Tics are involuntary or semivoluntary, abrupt, brief, nonrhythmic, recurrent movements or sounds. Tourette syndrome (TS) is the most common cause of tics; however, several other disorders have been associated with tics and tic-like movements. Etiologies of secondary tic syndromes and disorders (STS) include hereditary, drug-induced (including tardive), toxins, traumatic, cerebrovascular, infectious, parainfectious, autoimmune, functional disorders, and others. Age at onset after 18 years, lack of comorbid attention-deficit/hyperactivity disorder, obsessive-compulsive disorder, and no family history of tics are considered typical features of STS. Atypical neurologic manifestations such as additional movement disorders, seizures, decreased level of consciousness, and neurologic deficits, temporally related to some triggering event, such as brain trauma, stroke, or drug exposure, should raise suspicion of STS. These patients usually show a more restricted body distribution, less severe and less complex tics compared with patients with TS. Some tics, typically observed in TS, such as eye-blinking, facial grimacing, and complex motor and phonic tics that are preceded by a premonitory urge may not be present in STS. However, there is a substantial overlap of features between patients with TS and STS. Pharmacologic treatment of STS is similar to TS. Additionally, these patients may require specific treatment, such as anticonvulsants, antibiotics, immunotherapy, or drug-discontinuation. Therefore, prompt recognition and early treatment intervention of STS is imperative for a favorable outcome.

The aim of the present case series was to describe an instructional (attention) intervention for improving motor function in two children rehabilitating from Sydenam's chorea syndrome. Evidence suggests that paying attention to the body can be advantageous for afferent proprioceptive processing during motor skills wherein this information is relevant for successful task execution. This unique approach may also hold true for individuals with movement disorders, such as Sydenham chorea syndrome: a rare neurological condition that results in uncoordinated movements. The present study provides a case study of two children unable to walk independently due to low postural stability. Both children completed "10-Meter Walk" and "Timed Up and Go" tests as a baseline, before undergoing three sessions per week of an intervention, for three months. Both children practiced walking and dynamic balance, with one child instructed to adopt an internal (bodily) focus and the other an external focus. A post-test experimental phase was then conducted to measure learning. Results revealed superior motor function when adopting a focus on body motion. When movement disorders create ambiguity in motor efference, an internal focus on task-relevant proprioceptive information may facilitate more appropriate movement organization. Sydenham chorea syndrome is a rare neurological movement disorder, resulting in involuntary and uncoordinated movements. The present case study found that children with this condition have improved walking performance when able to attend to their body movements (i.e. an internal focus of attention). This has implications for future clinical practice.

Sydenham chorea (SC) presents with random abnormal involuntary movements that occur after an autoimmune reaction to a prior group A beta-hemolytic streptococcal infection. While most cases resolve spontaneously, some cases have a prolonged duration of symptoms and recurrences. We discuss a 22-year-old woman who presented with a two-month history of involuntary, brief, random, and irregular movements of the limbs. She had a history of multiple streptococcal throat infections. At age two, she had scarlet fever. After ruling out other causes of chorea, she was diagnosed with Sydenham chorea. She was treated with intravenous immunoglobulin, oral prednisone, and amantadine, resulting in full symptom resolution. Interleukin-12 (IL-12) was elevated approximately seven months after hospital discharge. Chronic elevation of IL-12 differs from previously published findings, which describe elevation only during the acute phase of the disease. Intensive immunosuppressive treatment during the acute phase, along with adherence to antibiotic therapy, may have contributed to the full resolution of her chorea.

An international panel of 27 experts (pediatric and movement disorder neurologists, psychiatrists, and parent representatives) from all continents participated in a Delphi process to establish international consensus guidelines for the evaluation, diagnosis, and management of children with Sydenham chorea (SC) based on best evidence and expert opinion. In total, 88 recommendations reached consensus. Practitioners should identify key signs of SC (chorea and hypotonia), screen for behavioral, mobility, swallowing, speech, and cognitive impairments, and acute rheumatic fever (ARF) features including carditis. Etiological evaluation will differ according to population ARF risk. At all times, patients, families, and educators should receive support, information, and guidance to minimize the impact of SC on academic and social functioning. Antibiotic treatment is recommended at first presentation. Long-term secondary antibiotic prophylaxis should follow international or local guidelines, and measures to reduce pain and distress associated with intramuscular antibiotics will aid in adherence. Immunotherapy (corticosteroids) is recommended in moderate to severe SC. In those with inadequate recovery, intravenous immunoglobulin or plasma exchange should be given. In SC relapse, repeat clinical assessments, etiological investigation, and antibiotics plus corticosteroid therapy should be considered. This consensus guideline will standardize the evaluation and management of patients with SC and direct future research to improve the lived experience and outcomes of patients and families.

We describe the case of an eight-year-old female presenting with abrupt-onset involuntary movements, emotional lability, and gait disturbances, consistent with Sydenham's chorea (SC). Her condition deteriorated despite initial antibiotic treatment and symptomatic management. Notable findings included elevated antistreptolysin O titers and antideoxyribonuclease B antibodies, suggestive of recent Group A Streptococcus infection. Brain magnetic resonance imaging revealed punctate gliosis in the supratentorial white matter, and extensive workup excluded alternative diagnoses. Despite escalating therapy with valproic acid, clonidine, and haloperidol, the patient exhibited persistent choreiform movements and emotional dysregulation. High-dose corticosteroids (methylprednisolone) were initiated, resulting in significant symptomatic improvement and restoration of ambulatory function. Long-term prophylaxis with benzathine penicillin G was implemented to prevent recurrence. SC remains an under-researched complication of acute rheumatic fever, with treatment often extrapolated from limited case reports and expert consensus. This case underscores the potential role of corticosteroids in refractory SC. This case also highlights the complexity of managing prolonged SC and the importance of individualized, multifaceted treatment strategies.