivity disorder were the most common. Relapses occurred in nine cases. Additional services that were accessed included cardiology, rheumatology, physiotherapy, occupational therapy and speech therapy. Medication included prophylactic penicillin and symptomatic treatment.

Conclusion: Children with SC and psychiatric disorders had variable long-term outcomes and required multidisciplinary management.

Keywords: Sydenham chorea; auto‐immune neuropsychiatric disorders; movement disorder in childhood; post‐streptococcal disorder; rheumatic fever.