Chorea minor: causes, symptoms, treatment. Chorea in children Minor chorea in children is a common disease

Chorea minor (Sydenham's chorea) - the main form of rheumatic lesions nervous system in children. It is often the first clinical sign of rheumatism, but it can develop against the background of a latently current disease or in its interrecurrent period. Children aged 5 to 15 years old are more likely to get sick (girls - about 2 times more often than boys).

The etiology and pathogenesis of X. m are inseparable from other rheumatic lesions. The main etiological role is played by streptococcal infection, which is considered as the triggering mechanism of the disease, including a number of immunological, in particular allergic, mechanisms. In the formation of pathological reactivity, a significant role belongs to violations of the adaptive system of the hypothalamus - pituitary gland - adrenal glands. Humoral and cellular immunological disorders are manifested by an increase in the titer of antistreptolysin-O, antistreptohyaluronidase and antistreptokinase.

Pathological changes are of a degenerative-toxic and inflammatory nature. The main changes are localized in the subcortical nuclei and superior cerebellar peduncles; the small cells of the checiform nucleus are most affected. The cortex, red nuclei, substantia nigra, cerebellum and other structures are also affected. There is vasculitis with fibrinoid swelling and hyalinosis of the vascular wall, degenerative changes neurons, microglial reaction.

The clinical picture. HM. usually develops gradually against the background of normal body temperature. Febrile in some patients occurs as a result of other rheumatic lesions. The initial manifestations primarily include cerebrasthenic syndrome. Patients have irritability, slight excitability, emotional instability. Motor disinhibition, awkwardness of movements gradually increase, objects begin to fall out of hands, in children school age handwriting deteriorates significantly. After about 1-2 weeks, hyperkinesis appears facial muscles and limbs. The patient wrinkles his forehead, squeezes his eyes, stretches his lips. Choreic hyperkinesis in the limbs is fast, impetuous, widely sweeping, non-stereotyped. In the initial period of the disease, it is more pronounced in the proximal parts of the arms and legs. At rest, hyperkinesis decreases or disappears, and with excitement, physical stress, fatigue, it increases significantly. In the most severe cases, a "motor storm" occurs - the patient is constantly in motion: he is thrown up, sometimes he cannot stay in bed, he hits himself, gets multiple bruises, loses the ability to perform targeted movements, cannot bring food to his mouth, walk , stand, sit. Speech becomes dysarthric, some syllables or words are pronounced too loudly, others in a whisper. However, in many cases, hyperkinesis in X. m is expressed indistinctly and they have to be detected by special techniques. In this case, the most simple and convenient test by Yuratskaya and Shanko: a child in the Romberg position is offered to stretch out his arms, spread his fingers, close his eyes and stick out his tongue. This test can also be performed with a dosed physical activity(squatting, running in place, jumping on one leg). As a result of such an examination, it is possible to detect general motor restlessness, twitching of the tongue and fingers.

A constant symptom of the disease is muscle hypotension, up to atony with mild chorea. In these cases, active movements and the implementation of hyperkinesis become impossible. Arises clinical picture pseudoparalysis. In some cases, the child cannot even hold his head. The appearance of hyperkinesis in patients with X. m testifies to the positive dynamics of the disease. The reason for the development of muscle hypotension is functional and dynamic disorders of the descending connections of the limbic-reticular system.

Along with hyperkinesis and muscle hypotonia, psychotic disturbances with delusions, hallucinations, and motor excitations can be observed. These patients require hospitalization in a psychiatric ward.

When H.M. other neurological symptoms are noted, for example, the symptom of "eyes and tongue", when the patient cannot simultaneously keep his eyes closed and his tongue out; Cherni's symptom is a violation of the synergistic movements of the diaphragm and intercostal muscles during breathing, and therefore the abdominal wall sinks when exhaling. Changes in tendon reflexes occur (with mild chorea, they do not disappear); knee reflexes are of a pendulum-like nature, or when they are caused, the leg freezes in the extension phase in knee joint... Sometimes there is a hypertensive syndrome, accompanied by headache, vomiting, small changes in the fundus. In the majority of patients, H.m. functional changes in cardiac activity are determined, which subsequently quickly disappear. Some patients have myocarditis or endocarditis, and therefore require a cardiac examination. With a recurrent course of X. m. Changes in the heart occur more often and are more pronounced than with the onset of the disease. The high vascular permeability characteristic of rheumatism is also expressed in chorea. It is detected when checking the symptoms of a pinch or tourniquet, as well as a can sample. Changes biochemical analyzes and a general blood test for chorea are determined by the course of the main rheumatic process.

