It is a diffuse encephalopathy related to wind-dampness, hence also known as wind-dampness chorea. This disease can occur alone or coexist with Bi disease.

bubble_chart Diagnosis

1. History and Symptoms:

It is more common in adolescents and females, but can also affect adults and pregnant women. The onset is mostly subacute. Early manifestations include irritability, clumsiness in hands and feet, and some mild involuntary movements, followed by involuntary, irregular, non-repetitive, and purposeless rapid movements such as grimacing, protruding tongue, nodding, neck twisting, shoulder shrugging, waist twisting, palm flipping, arm rotating, knee bending, leg kicking, and chest thrusting. Symptoms worsen with emotional agitation. The condition often starts on one side of the face or fingers and gradually spreads to half or the entire body; the upper limbs are more affected than the lower limbs, symptoms lessen at rest and disappear during sleep. Some patients may also exhibit slurred speech.

2. Physical Examination Findings:

Hypotonia, weak tendon reflexes, uncoordinated movements, and cerebellar signs such as ataxia may be present. If the cerebral cortex is involved, emotional instability, irritability, and excitability may occur, with severe cases showing confusion or agitation.

3. Auxiliary Examinations:

1. Elevated ESR and anti-streptolysin O (ASO) titer;

2. Immunological tests: IgG, IgM, and IgA may be elevated;

3. Lumbar puncture CSF examination: Immunoglobulins may be elevated in the early stage.

4. EEG abnormalities in 55–75% of cases, characterized by high-amplitude slow waves in the parieto-occipital region and reduced α rhythm.

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This condition should be differentiated from habitual spasms, Tourette syndrome, involuntary movements caused by hepatolenticular degeneration (Wilson's disease), and chronic progressive chorea (Huntington's disease).

bubble_chart Treatment Measures

The prognosis of this disease is generally good, with most patients recovering within 2-3 months without severe sequelae, but recurrence is possible.

1. During the acute phase, bed rest should be maintained until choreic movements disappear, and anti-"O" and ESR return to normal. For severe choreic movements, administer Librium 10mg three times daily or Luminal 30mg three times daily orally. For severe agitation, give diazepam 10mg intravenously or chlorpromazine 25–50mg intramuscularly. Nasogastric feeding may be provided for patients with dysphagia.

2. Prevention and treatment of wind-dampness: Penicillin 400,000–800,000 units intramuscularly twice daily for two weeks as one course. Sodium salicylate 1.0g three to four times daily, or aspirin 0.5–1.0g three to four times daily. For children, administer 0.1g/kg/day. Treatment should be maintained for 6–12 weeks. For patients with pronounced wind-dampness symptoms, add prednisone 30mg/day administered in divided doses, three to four times daily, with a total course of 2–3 months.

3. For patients with recurrent wind-dampness-heat symptoms that are difficult to control, immunosuppressive drugs such as azathioprine may be tried at 25–50mg two to three times daily.

4. Chinese medicinals: Aged Citrus Peel 10g, Fourstamen Stephania Root 6g, Spirodela 10g, Cinnamon Twig 10g, Acorus 8g, Glossy Privet Fruit, Pricklyash Peel, Fortune Eupatorium Leaf, and Gentian Macrophylla Root 6g each, Saposhnikovia Root, Pale Butterflybush Flower, Tangerine Leaf, Patchouli 10g, Dried Ginger 3g. Decoct and take one dose daily.