Perspectives on Psychiatric Features of Sydenham Chorea
IMPACT:
The review article published in Pediatrics examines the psychiatric and behavioral features of Sydenham chorea (SC) and supports the understanding of SC as a poststreptococcal autoimmune illness with a neuropsychiatric profile and symptoms.
Given the global health burden of acute rheumatic fever and the cardiac involvement reported in 60% to 80% of children with SC, recognizing the neuropsychiatric manifestations of SC has broader clinical and population health relevance, even when motor abnormalities are subtle.
SUMMARY
Sydenham chorea (SC) is a poststreptococcal autoimmune neurologic disorder and a major manifestation of acute rheumatic fever. Although it is traditionally recognized as a movement disorder characterized by involuntary movements, the psychiatric, emotional, behavioral, and cognitive features of SC have been described for more than a century. This review article examines more than 150 years of medical literature to trace how these features have been understood and how the medical perspective has evolved toward recognizing psychiatric symptoms as manifestations of the underlying disease process.
The literature describes reported obsessive-compulsive symptoms, anxiety, attention and hyperactivity problems, tics, mood disturbances, irritability, behavioral and personality changes, cognitive difficulties, and sleep disturbances. Importantly, psychiatric symptoms may be prominent even when motor manifestations are subtle. Psychiatric disorders have also been reported in children with acute rheumatic fever without chorea, suggesting that neuropsychiatric manifestations may not depend entirely on the presence or severity of the movement disorder. Studies further indicate that psychiatric symptoms can persist after the motor abnormalities of SC have resolved.
The authors emphasize the long-standing debate over whether the psychiatric features of SC were psychological reactions or results of the movement disorder, or manifestations of the same underlying disease process. Over time, clinical observations, neuropathologic findings, neuroimaging, and immunologic research increasingly supported an involvement of the basal ganglia and associated neural circuits. These circuits play important roles not only in movement, but also in emotion, behavior, motivation, learning, decision-making, and other aspects of cognition.
The paper concludes that SC is appropriately understood as a neuropsychiatric movement disorder in which motor and psychiatric manifestations can arise from the same underlying poststreptococcal autoimmune process. The review emphasizes how behavioral and emotional dysregulation is associated with basal ganglia dysfunction, which is now understood to be a target of poststreptococcal autoimmune responses.
LINK TO PAPER: https://doi.org/10.1542/peds.2026-076410
CITATION
Lisa Mendelman, Russell C. Dale, Katherine Mackenzie, J. Michael Bostwick, Ellen R. Wald, Terence Sanger, Kate Miles, Sarah Kendell, Mark S. Pasternack, Jennifer Frankovich; Perspectives on Psychiatric Features of Sydenham Chorea. Pediatrics 2026; e2026076410. 10.1542/peds.2026-076410