This study revealed that 35 (70%) of the patients were female and 15(40 %) patients were male. Females were found to be most frequently affected than males The mean age incidence of patients of Sydenham’s chorea was found to be 13.7 , the median age range between 7 to 27 years .
In Australia study the female percentage was (89.8 %) & the mean age was 10.9 years at first episode [7]. In the Indian study girls incidence was (60 %); the mean age at presentation was 11.1 yr (range 7-16 yr) [8].
The Turkey study revealed that, the mean age at the onset of the symptoms was 11.7 +/- 2.6 years (range 6-17 years). The study revealed that 63% of the patients were female and 37% were male (male/female: 1.7/1) [9] .
In comparison to this study confirmed that the percentage of our female affection predominated the male affection.
The mean age in our study is higher than that found in other studies; this may reflects that, Sydenham’s chorea occurs at higher age group in Sudanese in comparison to other population or it can be attributed to second attack of Sydenham’s chorea considering that sydenhams chorea occasionally presents a subtle form .
Much of the studies documented that Sydenham's chorea is still a common problem in the developing countries due to the high incidence of ARF; the Assiut, Egypt study found that rheumatic chorea was most common among the studied population [10] .
The chorea last from 2 to 15weeks in the study ,this finding is in line with the observations of others[7].Regarding the pattern of onset of chorea most patients were found to have acute onset (67.3o%) rather than gradual (32,70%) ,this is supported by the fact that Sydenham's chorea typically has usually acute onset .
Generalized chorea in patients with Sydenham’s chorea was seen in 33 (66%), hemichorea in 17 patients (34%), comparing this with India study, generalized chorea was seen in 40 (66.6%) and hemichorea in 20 patients (33.3). This reflects that Sydenham’s chorea commonly present as generalized rather than partial chorea.
The study revealed that most movements initialy started at the limbs (82%%) rather than orofascial (18%) . This is described well in the literature.
The study found that chorea suppressed during sleep (100%) & provoked with certain factors e.g. stress (25% ) & sudden movement (7.7%). This matches most of the available reports [11,12 ] .
Higher function disturbances were common; of which speech was the most affected item, mainly as dysartheria (71.1%); this finding correlates with the review, that chorea commonly associated with dysartheria.
Most of the patients who diagnosed as Sydenham’s chorea exhibited decreased school performance ( 27patients – 53.8% ), emotional lability ( 34 patients – 69.2% ) this goes with what has been found in literature [6,13,14] . Darting tongue & milking sign were found in 42.3% of all patients.
Psychiatric symptoms were reported in 23 patients (44.2%) mainly as restlessness & emotional labiality. This confirmed well with the literature[5] which reported high frequency of these symptoms in Sydenham's chorea.
In our study, past history of ARF occurred in 12 (24%) patients, in comparison to the Turkey study a past history of ARF [9] was accounted for 30%. Family history of ARF occurred in 34%in this study; this is similar to the results of other studies, such as Sydenham's chorea study in western Pennsylvania in which family history of ARF existed in 30% of patients [11].
The study found ten patients (20%) had a recurrent attack; the recurrence rate was 37.9% in the Turkey study; this can be explained by the short time of our study & the lack of close follow up to study sample for long period.
The duration of Sydenham’s chorea varied between 7 to 50 days in our study; closely related to other reports. All the patients with Sydenham’s chorea had their movement stopped completely within 1 to 2 weeks after treatment, no single case persisted, this is goes with the literature as persistence rate in patients with is low in Sydenham’s chorea [3,5] .
To discuss the association of Sydenham’s chorea with the other manifestations of ARF, the results are as following; Eighteen patients had arthritis only (36%), carditis 30 patients (60%), arthritis and carditis in 18 patients (36%), and pure chorea 14 patients (28%).
Erythema marginatum and subcutaneous nodules were not observed in our patients these are comparable to the Turkey study; in which Carditis was 25% , arthritis in 33% carditis & arthritis in 28%, carditis & chorea in 12% , and chorea in3%.; also we can see carditis (44%), arthritis (11%), erythema marginatum (3%), and subcutaneous nodules (0%) were collected from Sydenham's chorea study in western Pennsylvania[11] .
The study showed carditis occur in 30 patients (60%). six patients (12%) with pure chorea had silent valvitis demonstrated only by echocardiographic testing but without any significant murmur (mitral regurgitation in 1 and combination of mitral and aortic regurgitation in 3 cases). So carditis increased up to 72%, reflects high affection (more severe disease) in Sudanese patient.
In our study Only 13 patients (26%) gave a history of pharyngitis ,this is because pharyngitis may precede the onset of chorea by as much as 6 months, many patients may not provide a history of streptococcal infection, but still we have allow percentage as history of pharyngitis is obtained in 41%, in Turkey study.
Elevated ASO levels were detected in 44 (88%) of the patients. Highly elevated ESR was detected (>100 mm/h) in 18 (14%) and moderately elevated ESR (30-70 mm/h) in 77 (59%) patients. This reflected that acute phase reactants were raised almost in most of the patients with Sydenham’s chorea. In comparison to other studies in Turkey Elevated ASO titre in 83%; in Indian study; a raised ESR and positive ASO titer were seen in 37 and 20 patients respectively.
Prolonged PR or first-degree block was noted in 9 (18%) patients in our study & was found to be prolonged in 13% of patients in India one.
Mitral regurgitation was found in 20 patients (83%), aortic regurgitation in 6 patients (44%) and combination of mitral and aortic regurgitation in 10 patients (27%). The mitral valve was the most commonly affected valve (64%), followed by aortic valve (22%). The mitral valve is the most commonly affected valve in rheumatic heart disease.
In 50 patients with Sydenham’s chorea, brain image(brain MRI) was done in 11 patients, all was reported to be normal, this goes with most of the studies done for that issue, one of these was done in western Pennsylvania which revealed that in patients with Sydenham’s chorea, brain computed tomography was abnormal in just 1 of 20 patients and that the abnormalities did not aid in diagnosis and included nonspecific increased finding [11].