Chorea and its Homeopathic management

Dr Selma Varghese  

Chorea is an abnormal involuntary movement derived from the Greek word “dance”.  It is characterized by brief, abrupt, irregular, unpredictable, non-stereotyped movements. In milder cases, they may appear purposeful; the patient often appears fidgety and clumsy. They can affect various body parts, and interfere with speech, swallowing, posture and gait. Chorea may worsen with anxiety and voluntary movements, and subsides during sleep. Chorea is characterized by brief, semi-directed, irregular movements that are not repetitive or rhythmic, but appear to flow from one muscle to the next.

These ‘dance-like’ movements of chorea often occur with athetosis, which adds twisting and writhing movements. Walking may become difficult, and include odd postures and leg movements.

Unlike ataxia, which affects the quality of voluntary movements, or Parkinsonism, which is a hindrance of voluntary movements, the movements of chorea and ballism occur on their own, without conscious effort. Thus, chorea is said to be a hyperkinetic movement disorder.

When chorea is serious, slight movements will become thrashing motions; this form of severe chorea is referred to as ballism or ballismus.

Causes

• Chorea can occur in a variety of conditions and disorders.
• Chorea is a primary feature of Huntington’s disease, a progressive neurological disorder.
• Twenty percent (20%) of children and adolescents with rheumatic fever develop Sydenham’s chorea as a complication.
• Chorea gravidarum is rare type of chorea which is a complication of pregnancy.
• Chorea may also be caused by drugs (levodopa, anti-convulsants, anti-psychotics), metabolic disorders, endocrine disorders, and stroke.
• Wilson’s disease, a genetic disorder that leads to toxic levels of copper in the body
• Transmissible spongiform encephalopathy’s: A group of neurodegenerative diseases such as Creutzfeldt-Jakob disease and Kuru, caused by prions.
• Neuroacanthocytosis, a genetic disorder that may affect the blood, brain, peripheral nerves, muscle and heart. Common features include peripheral neuropathy, cardiomyopathy and hemolytic anemia. Other features include limb chorea, facial tics, other oral movements (lip and tongue biting), seizures, a late-onset dementia and behavioral changes.

Symptoms

• Swelling and inflammation (arthritis) of one or more joints that may be characterized by redness, warmth, tenderness, and pain (arthralgia) of affected joint regions. Arthritis and fever are the most common symptoms initially recognized in association with ARF.
• Symptoms of muscular twitching, among which are twitching and spasms of the eyeballs and eyelids; it has angular choric movements and spasmodic motions of the extremities, which are not confined to one side of the body, but affect the upper half on one side of the body and the lower half on the other.
• Symptoms may appear gradually or suddenly, and may include muscle weakness, hypotonic (decreased muscle tone), and clumsiness. The symptoms vary in severity–from mild cases in which there is restlessness, facial grimacing, and a slight degree of in-coordination of movements, to severe cases involving involuntary movements that incapacitate the child. 

Homeopathic Medicines for Chorea

Homeopathy plays a supportive role in managing chorea. Homeopathy medicines for managing chorea are of natural origin and don’t have any side effects. The top grade medicines for managing chorea are Tarentula Hispanica, Mygale, Agaricus, Cina, and Causticum. The most suitable medicine is selected based on the individual characteristic features in every case.

1. Tarentula Hispanica – Top Grade Medicine for Chorea

Tarentula Hispanica tops the list of medicines for managing chorea. In cases where this remedy is required, all the limbs are affected with involuntary movements. This can be attended with intense hyperaesthesia (increased sensitivity of skin). Constant movements of the arm, tossing of the arms from side to side, constant motion of hands that leads to difficulty in doing anything with the hand are some accompanying symptoms. Involuntary movements of the leg and feet are prominent, leading to an inability to walk. Difficulty in speech, heaviness of the tongue with involuntary movements, and choreic movements of the head are also present. In such cases, the head is turned violently from side to side and in other directions. Nervous contractions in muscles of the face are also noted. All these movements are less intense at night in cases where Tarentula is required.

2. Mygale – For Uncontrollable Movements of Face, Arms, and Legs

Mygale is a beneficial medicine to treat chorea with uncontrollable movements of arms, legs, and face. Among them, the contractions and movements of facial muscle are most marked. There is a constant motion of the legs. The legs jerk excessively, making it difficult to stand or walk. The gait becomes unsteady and it becomes difficult to keep hands in the same position even for a minute. The person needing Mygale may also have involuntary head movements, throwing the head backward and then forwards is prominent. Constant jerking of the head (mostly to the right side) is also noted. Shrugging of shoulders, difficulty in putting out tongue and grating of teeth at night are other indications to use Mygale. The chorea symptoms get better during sleep and are worse in the morning where Mygale is indicated.

3. Agaricus – For Chorea with Uncertain, Unsteady Gait

Agaricus is well-indicated for cases of chorea where an uncertain, unsteady gait is prominent. While walking the person tumbles over everything in the way. It is given for both involuntary motion/jerking of single muscles of a body part as well as involuntary trembling/dancing of the whole body. The limbs may feel cold and weak with above indications. It is also helpful when chorea affects limbs crosswise i.e. left arm and right leg.

