(ST. VITUS DANCE)
=Definition.=—A functional disorder of the nervous system, chiefly
affecting children, more than twice as frequent in females as males;
characterized by irregular involuntary muscular contractions, often
slight mental disturbance, and liability to endocarditis.
=Osteopathic Etiology.=—The disease affects children of all stations,
but is more common among the lower classes. The greater number of
cases occur before the age of twenty. It sometimes develops during the
early months of pregnancy, when it often assumes the maniacal type.
Chorea is frequently associated with endocarditis and rheumatism and
delayed menstruation. It occasionally follows infectious diseases of
childhood, especially scarlet fever. Fright, mental worry, sudden grief
and overstudy may bring on an attack. Children of neurotic stock are
more susceptible. Heredity plays some part as a predisposing cause.
Reflex irritation from worms or from genital irritation has a slight
influence upon the disease. Overwork in school is an important factor.
=Derangement= of the =anatomical structures=, involving the nervous
system along the spinal column, is the most common predisposing
cause. Most of the anatomical displacements are found in the cervical
vertebræ, although the upper dorsal may be involved.
=Pathologically=, as yet, no constant anatomical lesions have been
found. Emboli occur in some cases, but this might be expected, as
endocarditis so frequently occurs as an effect and not the cause of
chorea. “In cases not rheumatic, the most probable explanation of the
symptoms is to be found in vascular changes, having their origin in
disturbed nutrition.” (Holt) According to osteopathic theories and
investigations, the disease is due to various irritations to the spinal
centers and nerves of the affected region. The disordered nerve cells
may be the result of direct pressure, hyperemia, anemia, etc., and the
action upon the brain centers is possibly a reflex act. Of late acute
chorea is regarded by some as an infectious disease.
=Symptoms.=—In the majority of cases the muscular movement is
not severe. They are purposeless and the child appears awkward.
Restlessness, disturbed rest at night, crying spells, pain in the
limbs, headache and irritability, are some of the premonitory symptoms.
In =mild cases= one hand, or the hand and face, are involved.
Occasionally there is some difficulty in talking. The irregular, jerky
movements are characteristic of this disease. The child is anemic, and
the muscles are weak. In =severe cases= the movements are general,
the power of speech is lost, and the patient is unable to get about.
The condition usually occurs after one or more mild attacks, although
it may occur primarily. During an attack of chorea, the child’s
disposition changes, he becomes irritable, cannot concentrate his mind,
memory is affected and hallucinations may occur. The reflexes do not
usually differ from the normal. =Maniacal chorea= is most serious, and
often proves fatal, although recovery may occur. This form occurs most
frequently in pregnant women. Speech is greatly affected and insomnia,
fever and maniacal delirium develop. The =duration= is from six to ten
weeks, in the average case. Mild cases may recover in a month or less,
others last six or more months. There is a tendency of chorea to recur;
rheumatism seems to favor this tendency. In children recovery is the
rule.
=Diagnosis.=—In the majority of cases chorea is easily diagnosed. The
symptoms are generally very characteristic. In a few cases of hysteria
there may be difficulty of diagnosis, but history and rhythmical
movements will usually differentiate. In =hereditary ataxia= the slow,
irregular movements, the scolioses, scanning speech, talipes and the
existence of other cases in the family, will differentiate this from
chorea. =Cerebral sclerosis= usually occurs in infancy; impaired
mentality, exaggerated reflexes, rigidity and chronic course of the
disease, are points which render the diagnosis easy.
=Treatment.=—Nearly all cases can be cured.[120] The predisposing
causes of chorea, osteopathically, are usually found to be subluxations
of the vertebræ or ribs at any point, but particularly in the cervical
vertebræ. Chorea is one of the diseases of the nervous system, in which
constant morbid changes are not found upon the post-mortem examination.
Possibly the reason is because the lesions causing the diseased state
are not deeply seated enough to primarily affect motor centers; but
are lesions of the spinal column and ribs, affecting simply the nerve
fibers reflexly, as they pass through the intervertebral foramina.
There will be found well marked lesions, and upon their correction the
osteopath finds complete recovery largely depends.
The muscle, or group of muscles, involved, will give a =direct clue=
as to where the lesion will probably be found. In nearly all cases,
it is in the spinal region of innervation to the affected muscles.
Other cases may be due to cerebral lesions, as well as to intestinal
and uterine disturbances. Search should be made for possible =reflex=
irritation, such as intestinal parasites, adherent prepuce, eye strain,
nasal abnormalities, etc.
All cases should be taken from school, carefully guarded from
excitement, and placed under the most favorable =hygienic= conditions,
with a certain amount of discipline as to self control. The more
serious cases should be placed in bed, so that rest will be secured as
well as diminished liability to heart complications.
The =diet= must be carefully watched and the bowels attended to
regularly. A milk diet during the early stage is highly recommended.
Do everything possible to restore the general health. Mild gymnastics,
in most cases, will be found of service. Amusement should be given the
child, in the open air if possible. In severe cases where the skin is
harsh and dry, the hot air bath, providing the strength is good, will
give considerable relief from the intensity of the disease. A few cases
of acute chorea run into a =chronic form=, but the latter, as a rule,
yields to osteopathic treatment.