Sydenham chorea is a neuropsychiatric manifestation of acute rheumatic fever characterised variably by chorea, decreased muscle tone, and in some cases psychiatric and behavioural symptoms such as obsessive-compulsive symptoms and hyperactivity. When the presentation is severe, or an initial treatment step has not achieved the expected reduction in choreiform movements, escalation to a more intensive regimen is required.
The prior treatment line for moderate chorea uses anticonvulsant therapy — carbamazepine or sodium valproate — alongside supportive measures. The expected outcome is a reduction (though not necessarily elimination) of choreiform movements, with response possible within one to two weeks. When that reduction is not achieved, this protocol provides the next step.
For severe chorea that has not responded to anticonvulsant therapy, the approach adds corticosteroid therapy on top of existing supportive measures. The choice of agent and the full dosing schedule are defined in the structured protocol — see the full regimen below.