With the correct regimen and treatment, X. m lasts about 2 months, mild chorea drags on up to 5-6 months. With more acute development and severe hyperkinesis, regression of symptoms is faster than with subacute development and mildly expressed neurological disorders. In about half of the patients, X. m proceeds with relapses, which more often occur after 1-2 years, in some patients, multiple relapses are observed after a short period of time (continuously recurrent course). Usually, relapse is preceded by tonsillitis or exacerbation of the rheumatic process. In all cases, relapse should be considered as a manifestation of the activity of rheumatism.

Treatment. The main principles of therapy are the combination of antirheumatic drugs with sedatives. Bed rest is established, traumatic factors are eliminated, and adequate nutrition is provided. From antirheumatic drugs give salicylates, butadion, brufen in age doses. The average duration of treatment with these drugs is 4 weeks. Penicillin and ampicillin are also prescribed in usual doses. Shown antihistamines(suprastin, tavegil, fenkarol, etc.), and it is advisable to change the drugs every 7-10 days. With low effectiveness of therapy and in the case of relapses, glucocorticoids (prednisolone, dexazone, dexamethasone) are indicated; the maximum dose of these drugs is given within 7-10 days. The total duration of treatment is 40 days. Large doses shown ascorbic acid(0.1-0.2 g 2-3 times a day), vitamins of group B. Sedatives are prescribed: bromides, valerian preparations, phenobarbital, phenibut. With severe hyperkinesis, haloperidol and chlorpromazine are prescribed for several days. For any forms of rheumatism, the rehabilitation of a possible focus is indicated. streptococcal infection(tonsils, carious teeth, sinusitis). Surgical intervention in these cases, it is carried out in the interictal period.

At the heart of this disease is rheumatic vascular lesions of the brain. Mainly the subcortical nodes of the brain are affected. Chorea can be called a rheumatic breed. Very often the disease is combined with rheumatic lesions. Children are most often affected, and girls get sick more often.

The beginning is expressed indistinctly. The first symptom is an increase in physical activity (hyperkinesis): children spill the contents of plates and cups, drop a spoon from their hands, gait is disturbed, handwriting changes (letters become uneven, jumping). The child often grimaces, his movements become somewhat pretentious and unnatural. Usually at this time, adults and teachers regard the child's behavior as a prank and often punish him.

With the development of the process, hyperkinesis intensifies, the movements become uncoordinated, irregular. In the facial features, frowning of the eyebrows, a tug of the mouth to one side, and twitching of the tongue are observed. When the neck muscles are involved in the process, nodding, tilting or extension movements of the head appear. Gradually, all large muscle groups are involved in the pathological process. Sometimes it comes to the so-called motor storm, which deprives the child of the ability to move and take care of himself.

When the first signs of the disease appear, it is necessary to contact and be examined for as soon as possible. The child is assigned strict bed rest with additional hours of sleep (since prolonged hyperkinesis tires the child and deprives him of his strength). The patient is given sedatives. Chorea treatment should be directed primarily towards treating the underlying disease that caused it (encephalitis, etc.). (E.G. Uzhegov)

Additional information from the Great Soviet Encyclopedia

Chorea(from the Greek chor? ia - dance) is a type of hyperkinesis, which is manifested by rapid twitching of the limbs, winks, smacking lips, etc. It occurs when some subcortical parts of the brain are organically damaged. The most common form of chorea is chorea minor, or Sydenham's chorea, which usually develops in children and adolescents as one of the manifestations. In addition to hyperkinesis, it is characterized by a decrease in muscle tone, asthenic manifestations (disturbance, tearfulness, irritability, etc.). The course of chorea minor is usually favorable, but relapses are possible. T. n. great chorea - hysterical choreiform twitching that was observed in the Middle Ages as a mass phenomenon - is only of historical interest.

The so-called late chorea-chorea of Huntington (was described in 1872 by the American psychiatrist J.S. Huntington) - refers to hereditary-degenerative diseases; inherited in an autosomal dominant manner, often manifests itself at the age of 35-40 years, is characterized by a chronic progressive course. Muscle tone in some cases is reduced, in others it is increased (rigid form). The most important symptom of Huntington's chorea is mental disorders in the form of apathy, loss of memory and intelligence, unstable delusional ideas, hallucinations, etc. Gradually develops deep dementia. Along with the defeat of the subcortical departments in H. Huntington, atrophy of the cerebral cortex is found.

