Senile Chorea - Option trochaic hyperkinesis, wherein debut in persons over 60 years of age, slow the progression, lack of communication with infectious diseases, cerebrovascular, tumor, etc. factors, intellectually-mental and mental safety of patients Hyperkinesia can be focal in nature and affect only the perioral region. Diagnosis is carried out according to the neurological status, blood tests for the presence of acanthocytes, analyzing the level of C-reactive protein, and rheumatoid factor, the results of EEG, brain MRI, genealogical analysis and DNA diagnostics. Symptomatic therapy, conducted primarily benzodiazepines and blockers of dopamine receptors.
small chorea, Huntington's chorea, neyroakantotsitoza that occur at an earlier age, senile chorea debut in the elderly over the age of 60 years. The long period of senile chorea existed in neuroscience as a separate nosological unit. Many neuroscientists have associated it with the secondary or atherosclerotic cerebrovascular chorea, developing in patients with chronic brain ischemia or after ischemic and hemorrhagic strokes, leading to degenerative changes in the striatum. At present, more and more authors are inclined to believe that senile chorea is a late manifestation of different genetic variants of chorea.
removing several teeth or tooth loss in a short period of time (t. n. "edentulous chorea").
dementia, characteristic of Huntington's chorea, is absent. The leading symptom is trochaic syndrome. There are involuntary, independent of the patient's motion caused by inconsistent and erratic contraction of individual muscle groups. Hyperkinesia characterized by speed and lack of coordination. They significantly complicate the execution of voluntary movements. Accompanied by a decrease in muscle tone.
Often, senile chorea manifests focal hyperkinesis, exciting only mimic muscles, most often - the area of the mouth (orofacial hyperkinesia). Thus there is an involuntary smacking breeding corners of the mouth, protruding tongue. Violent movements interfere with articulation muscles, as a result of developing dysarthria - speech disorder caused by disorders of articulation.
In some cases, senile chorea accompanied by generalized hyperkinesis, exciting all the facial muscles, the muscles of the limbs and body. At the same time there is grimacing, bustling chaotic movements of limbs, especially pronounced in the distal and reminiscent of gestures, forced squatting and crossing legs, danced gait.
encephalitis, intracranial tumors, cerebrovascular disease - carried out a number of additional surveys. The lack of specific clinical analysis of blood acanthocytes (star-shaped red blood cells) exclude the diagnosis neyroakantotsitoza. Biochemical analysis of blood in the normal range. Normal indicators of rheumatoid factor and C-reactive protein preclude the presence of small chorea. Electroencephalography reveals diffuse changes of bioelectric activity. MRI of the brain degeneration diagnoses the presence of areas of cerebral substance in the striatum and the subthalamic nucleus. Imaging eliminates the tumor or post-stroke etiology chorea.
Senile Chorea primarily differentiated with ferrets Huntington. The latter manifests before the age of 50. It has a more rapid progression, accompanied by mental disorders (depression, tendency to suicide, hallucinations), intellectual decline until dementia. Chorea Huntington is a genetic autosomal dominant disease. Finally differentiate it and senile chorea helps genetics consultation. The absence of the characteristic inheritance as a result of genealogical research and a negative DNA analysis to rule out Huntington's chorea.
Treatment and prognosis of senile chorea
With respect to senile chorea conducted primarily symptomatic therapy. To reduce the severity of hyperkinesis prescribed dopamine receptor blockers (trifluoperazine, reserpine, Ftorfenazin, haloperidol, chlorpromazine), pharmaceuticals benzodiazepine (clonazepam, diazepam), GABAergic agents (N-nicotinoyl-gamma-aminobutyric acid, baclofen), valproic acid preparations. Increasingly, it provided the use of atypical antipsychotics (clozapine, risperidone, olanzapine). They can be used, some anticonvulsants (topiramate) glutamatergic receptor blockers (memantine, amantadine). In some cases, the treatment regimen come in combination with an antipsychotic or anticonvulsant drug antiglutamatergicheskim.
Senile Chorea has an unfavorable prognosis for recovery. Hyperkinesia significantly impede career. However, the slow progression and lack of intellectual and mental disorders allows patients to retain the ability to self-service.