Chorea induced by oral contraceptives

Abstract

A rare complication of oral contraceptive therapy is the induction of chorea. We here describe five cases of chorea in patients receiving low- or high-dose estrogen-containing contraceptives. All patients were nulliparous, young (average age 19 years), and became symptomatic shortly (average of 5 weeks) after initiation of contraceptive therapy. Two patients previously suffered an episode of Syndenham chorea; one experienced chorea in the course of Henoch-Schönlein purpura; and two had a history of congenital cyanotic heart disease without chorea. Dyskinesia resolved in all patients upon discontinuing the medication. Patients with preexisting striatal abnormalities appear more susceptible to oral contraceptive-induced chorea which is reversible on drug discontinuation. The mechanism of oral contraceptive-induced chorea is unknown, but clinical and experimental data suggest that it involves altered central dopaminergic activity.

PIP: It is known that chorea is a rarely-occurring complication of oral contrceptive therapy. 5 case histories of chorea in patients receiving either low- or high-dose estrogen-containing contraceptives are reviewed. All the patients were young and nulliparous. They developed the symptoms within an average of 5 weeks after therapy initiation. Dyskinesia ceased upon cessation of the oral contraceptive therapy. A summary of 17 previously-reported cases of oral contraceptive-associated chorea is also presented in tabular form. These cases plus the 5 reviewed in this paper suggest that chorea arises in women with abnormalities of the basal ganglia of various etiologies and will probably not occur in normal individuals. Studies with animals have indicated that female sex hormones may enhance central dopaminergic sensitivity, bringing on chorea in oral contraceptive patients. In the 3 of 5 patients here described who had previously experienced an episode of chorea, the contraceptive-induced disorders, i.e., asymmetries, orofacial involvement, and personality changes, were similar to the original movement disorders. The other 2 cases studied here had not experienced a chorea episode but did have a history of neonatal cyanosis.