About 10% of children with rheumatic fever due to a group A streptococcal tonsillitis develop an inflammatory brain condition with St. Vitus Dance (also called “Sydenham’s chorea“).
This is due to a cross reactivitiy between streptococcal antigens and brain tissue, which have a resemblance, and this leads to an inflammatory reaction in the brain and an associated neurological condition.
The patient develops rapid involuntary movements that disappear during the sleep. Facial grimacing is common. In mild cases there might only be a certain clumsiness or having problems with dressing or eating. The condition lasts 3 to 6 months. It occurs more so in girls than boys and is often associated with rheumatic fever. The diagnosis of St. Vitus dance is mostly clinical and done by a neurologist.
EEGs show only non specific changes. The condition is self limiting and is only a transitory phenomenon and part of rheumatic fever. Occasionally the specialist may treat the condition with small amounts of benzodiazepines or antipsychotics (Ref. 7).
St. Vitus Dance
References:
1. F Zara et al. Am J Hum Gen 2000 May 66(5): 1552-1557.
2. S Yeung et al. Europ J Paediatr Neurol 2000; 4(1): 31-33.
3. LS Leung et al. Neurosci Biobehav Rev 2000 Sep 24(7): 763-775.
4. DJ Yen et al. Epilepsia 2000 Sep 41(9) 1162-1166.
5. E Starreveld et al. Can Fam Physician 2000 Sep 46: 1817-1823.
6. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 172.
7. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 271, p.2415.
8. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.
9. Rakel: Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier
