Chorea or Hemiplegia refers to involuntary movements characterized by their random, brief, and non-rhythmic character. Chorea is a movement disorder that occurs in many different diseases and conditions.

Dozens of genetic conditions, autoimmune and infectious diseases, endocrine disorders, allopathic medications and even pregnancy can have chorea as a symptom.

They are often described as seeming to “flow” from one body part to another unpredictably, though they can also be confined to a single area of the body (such as the mouth area or hands).

Chorea or Hemiplegia movements can often look like restlessness or fidgeting to those not familiar with them. They can usually be reduced to some degree when the affected person concentrates on suppressing them.

The movements can also be masked or hidden when they are combined with normal voluntary movements.

Patients with chorea will sometimes become clumsy or drop objects repeatedly, and chorea can lead to falling when it affects walking.

The characteristic pattern of walking that occurs in chorea is often easily recognizable by movement disorders neurologists.

Different types of diseases and disorders can cause chorea, it can affect almost anyone from infants and children to the elderly.

Causes of Chorea or Hemiplegia 

Chorea is a symptom and not a specific disease, similar to the way a fever can happen for many different reasons. Chorea is a neurological symptom that originates in an area of the brain called basal ganglia, which are collections of nerve cells deep inside the brain that control movement. Dozens of genetic conditions, autoimmune diseases, metabolic disorders, infections and medications can affect basal ganglia and lead to the onset of chorea.

The most common causes of chorea are:

• Huntington’s disease:

People inherit this genetic disorder from their parents. In addition to chorea, it causes changes in personality and problems with speech, coordination, and memory. Symptoms of Huntington’s disease get worse over time (usually over 10 to 20 years).

• Rheumatic fever:

Around one to eight months after having rheumatic fever, children can develop Sydenham chorea (also called St. Vitus dance). Rheumatic fever is a complication of group A streptococcal infection, such as strep throat infection that wasn’t treated properly. Most of the time, kids with Sydenham chorea get better without treatment in less than two years.

Other infectious diseases (Rarely):

• Lyme disease, toxoplasmosis, HIV/AIDS, endocarditis, syphilis, encephalitis, meningitis, Legionnaires’ disease, Creutzfeldt-Jakob disease are among infectious diseases that can cause chorea.
• Autoimmune diseases: People who have systemic lupus erythematosus (also called SLE or just lupus) can develop chorea. Multiple sclerosis, sarcoidosis, Sjogren syndrome, Behcet disease are among other autoimmune diseases that can cause chorea.
• Stroke: Some people develop chorea if they have a stroke or a tumor that occurs in or near basal ganglia.
• Pregnancy: Though rare, a type of chorea called chorea gravidarum can occur during pregnancy. (If pregnancy is the cause of the chorea, it may appear during the first three months of pregnancy and stop shortly after the birth of the baby.)
• Endocrine and metabolic disorders: Hypoglycemia, hyperglycemia, hyperthyroidism, hypoparathyroidism, hyperparathyroidism, hyponatremia, hypernatremia, hypocalcemia, hypomagnesemia, polycythemia vera and hepatic failure are some of the conditions that can cause chorea.
• Medications: Levodopa, neuroleptics, amphetamines, antihistamines, tricyclic antidepressants, anticonvulsants, cocaine, oral contraceptives are among the many medications known to cause chorea. Antipsychotic drugs can also cause chorea as part of a condition called tardive dyskinesia.
• Toxins: Carbon monoxide poisoning, mercury, alcohol intoxication can cause chorea.
• Older age: Sometimes chorea develops in older people without a known cause. This is called senile chorea and tends to affect the muscles in and around the mouth.

Symptoms of chorea

The symptoms of chorea are much the same no matter what caused the movement disorder. The most common signs of chorea are:

• Involuntary muscle movements:

Also called fidgety movements or dance-like movements usually appear in the hands, feet, and face. They can affect the way you walk, swallow and talk. The movements may be fluid or somewhat jerky. They can make it look as if you’re dancing, playing the piano, or even writhing in pain. The movements often get worse if you’re stressed or anxious and go away when you’re sleeping.

• Milkmaid’s grip:

Rather than holding your hand steady when you try to shake someone’s hand, you may grip and release your fingers over and over again. Doctors call this symptom milkmaid’s grip because it looks like you’re milking a cow.

• Jack-in-the-box tongue

When you try to stick out your tongue, it may slide in and out of your mouth. This sign of chorea is sometimes called jack-in-the-box tongue or harlequin tongue.

• Speech problems:

Kids and adults may develop slurred speech as the muscles involved in making speech lose coordination.

• Headaches and seizures:

Kids who develop chorea after rheumatic fever can have seizures and headaches. Some children also have behavioral and emotional issues.

Differential diagnosis of Chorea or Hemiplegia

Huntington’s disease: Huntington’s disease is a genetic disease caused by a specific gene mutation. It is the most widely recognized cause of chorea, but it is just one cause, and not even the most common one.

Parkinson’s disease:

In patients who take medications to treat the symptoms of Parkinson’s disease, the medications can cause choreic movements that are more commonly referred to as dyskinesias. These movements occur secondary to the anti-parkinsonian medications and are not caused by Parkinson’s disease directly. Medications that are used to treat Parkinson’s disease can sometimes cause other abnormal movements as well, such as dystonia.

Athetosis:

Allopathic treatment of Chorea or Hemiplegia

The type of treatment depends on what is causing the movement disorder.

• If Huntington’s disease is the cause, although doctors can’t cure the disease, they can prescribe medications that may be able to control the movements. Doctors prescribe deutetrabenazine (Austedo®) or tetrabenazine (Xenazine®) to control muscle movements of Huntington’s chorea.
• If chorea is part of a tardive dyskinesia syndrome, the medications valbenazine (Ingrezza®) and deutetrabenazine are usually considered.
• Amantadine is sometimes tried if levodopa (Parkinson medication) is the cause of the chorea. Antipsychotics are sometimes considered if you have both chorea and psychiatric conditions present, such as agitation, irritability, anxiety, depression, suicide and apathy.
• Kids who have Sydenham chorea usually get better in less than two years without any treatment at all. If the chorea is severe, doctors can prescribe medication (for example, corticosteroids) to help control the movements. Doctors also prescribe antibiotics to kill the rheumatic fever infection.
• If chorea is caused by a medication, stopping the medication may help lessen the abnormal muscle movements.
• If chorea is caused by endocrine or metabolic disorders (such as hyperthyroidism, hypoglycemia, hypoparathyroidism, hypocalcemia, hypomagnesemia), treating those conditions usually lessens the abnormal muscle movements.
• The use of deep brain stimulation to reduce chorea has been tried in some patients but is considered an experimental treatment for this disorder. Deep brain stimulation may be an option if chorea is severe and all other treatments have been tried and failed.

Side effects of the treatment for chorea

Deutetrabenazine and tetrabenazine can cause suicidal thoughts and actions in people with Huntington’s disease. Before taking these drugs, it’s very important to tell your doctor if you’re depressed. People who have a history of depression should not take these medications.

Taking corticosteroids for a long time can weaken your bones and lead to a condition called osteoporosis. People have also reported weight gain and high blood pressure after long-term use of corticosteroids.

All allopathic medications have potential side effects. Talk to your patient about the risks of all drugs considered to treat his/her chorea.

Homeopathic treatment of Chorea or Hemiplegia

1. Phosphorus:

Paralysis, Restless, fidgety. Hypo-sensitive, Vertigo, Heat from spine, Neuralgia, Burning pains.

Chronic congestion of head; Brain-fag, Hippocratic face readings, Ascending sensory and motor paralysis from ends of fingers and toes, Weakness and trembling, from every exertion, Arms and hands become numb, Post-diphtheritic paralysis.

2. Mygale:

It is quite characteristic of the spider poisons to produce spasmodic diseases.

depressed, the muscles of the face twitch constantly, The mouth and eye open and close in rapid succession, the head is jerked to one side, usually the right control over the muscle seems to be lost, If the patient attempts to put his hand to his head it is jerked backwards violently, and words are jerked out in talking, The legs are in motion while sitting, and dragged while attempting to walk.

Uncontrollable Movements of Face, Arms, and Legs, Involuntary head movements, throwing the head backward and then forwards is prominent, Constant jerking of the head (mostly to the right side), Shrugging of shoulders, difficulty in putting out tongue and grating of teeth at night.

All symptoms get better during sleep and are worse in the morning.

3.Agaricus Muscarius:

For Chorea with Uncertain, Unsteady Gait –  Agaricus is well-indicated for cases of chorea where an uncertain,Clonic spasms when awake, quiet when asleep, Though jerking when going to sleep; spasmodic motions, from simple involuntary motions and jerks of single muscles to a dancing of the whole body, Attack crosswise ,an upper right and a lower left extremity, or vice versa, Convulsive condition of the muscles of head and neck, constantly, Extreme mobility of lower limbs and the body generally, Frequent nictitating of eyelids; twitchings and spasms of eyeballs; redness of inner canthi of eyes; lachrymation.

Body convulsed, as if a galvanic battery were applied to the spine. Ravenous appetite, but difficulty of swallowing, Cervical glands swollen; inarticulate speech, Itching of eyelids and of different spots on skin, resembling chilblains; weakness and coldness of limbs; unsteady walk.

4. Cina:

For Chorea or Hemiplegia Affecting Face and Upper Limbs, Cina is a helpful remedy for chorea affecting the face and upper limbs. The involuntary movements on the face are marked around the eyes. Another feature is throwing of arms from side to side. The limbs are distorted with jerking and trembling. A weakness of the hand is also present, making it difficult to hold things. Complaints usually appear on one side. Few general symptoms like irritability, screaming, striking and restless sleep may also be present.

5. Causticum:

For Right-Sided Chorea, Causticum is the next prominent medicine for managing chorea. Causticum is most indicated in cases of chorea when the right side of the body is more affected. The face, tongue, arm, and leg get affected.

There are marked twisting and jerking of limbs. An unsteady gait is present with involuntary body movements.

Weakness of muscles is also present with the above symptoms.

Worsening of symptoms may be noted during the night. Causticum is also indicated for chorea during pregnancy.

6. Cuprum Metalicum:

For Left-sided Chorea or Hemiplegia Cuprum Metalicum is a valuable medicine, There is jerking of arms and legs. The arms and legs also feel weak, weary and lame.

There may be muscle contractions. Jerking of hands is also present. The person can hold nothing in hand and the objects fall to the ground.

Speech is also affected with trembling of the tongue.

Choreic movements start in the muscles of the fingers and toes and extend to the limbs. The patient is better or more quiet during sleep, but when awake the terrible contortions and awkward movements are excessive.

7. Magnesia Phos:

For Chorea or Hemiplegia when Symptoms are Better During Sleep, Magnesia Phos is an important medicine.

Involuntary shaking of limbs, face, mouth, and head is present. Involuntary movements of limbs along with contortions may also appear.

Sudden forward motion of the head is well-noted,  jerking of the mouth and speech is also very defective.

8. Veratrum Viride:

For Chorea or Hemiplegia when Symptoms are Worse during Sleep.

The symptoms present are involuntary motions of facial muscles (face turned into horrible contortions), jerking/continual nodding of the head, jerking of arms and legs, Constant movement of the lower jaw, speech affected, with the dropping of words when speaking.

9. Secale Cor:

Secale Cor is used in cases of Chorea or Hemiplegia when the chief indication is symptoms beginning in the face and then spreading all over the body.

The symptoms may become severe and rise to dance and jumping.

The arms and legs are in constant motion.

Head movement from side to side is present, trunk in constant motion, tongue jerks out and speech becomes difficult and indistinct.

10. Kali Bromatum:

Kali Bromatum is a significant medicine to treat violent Chorea or Hemiplegia that arises from fright.

Great trembling of hands (Legs and arms are affected).

The gait is unsteady, irregular, and staggering (similar to a drunk person walking), facial muscles could be affected, the tongue protrudes with a jerk, and the person can barely speak.

All the movements are violent.

10. Saccharum Lactis (Lactulose):

Amblyopia. Angina pectoris. Body-odour, offensive. Diabetes. Dyspepsia. Earache. Gout. Headache. Hysteria. Labia, soreness of. Nervousness. Neuralgia. Ovaries, affections of. Over-exertion. Ptosis. Sciatica. Sighing. Stye. Umbilicus, inflammation, fear and trembling of whole body, Longing and melancholy, Hysteria in evening, laughing and crying, jumping up and lying down, but could not stand, L. side of head felt all drawn, Inflammation and awful pain in lower limbs extending down

11. Belladonna:

Belladonna acts primarily on the brain, great general sensitiveness, sensitiveness of the special senses-sensitive to light, hydrophobia, remarkable quickness of sensation and/or of motion, Melancholy, with grief, hypochondriacal humour, moral dejection, and discouragement, delirium, and mania, with groaning, disposition to dance, to laugh, to sing, and to whistle.

