Chorea affects children with cerebral palsy by causing **involuntary, irregular, and unpredictable movements** that complicate their motor control and daily functioning. In cerebral palsy (CP), chorea is often part of a subtype called **choreoathetoid cerebral palsy**, which combines features of chorea and athetoid movements—slow, writhing motions. These involuntary movements can affect various body parts, including the hands, feet, arms, legs, face, lips, and tongue, leading to difficulties with speech, swallowing, eating, and maintaining posture[1][5].
Cerebral palsy is a group of permanent movement disorders caused by damage to the developing brain, often before or during birth. The damage affects muscle tone, coordination, and motor skills. Among the types of CP, **dyskinetic cerebral palsy** is characterized by extrapyramidal disturbances, which include chorea and dystonia (sustained muscle contractions causing twisting and repetitive movements)[1][5]. Chorea in this context manifests as brief, irregular, and unpredictable movements that can worsen with voluntary movement attempts or emotional stress and are present even at rest but typically disappear during sleep[1].
The underlying neurological cause of chorea in CP involves damage to the **basal ganglia**, a group of deep brain structures responsible for regulating voluntary motor control and suppressing unwanted movements. When these areas are injured, as in dyskinetic CP, the normal balance of muscle tone and movement control is disrupted, leading to fluctuating muscle tone—both hypotonia (low muscle tone) and hypertonia (high muscle tone)—and involuntary movements[1][5].
For children, chorea complicates the already challenging motor impairments caused by CP. The involuntary movements can:
– **Interfere with voluntary motor tasks**, making it difficult to perform activities like walking, grasping objects, or maintaining balance.
– **Affect facial muscles and oral motor control**, leading to speech difficulties (dysarthria), problems with swallowing (dysphagia), and feeding challenges.
– **Increase fatigue and frustration**, as children must constantly manage unpredictable movements alongside muscle tone abnormalities.
– **Impact social interaction and communication**, due to speech impairments and visible involuntary movements.
Because chorea movements are unpredictable and can fluctuate, children with choreoathetoid CP often experience **difficulty maintaining stable postures**, such as sitting or standing, which affects their independence and participation in daily activities[1].
Treatment options for chorea in cerebral palsy are limited and focus on managing symptoms rather than curing the underlying brain injury. Medications such as **tetrabenazine** (which depletes dopamine to reduce hyperkinetic movements) and **levodopa** have been used with variable success but may cause side effects and do not fully eliminate chorea[4]. Physical, occupational, and speech therapies are essential to help children maximize their functional abilities and adapt to their motor challenges.
Chorea in CP differs from chorea seen in other neurological disorders like Huntington’s disease, which is a progressive, inherited neurodegenerative condition characterized by chorea along with cognitive and psychiatric decline[2][3]. In CP, chorea results from static brain injury rather than progressive degeneration, so symptoms may remain stable or improve with therapy over time.
In summary, chorea in children with cerebral palsy is a complex movement disorder caused by basal ganglia damage that leads t
