Chorea gravidarum is a rare movement disorder that occurs during pregnancy. It causes involuntary, rapid, and irregular movements affecting the face, limbs, and trunk.

This rare condition can have various causes, including complications from rheumatic fever, systemic lupus erythematosus, and antiphospholipid syndrome. The cause can also be uncertain.

This article looks at the symptoms and causes of chorea gravidarum. It also discusses how doctors diagnose and treat the condition.

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Chorea gravidarum presents with various symptoms, including:

  • Involuntary movements: Rapid, unpredictable, jerky movements can affect any body part, including the limbs, face, and trunk. These movements are the hallmark of the condition and can vary in intensity.
  • Motor impairment: Involuntary jerking motions may make it difficult to control voluntary movements, which can affect daily activities and tasks.
  • Facial grimacing: Involuntary facial movements may occur, including grimacing or other unintentional expressions.
  • Speech disturbances: The condition affects control of the muscles involved in speech, leading to difficulties in articulation or changes in speech patterns.
  • Emotional and behavioral changes: Individuals may experience mood shifts, irritability, or emotional instability, partly due to the stress of coping with the disorder and its impact on daily life.

The exact cause of chorea gravidarum is not always clear, but it may be associated with several factors:

  • Autoimmune disorders: Conditions like systemic lupus erythematosus (SLE) and antiphospholipid syndrome, which affect the immune system, can lead to the development of chorea in pregnant people. These conditions can cause inflammation and damage to brain tissues, leading to movement disorders.
  • Infections: Historically, rheumatic fever, caused by a streptococcal bacterial infection, has been linked to chorea gravidarum. Rheumatic fever can lead to Sydenham chorea, which may exacerbate or appear as chorea gravidarum during pregnancy.
  • Metabolic and electrolyte imbalances: Pregnancy can lead to changes in metabolism and the balance of electrolytes and other chemicals in the body. In rare cases, this can contribute to the development of chorea.
  • Vascular and hematologic conditions: Conditions that affect blood flow or the hematologic system may lead to chorea, including:
    • eclampsia — a severe complication of preeclampsia
    • hypercoagulable states — an increased tendency to form blood clots
  • Genetic factors: Although it is less common, pregnant people with a history of genetic movement disorders, such as Huntington’s disease, may experience worsening symptoms during pregnancy.
  • Idiopathic: In some cases, the cause of chorea gravidarum remains idiopathic, meaning doctors cannot identify a cause.

Diagnosis involves a thorough medical history, physical examination, and sometimes neurological imaging and blood tests to rule out other causes of chorea and to identify any potential underlying conditions.

Doctors may recommend the following tests:

  • Neurological assessment: This includes evaluating involuntary movements, muscle tone, coordination, and other neurological functions.
  • Pregnancy assessment: An obstetric examination can help doctors monitor the health of the pregnancy and detect any complications that could be related to the chorea or affecting it.
  • Magnetic resonance imaging (MRI): Doctors use MRI scans to rule out structural abnormalities in the brain that could be causing the symptoms.
  • Computed tomography (CT) scan: Although less common than MRI, a CT scan can also help identify brain abnormalities in certain cases.
  • Complete blood count (CBC): This blood test checks for infections or anemia that might contribute to the symptoms.
  • Thyroid function tests: These tests may help exclude hyperthyroidism, which can sometimes present with choreiform movements.
  • Antibodies test: This blood test screens for autoimmune conditions, such as antiphospholipid antibodies, which can be associated with chorea.
  • Rheumatic fever markers: Another blood test may look for markers such as antistreptolysin O titers if doctors suspect rheumatic fever as a cause.
  • Electroencephalogram (EEG): Doctors may recommend an EEG if they suspect seizure activity.
  • Genetic testing: Doctors may test for conditions such as Huntington’s disease, especially if there is a relevant family history or the presentation is atypical for chorea gravidarum.

Managing chorea in pregnancy involves a multidisciplinary approach, including obstetricians, neurologists, and other specialists.

The primary goal is to control symptoms while minimizing risks to the pregnant person and developing fetus. Each case should be individualized based on the cause of the chorea, the severity of symptoms, and the gestational age of the pregnancy.

Doctors may prescribe dopamine antagonist medications, such as haloperidol (Haldol), to treat chorea gravidarum.

The outlook for people with chorea gravidarum varies. In many cases, the condition is self-limiting, and symptoms resolve independently following delivery.

For people with underlying conditions such as rheumatic fever or SLE, managing these conditions is crucial to improving the outcome. For people with Huntington’s, the outlook is poorer.

There is a risk of recurrence in subsequent pregnancies, especially if the condition is related to an underlying autoimmune disorder.

Here are the answers to some commonly asked questions about chorea.

Is chorea a genetic disorder?

Chorea can have genetic and nongenetic causes. People can inherit conditions that cause choreiform movements, such as Huntington’s disease. Nongenetic causes include infections, trauma, and inflammation.

Chorea gravidarum often results from an autoimmune disorder, such as lupus or multiple sclerosis, which people do not inherit directly but may have a genetic basis.

Does chorea happen during sleep?

Chorea typically decreases or stops during sleep. The involuntary movements associated with chorea are more prominent during waking hours and may significantly reduce or completely disappear during sleep.

Does chorea show up on MRI?

Doctors diagnose chorea based on observing involuntary movements, and chorea does not show up on an MRI scan. However, in some cases, doctors can use MRI to identify underlying causes or brain abnormalities associated with certain types of chorea. For example, in Huntington’s disease, MRI might show atrophy of specific brain regions.

Chorea gravidarum is a rare movement disorder that occurs during pregnancy. Its main symptoms are involuntary, rapid, and unpredictable movements affecting the limbs, face, and trunk.

Treatment focuses on managing the symptoms and addressing any identifiable causes. Doctors may prescribe medication with caution due to potential risks to the fetus.

Symptoms often resolve after delivery, although close monitoring throughout pregnancy and postpartum is essential. There is a risk that chorea gravidarum will recur in subsequent pregnancies.