bubble_chart Overview

It is a diffuse encephalopathy related to wind-dampness, hence also known as wind-dampness chorea. This disease can occur alone or coexist with Bi disease.

bubble_chart Diagnosis

1. Medical history and symptoms:

   More common in adolescents and females, but adults and pregnant women can also be affected. The onset is mostly subacute. Early manifestations include irritability, clumsiness in hands and feet, and some mild involuntary movements, followed by involuntary, irregular, non-repetitive, and purposeless rapid movements such as eyebrow raising, eye blinking, grinning, mouth opening, protruding tongue, head nodding, neck twisting, shoulder shrugging, waist twisting, palm flipping, arm rotating, knee bending, leg kicking, and sudden chest thrusting or abdominal protrusion. Symptoms worsen with emotional agitation. The condition often starts on one side of the face or fingers and gradually spreads to half or the entire body; the upper limbs are more severely affected than the lower limbs, with symptoms alleviating at rest and disappearing during sleep. Some patients may also exhibit slurred speech.

2. Physical examination findings:

   May include hypotonia, weakened tendon reflexes, incoordination, cerebellar signs such as ataxia. Those with cerebral cortex involvement may display emotional instability, irritability, excitability, and in severe cases, confusion or agitation.

3. Auxiliary examinations:

   1. Elevated ESR and anti-streptolysin O (ASO) titer;

   2. Immunological tests: IgG, IgM, and IgA may be elevated;

   3. Lumbar puncture CSF examination: Early-stage immunoglobulin levels may be elevated.

4. EEG abnormalities in 55%-75% of cases, characterized by high-amplitude slow waves in the parieto-occipital region and reduced alpha rhythm.

bubble_chart Treatment Measures

The prognosis of this disease is generally good, with most patients recovering within 2-3 months without severe sequelae, but recurrence is possible.

1. During the acute phase, bed rest should be maintained until choreiform movements disappear, and anti-"O" and erythrocyte sedimentation rate (ESR) return to normal. For severe choreiform movements, Librium 10mg three times daily or Luminal 30mg three times daily can be administered orally. For severe agitation, diazepam 10mg can be given intravenously, or chlorpromazine 25-50mg intramuscularly. Nasogastric feeding may be provided for patients with swallowing difficulties.
2. Prevention and treatment of wind-dampness: Penicillin 400,000-800,000 units twice daily intramuscularly for two weeks as one course, sodium salicylate 1.0 three to four times daily, or aspirin 0.5-1.0 three to four times daily. For children, the dosage is 0.1/kg/day. Treatment should be maintained for 6-12 weeks. For patients with obvious wind-dampness symptoms, prednisone 30mg/day can be added, administered in divided doses three to four times daily, with a total treatment course of 2-3 months.
3. For patients with recurrent and uncontrolled wind-dampness heat symptoms, immunosuppressive drugs such as azathioprine can be tried at 25-50mg two to three times daily.
4. Chinese medicinals: Aged Citrus Peel 10g, Fourstamen Stephania Root 6g, Spirodela 10g, Cinnamon Twig 10g, Acorus 8g, Glossy Privet Fruit, Pricklyash Peel, Fortune Eupatorium Leaf, and Gentian Macrophylla Root 6g each, Saposhnikovia Root, Pale Butterflybush Flower, Tangerine Leaf, Patchouli 10g, Dried Ginger 3g. Decoct and take one dose daily.

bubble_chart Differentiation

This disease needs to be differentiated from habitual spasms, spasm-coprolalia syndrome, involuntary movements caused by hepatolenticular degeneration, and chronic progressive chorea.