For the treatment of small chorea, use antirheumatic (salicylates, etc.), sedatives and (diphenhydramine, suprastin, etc.) funds. With late chorea, aminazine, reserpine are prescribed, and with its rigid form, anticholinergic agents (cyclodol, etc.), L-Dopa, midantan. (V.A.Karlov)

Read more about chorea in the literature:

Anosov N.N., Chorea of Huntington, in the book: Multivolume guide to neurology, t. 7, L., 1960;
Zucker MB, Infectious diseases of the nervous system in children, M., 1963;
Gittik L.S., Mala chorea, Ki? In, 1965.

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V childhood most often there is a nervous form of rheumatism, which is called rheumatic, or small, chorea. This is a special form of rheumatic encephalitis (inflammation of the main brain). School-aged children are more likely to suffer from rheumatic chorea, but there are also known cases of the disease in children. preschool age, mainly after 5 years.

Symptoms of rheumatic chorea in children

The process develops in individual parts the main brain, which causes changes in the predominantly subcortical area. The disease usually begins gradually. Usually, the child develops signs of increased irritability, tearfulness, the child gets tired easily and quickly, becomes moody, restless, inattentive at school and at home when doing household tasks. Changes occur in the child's behavior, which close people perceive as manifestations of carelessness, untidiness, and bad habits. The child has certain difficulties while dressing, he drops things, spills food, makes grimaces. The child's handwriting deteriorates, many corrections and errors appear in the notebooks, which are often regarded as indiscipline and negligence. Memory also deteriorates and night sleep: the child does not fall asleep soon, his sleep is shallow, restless. Following these signs, the gait soon changes, there are expressively identified additional obsessive wide movements in the arms, legs, twitching in the shoulder area, twitching of the facial muscles. The strength of the muscles in the arms and legs will weaken. All of the above changes can appear on both sides (left and right), but there are also one-sided. During sleep, involuntary twitching weakens or disappears completely.

Diagnosing rheumatic chorea in children

The detailed picture of rheumatic chorea does not present any difficulties in determining the diagnosis, but the initial period is often not recognized, the child continues to attend school, lead a normal life, and the disease intensifies.

Now more often there are cases of the disease on chorea with an erased course, in which many signs are weakly expressed. The nature of the general disorders in the child's condition is similar to that described above, but involuntary movements are manifested in an insignificant measure and only in certain muscle groups, sometimes only in the facial muscles. Timely appeal to a pediatrician and, if necessary, a consultation with a neurologist make it possible to recognize the disease and give the child the necessary medical assistance. When the onset of the disease was not noticed and the child continues to lead the previous lifestyle with daily stress, the degree of damage to the nervous system increases and the disease becomes more severe. In such cases, changes in the heart are often observed, which at the first stage cannot be manifested in many patients.

Pronounced manifestations of chorea usually last 1.5-2 months, and then some changes in the nervous system persist (increased irritability, fatigue, sleep disturbance, etc.), which, under conditions of a properly organized regimen and treatment, gradually disappear. Violation of the regimen, which lead to overwork of the child, a number of past diseases, failure to comply with the doctor's recommendations is the cause of an exacerbation of chorea.

In addition to rheumatic chorea, rheumatism in children can manifest itself in other forms of encephalitis with various changes in the nervous system. Changes in peripheral nerves may be observed. Significant violations are possible in mental state in individual patients, which requires qualified supervision and treatment in specialized departments.

Disturbances in the state of the nervous system are noted not only in patients with nervous forms, but also in more common "ordinary" forms of rheumatism, with damage to the heart and joints. They manifest themselves in the form of individual changes in the character and behavior of patients, in excessive irritability, instability of mood, increased fatigue, sleep disorders, appetite, such patients often complain of headache... Gradually, these phenomena disappear when the activity of rheumatism subsides and subject to the regime and the necessary treatment.

Chorea minor is a disease that manifests itself as a neurological rheumatic infection. Chorea minor is also called Sydenham's chorea, rheumatic or infectious chorea. In a sense, it is encephalitis of the rheumatic breed. This brain disease has a muscle origin and manifests itself in the form of hyperkinesis, which develop as a result of damage to the structures of the brain that provide the function of coordination of movements and are responsible for muscle tone. At the heart of the disease is damage to the vessels of the brain, mainly subcortical nodes are affected. Chorea minor also affects the heart rheumatically.