Mania, with groans, or with involuntary laughter; nocturnal delirium; delirium with murmuring; delirium, during which are seen wolves, dogs, fires, &c; delirium by fits, and sometimes with fixedness of look, Stupefaction, with congestion to the head; pupils enlarged.

Delirium.-Great apathy and indifference, desire for solitude, dread of society and of all noise.-Repugnance to conversation.-Disinclination to talk, or very fast talking.

Ill-humour, disposition irritable and sensitive, with an inclination to be angry and to give offence. Folly, with ridiculous jesting, gesticulations, acts of insanity, impudent manners.

Fury and rage, with desire to strike, to spit, to bite, and to tear everything, and sometimes with growling and barking like a dog. Dejection and weakness of mind and body.

Dread of all exertion and motion.

Loss of consciousness.-Fantastic illusions (when closing the eyes); Dementia, to such an extent as no longer to know one’s friends, illusions of the senses and frightful visions.-Complete loss of reason, stupidity, inadvertence, and distraction, inaptitude for thought, and great weakness of memory.-Memory: quick; weak; lost.

12. Sepia:

Convulsive motions of head and limbs, When talking jerking of facial muscles, General muscular agitation; desire to change constantly place and position, Ringworm like eruptions on skin every spring; uterine chorea with menstrual irregularities; Amelioration after menses and after a thunderstorm.

13. Opium

– Emotional chorea; trembling the head, arms and hands., Arms are thrown out at right angles with the body and spasmodic jerking of the flexors; convulsive movements of one or other arm to and fro, Twitching continue during sleep.

14. Tarentula Hispanica

For Chorea or Hemiplegia Tarentula Hispanica indicated when the choreic movements affect the right arm and right leg, and when the movements continue even at night, and are brought on by fright, grief, etc, restless and compelled to keep constantly in motion, the spine is sensitive, and there is trembling.

The patient can run better than he can walk, It is the remedy when diversion of the mind, especially music, relieves.

15. Zincum met:

Constant motion of the feet, which may continue during sleep, It is especially the remedy when the chorea is brought on by suppressed eruption or by fright, The general health is involved, right side most affected, Much depression and irritability.

16. Cimicifuga:

Homeopathic medicine of Chorea or Hemiplegia indicated when the movements affect the left side and are associated with muscle pain or rheumatic joint ailments, or when reflex from uterine derangements, then Cimicifuga is the remedy, There is sensitiveness of the spine and entire muscular system, If mental depression be present it is an additional indication, Cimicifuga is especially indicated in chorea in young girls, about the age of puberty, with menstrual disorders, especially suppression of menses, Fright chorea and chorea with loss of power of swallowing indicate the remedy, Sleeplessness is an important symptom, Difficult speech, patient bites tongue when talking are good indications.

17. Causticum:

The symptoms calling for its use are these: The right side is more affected than the left, The muscles of the face, tongue, arm, and leg are all involved, Words are jerked out when talking, Patient continually changes his position, throws himself about until he falls asleep exhausted, During sleep legs and arms “on the go;” the child is unable to articulate because of excessive nervousness, Indisposition to talk because of weakness of the throat and tongue muscles.

Complications associated with chorea

Depending on the cause of chorea, complications can be severe. Huntington’s disease is an ongoing disease that gets worse over time and has no cure. Although there is no cure for lupus, doctors can help you manage the disease with medications. Children who develop Sydenham chorea after rheumatic fever usually recover without long-term medical problems.

P. S : This article is only for doctors having good knowledge about Homeopathy and allopathy,  for learning purpose(s).

Chorea is a completely Curable disease, For proper consultation and treatment, please visit our clinic.

Location, address and contact numbers are given below.

NoN of above mentioned medicine(s) is/are the full/complete treatment, but just hints for treatment; every patient has his/her own constitutional medicine.

To order medicine by courier, please send your details at WhatsApp– +923119884588

Dr. Sayyad Qaisar Ahmed (MD {Ukraine}, DHMS), Abdominal Surgeries, Oncological surgeries, Gastroenterologist, Specialist Homeopathic Medicines.

  Senior research officer at Dnepropetrovsk state medical academy Ukraine.

Location:  Al-Haytham clinic, Umer Farooq Chowk Risalpur Sadder (0923631023, 03119884588), K.P.K, Pakistan.

Find more about Dr Sayed Qaisar Ahmed at :

https://www.youtube.com/Dr Qaisar Ahmed

https://www.facebook.com/dr.qaisar.dixecosmetics

https://www.dixecosmetics.com