wonder women
NOVEMBER, 2018 | THE HEALTH
Chorea in
women aged 40
and above
How can
chorea be
treated?
Dr John
Tharakan.
HPSSOCIETY.INFO
Abnormal excessive
movements caused by
an excess of dopamine
C
Huntington’s Chorea pathology.
HOREA is a symptom and
not a specific disease, in
the same way a fever can
happen for many different
reasons.
Gleneagles Medini
Hospital Consultant
Neurologist Dr John Tharakan
explained that in most forms of chorea,
there is an excess of dopamine, the
main neurotransmitter in the basal
ganglia, leading to abnormal excessive
movements.
Some of the common causes of
chorea, he said, are having been afflicted
with Sydenham chorea in childhood
which increases the likelihood of
chorea in women later in life, genetically
determined conditions like Huntington’s
disease, pregnancy - causing a condition
called chorea gravidarum that occurs
during the first three months of preg-
nancy but disappears without treatment
shortly after giving birth.
“In rare cases, use of oral con-
traceptives, lupus (systemic lupus
erythematosus), overactivity of the
thyroid gland (hyperthyroidism), high
blood sugar level (hyperglycaemia), a
tumour or stroke affecting a part of the
basal ganglia called the caudate nucleus
or the use of certain drugs such as
levodopa, phenytoin and cocaine could
also be attributing factors to the disease.
However, in older people it is known as
senile chorea - which happens for no
apparent reason.”
The characteristics of Huntington
disease in both male and female.
Common symptoms of chorea
Chorea is a series of involuntary move-
ments characterised by random, brief
and non-rhythmic jerking motions,
typically involving the hands, feet and
face.
“Patients with chorea will some-
times become clumsy or drop objects
repeatedly and chorea can lead to fre-
quent falls when it also affects walking.
The movements may merge impercepti-
bly into purposeful or semi-purposeful
acts, sometimes making chorea difficult
to identify. The jerky movements worsen
with anxiety and disappear in sleep. If
any of these symptoms develop, one
should consult a neurology specialist.”
In severe cases
In severe cases of chorea, involuntary
movements may occasionally appear as
violent flinging of the limbs that results
in the patient uncontrollably flailing
about. Such actions are known as bal-
listic movements, and is referred to as
ballism or choreoballism. The condition
can be severely debilitating and could
even lead to injury.
“Patients with chorea will sometimes become
clumsy or drop objects repeatedly and chorea can
lead to frequent falls when it also affects walking.”
Frequency of micturition
U
RINARY infections are common in women of
any age group compared to men as women
have a shorter urinary tract.
“One of the common causes for this is because
women don’t drink enough water and they don’t
pass urine so the germs travel up. Or it may be after
intercourse.” said Thomson Hospital Consultant
Obstetrician & Gynaecologist Dr Surinder Singh.
“This however is easy to treat. We would do
a urine culture for them and if we find that there
are any particular infection, we see the drug that
they are susceptible to and treat them. Treatment
is a course of antibiotics between seven to 10 days.
Splash cystitis
“In young girls and pre-adolescent who haven’t
reached puberty yet – the labia is not fully devel-
oped so if the toilet pan is quite deep and the water
splashes back onto their bottom where they urinate
– they could get an infection. This is known as a
splash cystitis.”
“It is also crucial to teach young girls how to
wipe after urinating. Do not wipe front and back,
25
CHOREA is diagnosed clinically,
meaning that it is based on the
examination of an experienced
physician. The clinical evaluation
includes a detailed history of
other medical problems, prior
surgeries, previous infections,
exposure to medications and
toxins (including alcohol and
illegal drugs), and a family
background of diseases.
Gleneagles Medini Hospital
Consultant Neurologist Dr
John Tharakan pointed out that
once the clinical diagnosis of
chorea is made, additional tests
will be ordered to identify the
underlying cause.
This usually include blood
tests as well as imaging studies
of the brain like magnetic
resonance imaging (MRI),
with more specialised tests
sometimes alongside.
Determining the cause of
the chorea can occasionally be
challenging even for movement
disorder specialists, and in
some patients, the cause may
not be identified at all. There is
currently no objective text that
differentiates chorea from other
types of involuntary movements.
Once the underlying cause
is determined however, the
corresponding treatment
follows. This may include
discontinuing a medication,
correcting a metabolic
abnormality, or medically
treating an autoimmune,
infectious, rheumatologic, or
endocrinological cause of chorea.
In some cases, in which the
chorea is due to prior damage
to the brain or an ongoing
degenerative process, there may
not be a treatment available to
influence the underlying disease.
The choreaic movements
themselves can be treated with
suppressant medication. In very
specific cases, neurosurgical
procedures can sometimes be
considered.
THE JAMA NETWORK
but only do it in one direction - front to back-
because the back is where the rectum is and where
the germs are and wiping front and back can cause
germs to the urinary area.”
Symptoms
Common symptoms of urinary infections include
pain when urinating, as well as frequency in pass-
ing urine also known as frequency of micturition
and nocturia where sometimes a person wakes
up several times in the middle of the night to pass
urine.
Surinder later pointed out to other related blad-
der issues in women such as prolapse of the bladder
due to child birth and instrumental delivery where
they would have other symptoms such as having a
leak whenever they coughed or laughed.
“They would also find it hard to control their
bladder – the urgency to rush to the toilet. This is
known as detrusor irritability where the bladder
wall is very irritable. There are drugs to treat this
nowadays.”
The picture shows the urinary tract anatomy with a close up of
bacteria in infected urine