I02.9
DESCRIPTION
A movement disorder with rapid involuntary jerks affecting any part of the body often incorporated into a voluntary movement in an attempt to mask it. It is an acute post-streptococcal infection movement disorder and constitutes one of the major criteria for the diagnosis of rheumatic fever. Patient has the appearance of being restless with constant movement which improves with sleep. The movements are classically random in place and random in time.
DIAGNOSTIC CRITERIA
Clinical
- Exclude drug reactions, hyperthyroidism, systemic lupus erythematosus and neurodegenerative disorders.
Investigations
- Cardiac screening, i.e. ECG, echocardiogram.
- Serum ASOT, anti-DNAse B.
- Erythrocyte sedimentation rate.
- Anti-dsDNA, if clinically indicated.
GENERAL AND SUPPORTIVE MEASURES
- Emotional support.
- School support.
- Occupational therapy.
MEDICINE TREATMENT
Movement disorders:
- Haloperidol, oral, 0.025 mg/kg/day in 2–3 divided doses.
- Increase dose slowly and incrementally to 0.05 mg/kg/day.
PLUS
If streptococcal infection:
- Phenoxymethylpenicillin, oral, 500 mg 12 hourly for 10 days.
OR
- Amoxicillin, oral, 45 mg/kg/dose 12 hourly for 10 days.
THEN
Until 21 years of age:
- Benzathine benzylpenicillin (depot formulation), IM, 1.2 million units every 28 days.
OR
- Phenoxymethylpenicillin, oral, 250 mg 12 hourly.
REFERRAL
- All patients for specialist assessment.