Everything to Know About Sydenham Chorea

Medically Reviewed By Karen Gill, M.D.

Sydenham chorea is a disorder that causes jerky, involuntary movements. It develops after group A Streptococcus infections, such as strep throat and rheumatic fever. Sydenham chorea is more common in children. However, the condition can develop in anyone with a group A Streptococcus infection within the previous few months. 

In the past, doctors didn’t treat Sydenham chorea as often because it can go away on its own. However, treatment can help ease symptoms and reduce complications. 

Read on to learn more about Sydenham chorea symptoms, causes, treatment, and outlook.

Sydenham chorea symptoms

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Sydenham chorea symptoms may develop gradually or suddenly. Symptoms generally involve unintentional, uncontrolled movements of the hands, face, and feet.

Symptoms of Sydenham chorea can include:

  • jerky, uncontrollable movements
  • involuntary facial expressions and movements that may resemble fidgeting
  • falling more than usual
  • restlessness
  • muscle weakness
  • difficulty speaking clearly
  • difficulty maintaining grip or a still position, which may lead to problems writing, dressing, or holding objects
  • difficulty performing activities or tasks, such as walking
  • difficulty focusing or keeping emotions stable

These symptoms may sometimes be misunderstood as hyperactivity or a lack of cooperation.

Sydenham chorea is caused by infection with a group A Streptococcus bacteria. You may notice Sydenham chorea develop a few weeks to months Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source after symptoms of a streptococcal illness. Examples of illnesses caused by streptococcal infections include:

Learn more about the symptoms of rheumatic fever, strep throat, and scarlet fever.

Contact a doctor as soon as possible for any symptoms of Sydenham chorea or streptococcal infection.

Sydenham chorea causes

Sydenham chorea develops due to infection with a group A Streptococcus bacteria. There are many ways a group A streptococcal infection can appear, including Trusted Source Centers for Disease Control and Prevention (CDC) Governmental authority Go to source :

Sydenham chorea is a neurological disorder, meaning it affects the nerves. Experts believe Sydenham chorea may affect the nerves as part of an autoimmune reaction. Autoimmune reactions are when the immune response damages healthy tissues.

For example, Sydenham chorea may develop due to the immune reaction to streptococcal infection damaging the nerve cells that help control movement.

How Streptococcus A spreads

Group A streptococcal infections can spread Trusted Source Centers for Disease Control and Prevention (CDC) Governmental authority Go to source via:

  • breathing in or touching respiratory droplets containing the bacteria, such as from sneezing or coughing
  • exposure to other bodily fluids that contain the bacteria, such as saliva from sharing a drinking glass or kissing
  • contact with skin sores caused by Streptococcus or fluid from these sores
  • food, though this is rare

These infections can spread even when people do not have noticeable symptoms.

Sydenham chorea risk factors

Sydenham chorea is more common in people assigned female at birth and children between ages 5 and 15. Sydenham chorea can also develop in infants and adults.

According to experts, the condition is less common Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source in the United States than it used to be. Also, Sydenham chorea is less likely to be severe than in the past. These improvements may be due to better hygiene practices, antibiotic treatments, and lower levels of the Streptococcus A strain responsible.

Still, the severity of Sydenham chorea can vary for each person.

Sydenham chorea diagnosis

Doctors use various information and tests to identify Sydenham chorea, such as:

  • a physical exam
  • your symptoms and medical history
  • diagnostic tests, including:
    • throat swabs
    • neurological tests, such as an EEG
    • heart function tests, such as an echocardiogram or EKG
    • blood tests
    • MRI or CT scans

Sydenham chorea treatment

According to the National Institutes of Health (NIH), some people with Sydenham chorea may recover with bed rest and others may need medical care. Your medical team may also refer you to a cardiologist to check your heart health.

Symptom relief

Some medications can help improve severe Sydenham chorea symptoms by reducing involuntary movements. These medications include:

  • antiseizure medications, such as valproic acid (Depakene, Depakote)
  • benzodiazepines
  • dopamine receptor-blocking agents, such as haloperidol (Haldol)
  • dopamine-depleting agents, such as tetrabenazine (Xenazine)

You may need to take these medications for a few weeks to months.

In some cases, short-term side effects like weight gain can occur. Severe or long-term side effects are infrequent, according to the National Organization for Rare Disorders.


Doctors may recommend long-term courses of antibiotics for Sydenham chorea, which could mean taking antibiotics for years, such as until adulthood.

Long-term antibiotic therapy aims to prevent repeat streptococcal infections and the damage to the heart’s valves they sometimes cause.

Immune therapy

Immune therapy involves taking steroids or medications called immunoglobulins during the first few weeks of symptoms. This can be done orally or via an intravenous line into a vein.

Immune therapy aims to relieve ongoing inflammation that may be causing Sydenham chorea symptoms.

Doctors may recommend immune therapy only for severe Sydenham chorea or cases that do not improve with other treatments.

Sydenham chorea outlook

According to a 2024 review Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source , most people fully recover from Sydenham chorea in 3 to 6 months. In rare cases, symptoms may continue for up to 2 years or return later.

Sydenham chorea may be more likely to return in people assigned female at birth who:

  • take estrogen
  • take birth control pills
  • get pregnant

Some people may experience complications as a result of the underlying Streptococcus infection, such as rheumatic fever and rheumatic heart disease.

Sydenham chorea prevention

There is no sure way to prevent Sydenham chorea.

However, treating streptococcal infections early with antibiotics can lower the chances Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source of developing Sydenham chorea.

Treatment can also help improve symptoms and quality of life during recovery. This may also help reduce the chances of nerve and heart problems if you develop a streptococcal infection later.


Sydenham chorea refers to symptoms such as jerky, uncontrollable movements that occur after a Streptococcus A infection. It may develop after strep throat or rheumatic fever.

Treatment with antibiotics and other medications may help reduce symptoms and prevent the condition from returning later in life.

Talk with a doctor promptly for any Sydenham chorea or movement symptoms.

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Medical Reviewer: Karen Gill, M.D.
Last Review Date: 2024 May 13
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