​Sydenham's chorea


Sydenham's chorea (also known as St. Vitus dance, St. Johannis' chorea, chorea minor or rheumatic chorea) is a symptom of acute rheumatic fever. Rheumatic fever is an inflammatory disease that can permanently damage the heart. It is common in children between the ages of three and fifteen. Sydenham’s chorea is usually contracted during childhood and is a neurological disease (that is, related to the brain). It is a movement disorder, during which you suffer from involuntary muscle movements such as twitching, jerking, jumping or dancing. This disease affects the limbs such as forearms, hands, lower legs and feet. These movements are abrupt and irregular, and usually cease when you are sleeping.  

The incidence of rheumatic fever and Sydenham’s chorea has dramatically reduced over the years, particularly in the Western world but in developing countries there are still some cases. It occurs most often in pre-pubescent girls but is sometimes also known to occur in boys.

The symptoms of Sydenham’s chorea are:

  • Involuntary, uncontrollable and jerky movements

  • Loss of fine motor skills (such as writing and holding objects)

  • Emotional problems such as fits of crying or laughter

  • Rheumatic fever and the accompanying symptoms such as fever, pain, swelling, rash, chest pain, fatigue etc.

  • Abdominal pain

  • Nosebleeds

  • Heart problems

Children may often attempt to hide these symptoms, for instance, sitting on their hands in order to control jerky movements. In some cases it may look like the child is being hyper or silly and it may go undiagnosed for a long time. Sydenham’s chorea usually involves a sore throat for many weeks before the disease sets in.

If your child is facing any of the above symptoms, or you notice a change in his/her emotional state accompanied by sore throat, fever or any of the other symptoms, it is highly recommended that you get your child screened for Sydenham’s chorea. You can obtain additional information and expert medical advice from the Mind and Brain Service Line at The Aga Khan University Hospital.

Your time with your doctor may be limited, so make sure to prepare for your visit beforehand. Here are some tips to help get you started.

There is no specific and conclusive test to screen for Sydenham’s chorea. However, if your doctor thinks your child is at risk for Sydenham’s chorea, he/she may conduct tests that may help in evaluating its probability of occurrence. Medical specialists working with the Mind and Brain Service Line at The Aga Khan University Hospital are equipped to provide comprehensive, state-of-the-art medical care, and discuss with you the measures being undertaken.

After an onset of rheumatic fever, Sydenham’s chorea may lag for many months and symptoms may not show until much later. Your doctor will conduct blood tests to check for infection, although by then the blood count has usually returned to normal. It may also not show up on brain scans such as MRI (Magnetic Resonance Imaging). 

Your doctor may test for resulting heart conditions from the onset of rheumatic fever using procedures such as:

  • Physical exam to check for swelling, fever and muscle spams

  • ECG/EKG (Electrocardiogram), which is a test that checks for problems with the electrical activity of the heart

  • Echocardiography, which is a procedure that uses sound waves to produce images of the heart

Treatment for Sydenham’s chorea involves treating the underlying symptoms. Your doctor will aim to treat the infection causing the symptoms and prescribe a dose of penicillin. There is also therapy and medication available to treat movement disorders such as haloperidol, pimozide, clonidine, valproic acid, carbamazepine and phenobarbitone. However, these may have several side effects and dosage needs to be monitored and controlled. Certain steroids have also been known to alleviate the symptoms. Clinical trials are being conducted to explore further options for treatment.

The Aga Khan University Hospital offers various support services to help with managing or recovering from the disease or condition. These include but are not limited to nutrition, physiotherapy, rehabilitation, specialized clinics and some patient support groups. Your doctor or nurse will advise you accordingly.

The Aga Khan University Hospital offers financial assistance to those who are in need and fulfil the eligibility criteria. For further information, you can contact the Patient Welfare Department. You can find the contact number of the Patient Welfare Department in the ‘Important Numbers’ section on the website homepage.

The financial counselling staff is available during office hours, at the main PBSD (Patient Business Services Department), to answer your financial queries on treatments’ costs and authorize admissions on partial deposit as per hospital policies allow. The financial counsellor in the emergency room is open 24/7. You can find the contact number of the Patient Business Services in the ‘Important Numbers’ section on the website homepage.

Your doctor and or nurse will give you specific instructions about the prescribed medication. Please ensure that you take or use the prescribed medicine as advised. It can be dangerous to your health if you self-prescribe. Please inform the doctor or nurse beforehand if you have experienced any adverse reactions to any medications in the past. If you experience any symptoms of drug poisoning, overdose or severe reaction please contact the Pharmacy Service at The Aga Khan University Hospital immediately. You can find the contact number of the Pharmacy Services in the ‘Important Numbers’ section on the website homepage



The information provided on our website is for educational purposes and not intended to be a substitute for medical advice, diagnosis or treatment. You should always seek the advice of your doctor or other healthcare professional provider.