Treatment Approach for Chorea

Evaluation and Diagnosis

Brain MRI without contrast is the optimal imaging modality for patients with chorea to identify structural causes and assess for neurodegenerative patterns, though it may be normal early in disease course 2, 3
Genetic testing is recommended for suspected Huntington's disease (HD), the most common cause of adult-onset chorea, to detect CAG repeat expansions in the huntingtin gene 2, 3
Evaluation should identify potential secondary causes of chorea including cerebrovascular disease, infectious, autoimmune, metabolic, and drug-induced syndromes 2

For chorea associated with antiphospholipid antibodies/syndrome, consider antiplatelet and/or anticoagulation therapy in addition to symptomatic treatment 1
Glucocorticoids alone or in combination with immunosuppressive therapy (azathioprine, cyclophosphamide) may be used for chorea related to systemic lupus erythematosus or other autoimmune conditions 1
Pulse intravenous methylprednisolone with intravenous cyclophosphamide has shown effectiveness in refractory cases with generalized autoimmune activity 1

Speech therapy may be beneficial for patients with orofacial chorea affecting speech and swallowing 4
Occupational therapy can assist with activities of daily living impacted by choreiform movements 4