4. Cina – For Chorea Affecting Face and Upper Limbs

Cina is a helpful remedy for chorea affecting the face and upper limbs. The involuntary movements on the face are marked around the eyes. Another feature is throwing of arms from side to side. The limbs are distorted with jerking and trembling. A weakness of the hand is also present, making it difficult to hold things. Complaints usually appear on one side. Few general symptoms like irritability, screaming, striking and restless sleep may also be present.

5. Causticum – For Right-Sided Chorea

Causticum is the next prominent medicine for managing chorea. Causticum is most indicated in cases of chorea when the right side of the body is more affected. The face, tongue, arm, and leg get affected. There is a marked twisting and jerking of limbs. An unsteady gait is present with involuntary body movements. A weakness of muscles is also present with the above symptoms. Worsening of symptoms may be noted during the night. Causticum is also indicated for chorea during pregnancy.

6. Cuprum Met – For Left-sided Chorea

Cuprum Met is a valuable medicine for chorea affecting the left side of the body. There is jerking of arms and legs. The arms and legs also feel weak, weary and lame. There may be muscle contractions. Jerking of hands is also present. The person can hold nothing in hand and the objects fall to the ground. Speech is also affected with trembling of the tongue.

7. Magnesia Phos – For Chorea when Symptoms are Better During Sleep

Magnesia Phos is an important medicine for chorea when symptoms are better during sleep. Involuntary shaking of limbs, face, mouth, and head is present. Involuntary movements of limbs along with contortions may also appear. A sudden forward motion of the head is well-noted. There is jerking of the mouth and speech is also very defective. The symptoms appear only during waking hours.

8. Veratrum Viride – For Chorea when Symptoms are Worse during Sleep

Veratrum Viride is a well-indicated medicine for cases of chorea where symptoms are worse during sleep. The symptoms present are involuntary motions of facial muscles (face turned into horrible contortions), jerking/continual nodding of the head, jerking of arms and legs. Constant movement of the lower jaw may also be present. The speech also gets affected, with the dropping of words when speaking. All of the above movements continue to occur during sleep.

9. Secale Cor – For Chorea when Symptoms Start from the Face

Secale Cor is used in cases of chorea when the chief indication is symptoms beginning in the face and then spreading all over the body. The symptoms may become severe and rise to dance and jumping. The arms and legs are in constant motion. Head movement from side to side is present. The trunk also appears to be in constant motion. The tongue jerks out and speech becomes difficult and indistinct.

10. Kali Bromatum – For Violent Chorea from Fright

Kali Bromatum is a significant medicine to treat violent chorea that arises from fright. Great trembling of hands is noted. Legs and arms are affected. The gait is unsteady, irregular, and staggering (similar to a drunk person walking). The muscles of the face are affected, the tongue protrudes with a jerk, and the person can barely speak. All the movements are violent.

11.Stramonium

Homeopathic medicine of chorea indicated when  movements characterized by great violence and affecting the parts of body corrosive.

More the upper extremities, or isolated groups of muscles, or affecting the whole body, producing the most grotesque leaps, motions and gestures, rotates arms, clasps hands over head.

Full of fear, strange and inconsistent fancies; motion all rapid, runs as fast as possible.

Attacks preceded by formication of limbs and melancholy.

Diplopia; aggravation at night, in dark place or dark room, during equinoxes, after fright or care. It may finally lead to idiocy.

Sepia

Convulsive motions of head and limbs

When talking jerking of facial muscles.

General muscular agitation; desire to change constantly place and position.

Ringworm like eruptions on skin every spring; uterine chorea with menstrual irregularities;

Amelioration after menses and after a thunderstorm

Silicea

Verminous irritation; especially from ascarides.

Distorted eyes, pale face, canine hunger, irritation, irritation of nostrils.

oedema of face and extremities

great thirst; sleep disturbed by frightful dreams; foot-sweat of disagreeable odor.

Sticta pul

Chorea complicated with hysteria, movements confined to lower extremities.

Aggravation evening

Sensation as if the legs were floating in the air when lying down.

Opium

Emotional chorea; trembling the head, arms and hands.

Arms are thrown out at right angles with the body and spasmodic jerking of the flexors; convulsive movements of one or other arm to and fro.

Twitching continue during sleep.

Reference

• Blueprints clinical cases neurology; Kevin Sheth, Odette A. Harris, Tracey A. Cho, Aaron B Caughey; 2006; 42
• Neuroacanthocytosis Syndromes II, Volume 2; Ruth H. Walker, Shinji Saiki, Adrian Danek; 2008; 22
• Principles and Practice of Emergency Neurology: Handbook for Emergency …; Sid M. Shah, Kevin M. Kelly; 2003; 152
• Principles and Practice of Emergency Neurology: Handbook for Emergency …; Sid M. Shah, Kevin M. Kelly; 2005; 151
• In a page: Signs & symptoms; Scott Kahan; 2004; 33
• Homoeopathic Therapeutics; Samuel Lilienthal; 1998; 195-198.
• Select your remedy; Rai Bahadur Bhishambar Das; 2007; 64, 65
• Illustrated guide to the homeopathic treatment; Dr. H.S Khaneja; 2010; 147

Dr Selma Varghese BHMS
Doing MD Organon of Medicine (part 1) under the guidance of Dr Jacintha M.
Fr Muller HMC Mangaluru