Chorea

Chorea happens when certain brain pathways misfire, causing sudden, involuntary movements that can affect the face, hands, feet, or other body parts. Many factors can lead to chorea, including genetic disorders, infections, autoimmune conditions, medication side effects, and pregnancy. These unpredictable movements often make daily activities more difficult.

Chorea is not a disease itself but a symptom of an underlying issue. Some causes, like Huntington’s disease, are inherited, while others, such as Sydenham’s chorea, follow infections. Hormone changes, strokes, or certain drugs can also trigger it.

Definition of Symptom

Chorea is a movement disorder with brief, irregular, and unpredictable involuntary movements. These movements can affect the face, arms, legs, and sometimes the trunk, often flowing from one muscle group to another.

The term “chorea” comes from the Greek word for “dance,” reflecting the restless and shifting nature of the movements. Unlike tremors, chorea does not have a regular rhythm. Common symptoms of chorea include:

• Sudden, jerky motions of the limbs or face.
• Movements that seem to start in one area and spread to others.
• Difficulty holding still or maintaining posture.

Chorea can occur alone or with related movement disorders such as athetosis (slow, writhing movements) and ballism (flinging limb movements). These conditions may appear together because they affect similar brain regions, especially the basal ganglia. In mild cases, symptoms may look like fidgeting or restlessness. In more noticeable cases, the uncontrolled movements can interfere with walking, speaking, or eating.

Term	Description
Chorea	Irregular, dance-like movements
Athetosis	Slow, twisting motions
Ballism	Forceful, flinging limb movements

Possible Causes/Diseases Condition

Many different conditions can cause chorea. These often involve the nervous system, immune system, or metabolism. Some causes are temporary, while others are related to long-term diseases. Common causes include:

• Huntington’s disease – an inherited disorder that damages nerve cells in the brain.
• Rheumatic fever – an inflammatory disease that can follow strep throat, sometimes leading to Sydenham’s chorea.
• Systemic lupus erythematosus (lupus) – an immune condition that can affect the brain.
• Stroke – damage to certain brain areas may trigger involuntary movements.

Other causes include metabolic disorders such as low blood sugar or thyroid problems, Wilson’s disease (a rare disorder involving copper buildup), and certain neurological disorders. In some cases, chorea develops during pregnancy, called chorea gravidarum. This usually improves after delivery but may need monitoring.

Cause/Condition	Type of Condition	Notes
Huntington’s disease	Hereditary disorder	Progressive, affects brain cells
Rheumatic fever / Sydenham’s	Post-infectious	Often in children and teens
Lupus (SLE)	Immune condition	Can affect multiple organs
Stroke	Neurological disorder	Damage location affects severity
Wilson’s disease	Metabolic disorder	Copper buildup in body
Chorea gravidarum	Pregnancy-related	Usually temporary

Other Non-Disease Causes

Chorea can sometimes result from factors other than diseases. These may include medication side effects, exposure to certain substances, or complications from medical procedures. Some prescription drugs can trigger chorea by affecting brain chemicals that control movement. Antipsychotics may cause or worsen involuntary movements in some people.

Medications can sometimes play a role in chorea. Drugs that alter dopamine levels, such as dopamine-depleting agents, are occasionally prescribed to manage symptoms but may also cause abnormal movements if the dosage is too high. Certain anticonvulsants used for seizure and mood control have been linked to chorea in rare cases.

Benzodiazepines, which are prescribed to reduce muscle overactivity, can also cause abnormal movements if they are stopped suddenly. In some cases, deep brain stimulation—a surgical treatment for movement disorders—can lead to temporary chorea if stimulation settings are not well adjusted.

Cause Type	Possible Effect on Movement
Medication side effect	May trigger or worsen chorea.
Treatment complication	Can cause temporary chorea.
Withdrawal reaction	May cause abnormal movements.

Environmental toxins, recreational drugs, or sudden changes in medication can also play a role.

How It Causes the Symptom

Chorea starts when parts of the brain that control movement send abnormal signals to the muscles. The basal ganglia, which help coordinate voluntary movement, play a central role in this process. Damage or chemical changes in the basal ganglia can disrupt normal movement control. This can cause involuntary, irregular, and unpredictable muscle contractions.

Dopamine, a brain chemical that helps regulate movement, is often involved. Too much dopamine activity, or increased sensitivity to dopamine, can overstimulate motor pathways and lead to jerky or flowing movements. Common causes include:

• Genetic conditions such as Huntington’s disease.
• Stroke or brain injury affecting the basal ganglia.
• Medication effects, especially drugs that alter dopamine levels.
• Metabolic or immune disorders that damage nerve cells.

Often, nerve cells in the basal ganglia lose their ability to filter and control motor signals. Without this control, muscles may activate in a random sequence instead of smooth, planned patterns.

Possible Complications

Chorea can lead to muscle weakness over time. Constant involuntary movements can tire the muscles or make it hard to keep up strength. Weakness can affect walking, balance, and the ability to do daily tasks. Some people develop milkmaid’s grip, where hand strength fades in and out during a handshake or when holding objects. This makes fine motor tasks, like writing or buttoning clothes, more difficult.

Involuntary movements may cause injuries. Sudden jerks or twists can lead to falls, bruises, or joint strain. People with severe symptoms may need mobility aids to reduce risk. Daily activities can become harder when movements interfere with eating, dressing, or speaking. This may increase dependence on others for care.

Possible Complication	Description
Muscle weakness	Loss of muscle strength due to overuse or reduced control.
Milkmaid’s grip	Fluctuating grip strength during hand use.
Injuries	Falls, bruises, or sprains from sudden movements.
Speech problems	Slurred or unclear speech from facial muscle involvement.
Difficulty eating	Trouble chewing or swallowing due to mouth and throat muscle movements.

Speech and swallowing problems can also happen if chorea affects the muscles in the face or throat. This may lead to choking risk or poor nutrition if not managed. Emotional and mental health challenges, such as anxiety or frustration, may develop when symptoms disrupt work, social life, or independence.

When to Seek Medical Attention

See a doctor if involuntary movements appear suddenly, get worse over time, or make daily activities difficult. Chorea can signal an underlying condition that needs prompt attention.

Get urgent medical help if you also have weakness, trouble speaking, or changes in vision. These symptoms may point to a serious neurological problem. Doctors often use tests to find the cause. Common options include:

Test	Purpose
Blood Tests	Check for infections, metabolic issues, or autoimmune disorders.
Genetic Testing	Find inherited conditions like Huntington’s disease.
MRI	Look for changes or damage in brain structures.
CT Scans	Find tumors, bleeding, or structural problems in the brain.

If chorea starts after beginning a new medication, talk to your doctor. Some drugs can cause these movements, and changing or stopping the drug with a doctor’s help may improve symptoms. Children with chorea need quick evaluation, especially if they also have fever, sore throat, or behavioral changes. These signs can be linked to certain post-infection conditions.