According to statistics, girls get sick twice as often as boys. The manifestation occurs at the age of 6-15 years, often in the cold season. The fact of a more frequent morbidity in girls is associated with the hormonal characteristics of the growing body and the production of female sex hormones. Of great importance is the fact that the cerebellum and striatal brain structures are involved in the pathological process. It manifests itself in the form of uncontrolled attacks, the duration of which is about three months, in some cases it can last up to six months or even several years. Chorea minor may have a relapse.

Minor chorea also affects adults aged 30-45 years. In this case, the clinical picture is accompanied primarily by severe mental disorders, most often irreversible.

Causes of small chorea

The disease is infectious in nature. It has been established that the cause of the development of small chorea can be considered the transfer of an infection of group A beta-hemolytic streptococcus. Such an infection mainly affects the upper respiratory tract and provokes the development of tonsillitis and tonsillitis. In the process of fighting the disease in the human body, antibodies are produced that fight streptococcus bacteria. Sometimes a so-called autoimmune response occurs - simultaneously with these antibodies, antibodies to the basal ganglia of the brain also begin to be produced. Further, an attack by nerve cells of the basal ganglia occurs, which provokes inflammatory processes in the subcortical formations of the brain, which are manifested in the form of hyperkinesis.

The main provocateurs of the production of antibodies to the basal ganglia of the brain can be considered:

genetic predisposition;
instability of the nervous system, for example, excessive emotionality;
hormonal disruptions;
a weak immune system;
development inflammatory processes in the upper respiratory tract;
dental caries;
lean body structure.

The presence of beta-hemolytic streptococcus can provoke the production of antibodies to other structures. human body(heart, joints, kidneys), and cause rheumatic lesions of these organs. This will be the reason for considering the disease as a variant of the rheumatic process as a whole.

Modern neuroscience is still investigating the nature and cause of the development of chorea minor. The assumption about the infectious nature of the disease was expressed at the end of the 18th century by the scientist Shtol. Today this issue is still under investigation.

Symptoms of small chorea

The clinical picture of chorea minor is visible within a few weeks after the transfer infectious disease(tonsillitis or tonsillitis).

The main clinical manifestations of chorea minor are movement disorders (involuntary twitching of the arms and legs). This is called choreic hyperkinesis - fast, chaotic, uncontrolled muscle contractions. Choreic hyperkinesis can manifest itself in the face, hands, limbs in general. They can affect the larynx and tongue, the diaphragm, or even the entire body at the same time.

At initial stage hyperkinesis is almost imperceptible, very often they are not paid attention to. Awkwardness and numbness of the fingers or a subtle twitching of the muscles of the face may at first be perceived as a grimace of a child. Twitching becomes more noticeable with excitement or other emotional outbursts. Over time, hyperkinesis becomes more pronounced and prolonged, can manifest itself in the form of a so-called "choreic storm", when uncontrolled twitching occurs simultaneously throughout the body.

To diagnose the disease as early as possible, it is necessary to pay attention to the symptoms of the following hyperkinesis at the very beginning of their manifestation:

Awkward movements when writing or drawing. The child has difficulty holding a pencil or brush, cannot concentrate to draw a straight line, puts blots, makes more blots than before; sometimes you can observe the milkmaid syndrome, when the hands are involuntarily clenched and relaxed.
Uncontrollable antics (protruding tongue, grimaces). Many attribute these signs to a child's bad manners, but if there are other types of hyperkinesis, then they should be paid attention to.
Inability to hold a given pose for a long time.
Involuntary yelling of words or sounds. This may be due to the contraction of the muscles in the larynx.
Indistinctness and confusion of words when speaking. This can be explained by involuntary contractions of the laryngeal muscles and tongue. If a child who previously did not differ in defective speech suddenly begins to pronounce words indistinctly, speech becomes slurred, then you should contact a neurologist, especially if other signs of hyperkinesis were noticed.

In severe cases, hyperkinesis of the muscles of the larynx and tongue leads to complete absence speech ("choreic mutism").

Sometimes hyperkinesis also affects the respiratory muscles of the diaphragm. In this case, the so-called Czerny syndrome or paradoxical breathing occurs. When you inhale, the stomach sinks inward, and does not protrude, as is normal. The child cannot concentrate his gaze on one object. Eyeball constantly runs in different directions.

