Five patients with chorea successfully treated with carbamazepine at plasma levels of 6.5 - 8.8 mcg/ml are reported from the Dept of Pediatrics, Child Neurology and EEG Service, Hospital Infantil Vall d’Hebron, Autonomous University, Barcelona, Spain. The cause of the chorea was streptococcal infection in 2, post-head injury (1), and unknown in 2. Therapy was continued for 3 to 36 months; it was discontinued in 1 because of an allergic cutaneous rash. [1]

COMMENT. Prednisone has also been advocated in the treatment of Sydenham’s chorea. Kelts and Harrison, reporting at the recent 17th annual meeting Child Neurology Society in Halifax, found predisone beneficial in 9 cases; an initial average dose of 1.8 mg/kg/day begun within 2 weeks of onset of chorea was tapered over 2 to 6 months.

Despite the self-limiting nature of the involuntary movements, they are frequently incapacitating and warrant treatment. If low to moderate doses of phenobarbital are ineffective, a trial of carbamazepine appears to be worthwhile, and predisone in resistant cases. Paradoxically, choreoathetosis or dystonia may occur as a side-effect of carbamazepine treatment in epileptic patients.