Neuropsychiatric aspects of Sydenham's chorea: a comprehensive review.

BACKGROUND: The recent demonstration of an etiologic role for Sydenham's chorea in obsessive-compulsive disorder has once again brought this disorder to psychiatric attention. Despite its traditional importance to psychiatry, there has not been a comprehensive review of Sydenham's chorea published for decades. METHOD: I utilized the Index Medicus and its predecessors, the Quarterly Cumulative Index Medicus and the Cumulative Index Medicus, to search for every English-language article on Sydenham's chorea written during the past 115 years and then read and compiled the articles and their pertinent references. RESULTS: Sydenham's chorea is a symptom of rheumatic fever and results from an autoimmune attack on the CNS. In addition to chorea, the acute attack is almost always characterized by psychiatric symptoms such as irritability, obsessions and compulsions, tics, and psychotic symptoms. Acutely, treatment involves valproic acid or haloperidol; steroids may also be appropriate. Chronic treatment with penicillin is required to prevent future attacks. In adult years, the neuropsychiatric sequelae of Sydenham's chorea include chorea gravidarum, some cases of obsessive-compulsive disorder, and possibly, certain cases of Tourette's syndrome and of schizophrenia. CONCLUSION: Sydenham's chorea is best considered a neuropsychiatric disorder, and most patients will benefit from psychiatric treatment. Certain cases of obsessive-compulsive disorder, and perhaps other adult psychiatric disorders as well, may benefit from approaches similar to those used for Sydenham's chorea.