Chorea Gravidarum Follow-up

Updated: Aug 11, 2017
  • Author: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS; Chief Editor: Selim R Benbadis, MD  more...
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Follow-up

Prognosis

General prognosis

Chorea gravidarum seldom persists indefinitely. Without treatment, the disease abates in 30% of patients before they give birth. In almost two thirds of patients, the chorea lasts until puerperium. Symptoms often dramatically disappear in the days after childbirth. In some patients, neurological sequelae may continue in the form of various degrees of incoordination, tremor, and clumsiness.

The absence of a control group (ie, women without chorea gravidarum in pregnancy) from Beresford and Graham's analysis of chorea gravidarum in pregnancy makes interpretation of the statistics difficult; they report that death occurred in 1.5% of pregnancies, fetal death in 3.3%, and premature labor in 6.6%. [54]

Death is now rare [43] ; the mortality rate of 12% reported by Willson and Preece [4] reflects death due to underlying rheumatic heart disease.

In the case of drug-induced chorea gravidarum, movements clear on drug withdrawal, and specific antidote therapy often is not needed. Individual susceptibility for adverse effects from these drugs may be due to preexisting basal ganglia abnormalities, such as prior Sydenham chorea or hypoxic encephalopathy.

In the case of contraceptive-induced chorea gravidarum, researchers know from animal experiments that female hormones enhance postsynaptic dopaminergic sensitivity. By binding to presynaptic dopaminergic transporter sites, cocaine blocks dopamine reuptake, thus potentiating dopaminergic transmission. It also may influence postsynaptic receptor sensitivity.

Fetal prognosis

Spontaneous abortion occurs at a normal rate [5] , and infants are healthy.

Willson and Preece mentioned two 19th century cases of neonatal chorea. One case involved a microcephalic child with athetoid cerebral palsy. The other case was said to involve transient chorea, but the movements were not described further. [4]

In view of the current rarity of chorea gravidarum, fetal mortality is difficult to assess; however, in Beresford and Graham's series, fetal loss was 6.6%, and only one half of this loss was directly attributable to chorea. [54] In chorea gravidarum, maternal mortality is reportedly less than 1%.

Future pregnancy

Of women with chorea gravidarum, 21% have recurrent chorea with subsequent pregnancies. [4]

Several cases have been described in which attacks occurred in 3, 4, and even 5 pregnancies. [55, 56]