As hyperkinesis progresses, self-care becomes difficult (eating, dressing, walking). Signs of hyperkinesis disappear when the child is asleep, but the process of going to sleep is accompanied by certain difficulties.

Other symptoms of chorea minor

Decreased muscle tone. Most often, the decrease in tone corresponds to the localization of hyperkinesis. But there are such forms of small chorea, when there are almost no signs of hyperkinesis, and muscle tone is lowered so much that the child becomes practically immobilized.
Disorders of the psycho-emotional state. Often, it is this symptom that is the first alarming sign of this disease, but such manifestations are associated with small chorea only after the manifestation of hyperkinesis. The child behaves inappropriately, often cries and is capricious, there is frequent forgetfulness and lack of concentration. In some cases, on the contrary, the child shows apathy towards the world around him, becomes lethargic.

When contacting a neurologist, the doctor may reveal several more symptoms during the examination and testing of the child:

The Gordon Phenomenon. When checking the knee reflex, the leg freezes in an extended position for a few seconds (hyperkinesis of the femoral muscle).
"The symptom of flabby shoulders" - when a sick child is lifted by the armpits, his head sinks strongly into the shoulders.
"Chameleon tongue" - a child cannot keep his tongue out if his eyes are closed.
"Choreic hand" - when the arms are outstretched, a special arrangement of the hands arises.

Diagnostics of the small chorea

The diagnosis of chorea minor usually begins with the patient's life history. The diagnosis is made on the basis of a blood test that detects markers of streptococcal infection. Electromyography (study of biopotentials of skeletal muscles), electroencephalogram, CT, MRI are also performed, which reveal focal changes in the brain.

Treatment of small chorea

Chorea minor is treated in a stationary mode. The patient is injected intramuscularly with antibiotics, anti-inflammatory drugs, salicylates. Sometimes hormonal drugs are used. In the acute period, it is necessary to create the most comfortable conditions for the child with minimal stimuli - light, sounds.

Forecast and prevention of small chorea

The prognosis for chorea minor is positive in most cases. With its early detection, treatment can be considered successful, although relapses may occur against the background of exacerbation of infectious diseases.

Prevention of small chorea consists in the timely administration of antibiotics for viral infectious diseases, as well as adequate and early treatment of rheumatoid manifestations, which prevents the progression of the disease in childhood.

Chorea is considered a childhood disease that predominantly occurs in children between the ages of 5 and 16. During it, involuntary increased motor activity occurs.

The disease is neurological in nature, while it manifests itself as rheumatic infection. In children who suffer from small trochee, psychoemotional disorders are pronounced.

Pathology is treatable, while it should be understood that the therapy itself can take a long period of time. If you do not take action in a timely manner, then the prognosis for the child will be extremely unfavorable.

Chorea in children is considered to be inherently rheumatic encephalitis. It affects the brain, directly affects the basal ganglia. If the disease occurs in early age, then after about 25 years, its relapse may appear. That is why people will be forced to adhere to preventive measures so that you can exclude the likelihood of recurrence of chorea minor.

It should be noted that various factors can provoke the problem. In this case, the main one is the progression of infection in the body. The risk group includes children who are from 5 to 15 years old. It is worth noting that during this period the body is weak, therefore it is susceptible to many diseases.

Most often, chorea is diagnosed in girls., while they must have a thin physique, as well as an overly sensitive psyche. In this case, boys are also susceptible to illness, so it is important for parents to exercise caution, because it is important to identify the symptoms of the disease in a timely manner.

A number of factors can be identified that provoke the appearance of small chorea:

Lack of weight. Moreover, asthenia can be natural, and even in this case, it can lead to the development of pathology.
Having an infection caused by streptococci. This can also contribute to the appearance of small chorea.
Caries, which did not begin to heal in a timely manner. When dental diseases appear, it is important to see a doctor in time so that you can improve your condition.
Various psychological factors. Chorea minor can be a consequence of such injuries.
Perceptibly low level the immune system. Parents need to make sure that everything is in order with this indicator. Otherwise, rheumatic chorea may appear.
The presence of sinusitis and tonsillitis. Such diseases also need to be treated on time, otherwise they can lead to the formation of a small chorea.
Hypersensitivity of the central nervous system. Such a feature of the child can lead to the fact that he will have a small chorea.
Increased tendency to viral diseases. Even if the child often catches a cold, he can still face rheumatic chorea.
Respiratory tract infection progression. It is dangerous to start such diseases, because they can lead to various disorders, including involuntary movements.
Hereditary predisposition. If at least one of the parents suffered from chorea, then the child may also face it.
Hormonal disruptions in the body. They can lead to various negative consequences, and one of them is rheumatic chorea.

