Dyskinesias and associated psychiatric disorders following streptococcal infections

Abstract

. Dale RC, Heyman I, Surtees RAH, Church AJ, Giovannoni G, Goodman R & Neville BGR . ( 2004 ) , 89 , 604 – 610 . Background The classical extrapyramidal movement disorder following β haemolytic streptococcus (BHS) infection is Sydenham's chorea (SC). Recently, other post‐streptococcal movement disorders have been described, including motor tics and dystonia. Associated emotional and behavioural alteration is characteristic.Aims To describe experience of post‐streptococcal dyskinesias and associated comorbid psychiatric features presenting to a tertiary referral centre 1999–2002.Methods In all patients, dyskinetic movement disorders followed BHS pharyngeal infection. BHS infection was defined by pharyngeal culture of the organism, or paired streptococcal serology. Movement disorders were classified according to international criteria, and validated by experienced child neurologists. Psychiatric complications were defined using ICD‐10 criteria using a validated psychiatric interview.Results In the 40 patients, the following dyskinetic movement disorders were present: chorea (n = 20), motor tics (n = 16), dystonia (n = 5), tremor (n = 3), stereotypies (n = 2), opsoclonus (n = 2) and myoclonus (n = 1). Sixty‐five per cent of the chorea patients were female, whereas 69% of the tic patients were male. ICD‐10 psychiatric diagnoses were made in 62.5%. Using the same psychiatric instrument, only 8.9% of UK children would be expected to have an ICD‐10 psychiatric diagnosis. Emotional disorders occurred in 47.5%, including obsessive‐compulsive disorder (27.5%), generalized anxiety (25%) and depressive episode (17.5%). Additional psychiatric morbidity included conduct disorders (27.5%) and hyperkinetic disorders (15%). Psychiatric, movement and post‐streptococcal autoimmune disorders were commonly observed in family members. At a mean follow‐up of 2.7 years, 72.5% had continuing movement and psychiatric disorders.Conclusion Post‐streptococcal dyskinesias occur with significant and disabling psychiatric comorbidity and are potential autoimmune models of common ‘idiopathic’ movement and psychiatric disorders in children. Multiple factors may be involved in disease expression including genetic predisposition, developmental status and the patient's sex.