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SYDENHAM'S CHOREA:ANALYSIS OF MOTOR DISORDERS WITH ELECTROMYOGRAPHY Nobuo Yanagisawa 1 , Hiroshi Tsukagoshi 1 , Yasuo Toyokura 2 1Department of Medicine (Neurology), Shinshu University School of Medicine 2Department of Neurology, Institute of Brain Research, Faculty of Medicine, University of Tokyo pp.651-660
Published Date 1976/7/1
DOI https://doi.org/10.11477/mf.1406203907
  • Abstract
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Electromyogram was recorded from affected muscles of the trunk and extremities of three cases with Sydenham's chorea (8, 9 and 16 years old females) and one case with chorea gravidarum with anamnesis of Sydenham's chorea (22 year old female).

Surface electrodes were used for simultaneous recordings from many functionally different muscle groups up to twelve and a 13 channel inkwriting oscillograph with amplifiers with time constants of 0.03-0.005 sec was used. Involuntary contractions at rest or during standing or in the course of skilled motion, response to passive stretch of muscles and isometric voluntary contractions were examined. Following results were obtained and compared with electromyogram of motor disorders in Huntington'schorea.

1) Phasic bursts of action potentials were ob-served in affected muscles in all cases corresponding to choreic movements. Distal parts of extremities were more severely affected. Agonists and antag-onists contracted independently or reciprocally in three cases. This was the same pattern as observed in Huntington's chorea with muscular hypotonia. Another case (case 1) with most frequent spells of involuntary movements showed simultaneous con-tractions in agonists and antagonists.

Size and shape of compound action potentials in phasic contractions were similar to that of Huntington's chorea. Therefore, more brusque and flinging movements in Sydenham's chorea than Huntington's chorea may not be attributable to difference in pattern of contractions itself. More marked hypotonia of affected muscles in Sydenham's chorea may be responsible for flinging, large move-ments.

2) Passive stretch of extremity muscles by ma-nipulation evoked no response in most cases. Only case 1 showed paradoxical contractions of Westphal in pretibial and quadriceps muscles. Simultaneous contractions in flexors and extensors in phasic in-voluntary movements with paradoxical contractions by muscle stretch, which were observed in case 1, were common findings in Huntington's chorea without muscular hypotonia.

3) In a case with chorea gravidarum tendon taps of biceps brachii muscle provoked contractions in forearm flexors, forearm extensors and thigh muscles successively. Tendon taps in other muscles or photic or sonic stimulations were ineffective. Significance of this widespread muscular contractions by biceps tendon tap was discussed in relation to startle response or spino-bulbo-spinal reflex.

4) Sudden brief relaxation of muscles during sustained voluntary contraction was observed in all cases. Coincidentally sudden brief abolishment of action potentials of agonists was observed without any active contractions in their antagonists or neighboring muscles. Same finding was obtained in Huntington's chorea but it was more typical in Sydenham's chorea. Thus in Sydenham's chorea, as in Huntington's chorea, not only the active in-voluntary contraction but also the active inhibition of innervation should be considered as a component of its motor disorders.


Copyright © 1976, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 2185-405X 印刷版ISSN 0006-8969 医学書院

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