Regardless of the reason, you will definitely need to start treatment in order to improve a person's well-being. Chorea minor requires long-term treatment, and the earlier a person starts it, the better. It is imperative to know the main symptoms of the disease in order to understand in what situations you need to immediately consult a doctor. Do not wait until your health condition deteriorates significantly and serious complications appear.

Symptoms

To begin with, it is worth noting that rheumatic chorea is of different types. The symptoms that a person will encounter directly depend on this. In particular, the disease is of the following forms: latent, subacute, recurrent, and also acute. In the first situation, symptoms may appear very weak or completely absent.

At the same time, the subacute and acute form manifests itself as clearly as possible, so it will be difficult not to notice the signs of small chorea. As for the recurrent type, it is characterized by outbreaks of pathology. At the same time, the child gets better and worse again.

It is imperative to consider the symptoms of chorea minor so that the disease can be suspected in a timely manner:

Involuntary movements, as well as muscle contractions that the child cannot control.
Perceptible decrease in mouse tone, weakness.
Increased activity of facial expressions. With a small chorea, the child will often grimace.
The inability to be in one position for a long period.
It is difficult for the patient to perform even simple actions with his hands.
Mental and emotional disorders. With a small chorea, the child may be too aggressive, capricious, and often have difficulty falling asleep.
Inability to fix your gaze on one point.
During the excitement, the minor will begin to pull himself, scratch himself, or perform other similar manipulations.
When the muscles of the larynx are tense, caused by chorea, the child may make strange sounds and even wheezing.
Unexpected speech therapy problems. It may happen that the child does not have the ability to speak.
Gait disorder in chorea minor is considered a natural symptom. The child will not be able to move normally, he will bounce.
A sharp increase in body temperature up to 38 degrees.

Doctors note that rheumatic chorea can be suspected based on underlying symptoms. The child will have problems with gait, facial expressions and handwriting will change. In this case, it is worth contacting a doctor, then the doctor will be able to confirm the presence of a chorea of the sydenham.

Diagnostics

If rheumatic chorea is suspected in a child, then a diagnosis will definitely be required. To do this, doctors prescribe a number of studies, with the help of which it is possible to identify the presence of deviations. First of all, the patient is referred for magnetic resonance imaging. This study allows us to understand if the child has rheumatic chorea. They can also be sent for computed tomography, which analyzes the brain.

With small chorea, it is often prescribed general analysis blood, because deviations in the indicator can be detected. The patient may be sent for electroencephalography to see if there is an abnormality in brain activity. All these studies make it possible to understand whether a person has chorea seidenhaem.

It is imperative that the doctor as a whole analyze the condition of the child so that the diagnosis can be confirmed or refuted. Chorea minor in children should be treated only under the supervision of a specialist so that positive results can be achieved.

Therapies

If the shidengama chorea is in acute form, then you will need to go to the hospital without fail. The patient should comply with bed rest, as well as be in a calm environment. Sleep will contribute to a quick recovery from chorea, which is why doctors will calm the nervous system.

It will be important to limit the patient's physical activity. Doctors with chorea of sidengam often prescribe pyramidon, as well as drugs that contain calcium. It is important for the patient to take vitamin complexes so that you can improve your well-being. Treatment of chorea in rare cases can be carried out pituitary hormones.

If the child is already recovering, then for him to recover fine motor skills it is recommended to knit, draw, sculpt or sew. In this case, when treating rheumatic chorea, you should walk in the fresh air for at least two hours in a bitch.

Directly therapeutic procedures are designed improve blood supply to the naked brain as well as metabolism. It is often required to have an anti-inflammatory effect. For this, with a small chorea of the sidenhem, salty coniferous baths, UHF of the frontal lobe, electrophoresis of sodium salicylate, ultraviolet irradiation are often prescribed.

If the child has had shidengama chorea, then the parents should reconsider their diet. It is important to add more vitamins as well as foods that contain protein. In particular, for rheumatic chorea, cottage cheese, fish, lean meat, and milk will be useful.

In order to quickly heal shidengama chorea, the child will need to receive more positive emotions. You also need to be constantly monitored by a doctor, because you need to closely monitor the patient's condition. In most cases, the treatment of chorea minor gives good results if long time to carry out procedures useful for a person.