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An Update on the Treatment of Chorea

  • Movement Disorders (A Videnovich, Section Editor)
  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

Abstract

Purpose of review

There are many causes for chorea, including genetic, autoimmune, pharmacological, and structural lesions. Where appropriate, treatment is based on reversing the underlying cause of chorea; many cases are self-limited, resolving when the primary disorder is treated. This review focuses on the management of chorea due to untreatable causes.

Recent findings

There are a limited number of double-blind randomized control trials assessing the efficacy of specific chorea treatments. Most therapeutic recommendations are based on small open-label studies, case reports, and expert opinion. This is in part due to the heterogeneity of chorea and chorea-associated syndromes and the variety of neurodegenerative phenotypes with variable progression rates.

Summary

Chorea can be treated with a variety of medications ranging from antiepileptics to antipsychotics. The recent development of selective vesicular monoamine transporter blocking agents has allowed for targeted chorea management with minimal side effects. Neurosurgical interventions such as deep brain surgery (DBS) and pallidotomy are reserved for medication-refractory chorea. As a symptom of neurodegenerative disease, chorea is only one aspect of the basal ganglia syndromes, and often, a multidisciplinary approach tailored to individual patient needs provides the best management.

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  1. Department of Neurology, Rutgers New Jersey Medical School, 90 Bergen St, suite 5200, Newark, NJ, 07103, USA

    Erin Feinstein DO

  2. Veterans Affairs Medical Center, Department of Neurology, Bronx Mount Sinai School of Medicine, New York, NY, 10029, USA

    Ruth Walker MD

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  1. Erin Feinstein DO
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Correspondence to Erin Feinstein DO.

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Erin Feinstein declares no conflict of interest. Ruth Walker has received consulting fees from the manufacturers of valbenazine, Neurocrine Biosciences, Inc. She has also received honoraria from Advance Medical Opinion, the International Parkinson Disease and Movement Disorders Society, and GE Healthcare.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Movement Disorders

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Feinstein, E., Walker, R. An Update on the Treatment of Chorea. Curr Treat Options Neurol 20, 44 (2018). https://doi.org/10.1007/s11940-018-0529-y

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