Treatment Overview
Living with chorea can feel like losing control over your own body. Characterized by brief, unpredictable, and irregular movements that flow from one muscle to another, chorea is often described as “dance-like,” but the reality is far more disruptive. These involuntary movements can interfere with eating, walking, and speaking, often leading to physical exhaustion and social anxiety. Whether caused by a genetic condition like Huntington’s disease, an infection, or a medication side effect, the impact on daily independence is significant.
Treatment is essential to dampen these movements and improve safety. By stabilizing motor control, patients can regain confidence in performing routine tasks and reduce the risk of injury from falls or erratic movements. Because chorea is a symptom of an underlying issue rather than a standalone disease, the treatment approach varies widely. A doctor’s recommendation depends heavily on the root cause, the patient’s age, and how severely the movements impact their quality of life (National Institute of Neurological Disorders and Stroke, 2023).
Overview of treatment options for Chorea
The management of chorea generally follows a two-pronged strategy: addressing the underlying cause and suppressing the symptoms. If the chorea is caused by a medication (such as certain drugs for Parkinson’s), the primary treatment is often simply adjusting or stopping that drug. If it is caused by an infection like Sydenham’s chorea, antibiotics are necessary.
However, for chronic or genetic conditions where the cause cannot be removed, the goal shifts to symptom management. Pharmacological therapy aims to reduce the severity of the involuntary movements without causing excessive sedation or stiffness. Doctors typically start with the mildest effective medication and adjust the dosage carefully. While physical therapy and safety modifications in the home are helpful, medications are the primary tool for controlling the biological drive behind the movements.
Medications used for Chorea
When medication is required to suppress movements, Vesicular Monoamine Transporter 2 (VMAT2) inhibitors are often the first-line treatment, particularly for chorea associated with Huntington’s disease. Drugs in this class include tetrabenazine, deutetrabenazine, and valbenazine. Clinical studies indicate that these medications can significantly reduce the severity of chorea, allowing for better physical function.
If VMAT2 inhibitors are ineffective or not well-tolerated, doctors may prescribe antipsychotic medications. Both typical (older) and atypical (newer) antipsychotics are used. Common examples include risperidone, olanzapine, and haloperidol. While these are primarily psychiatric drugs, their effect on brain chemistry makes them potent suppressors of unwanted movement.
In milder cases, or when other drugs cause too many side effects, benzodiazepines like clonazepam or anticonvulsants such as valproic acid may be used. These help calm the nervous system. For children with Sydenham’s chorea, the focus is distinct, often involving penicillin to clear the streptococcal infection and corticosteroids like prednisone to reduce brain inflammation (Mayo Clinic, 2023).
How these medications work
Most medications used for chorea target dopamine, a chemical messenger (neurotransmitter) in the brain that regulates movement and coordination. In conditions causing chorea, the brain’s motor circuits are essentially overactive, receiving too many “go” signals.
VMAT2 inhibitors work by depleting the amount of dopamine available at the nerve terminals. By lowering the overall level of dopamine, these drugs reduce the overstimulation of the motor pathways, effectively calming the involuntary movements.
Antipsychotic medications work slightly differently by blocking the receptors that receive dopamine. Instead of lowering the amount of fuel (dopamine), they put a cap on the engine, preventing the chemical from binding to the cells and triggering movement. Both mechanisms aim to restore a balance between movement initiation and inhibition (Food and Drug Administration, 2022).
Side effects and safety considerations
Chorea treatment balances reducing movement and maintaining alertness. VMAT2 inhibitors risk depression and suicidal thoughts, requiring critical mental health monitoring. Common side effects include drowsiness, fatigue, and restlessness (akathisia).
Antipsychotics can cause weight gain, metabolic issues, sedation, and sometimes muscle stiffness or tremors (Parkinson’s-like symptoms). Long-term use risks tardive dyskinesia. Alcohol should be avoided due to increased sedation. Seek immediate medical care for high fever with rigid muscles or sudden mood/behavior changes.
Since everyone’s experience with the condition and its treatments can vary, working closely with a qualified healthcare provider helps ensure safe and effective care.
References
- National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov
- Mayo Clinic. https://www.mayoclinic.org
- Food and Drug Administration. https://www.fda.gov
- MedlinePlus. https://medlineplus.gov
Medications for Chorea
These are drugs that have been approved by the US Food and Drug Administration (FDA), meaning they have been determined to be safe and effective for use in Chorea.