Pharmacotherapy for Sydenham’s chorea: where are we and where do we need to be?

Roberta Bovenzi, Matteo Conti & Tommaso Schirinzi (2023) Pharmacotherapy for Sydenham’s chorea: where are we and where do we need to be?, Expert Opinion on Pharmacotherapy, 24:11, 1317-1329, DOI: 10.1080/14656566.2023.2216380

• Sydenham’s chorea (SC) is the most common acquired chorea in children worldwide; still, its therapeutic strategies are empirical and non-evidence based.
• Current pharmacotherapy for SC basically consists of three pillars: antibiotic, symptomatic and immunomodulant medications.
• Antibiotic prophylaxis should be initiated as soon as SC is diagnosed, according to the WHO guidelines, to prevent beta-hemolytic streptococcal (GABHS) re-infection and reduce the risk of cardiac involvement.
• Symptomatic treatments, which consist in anti-seizure medications (ASMs) and dopamine depleting agents, should be considered when symptoms are clinically relevant; however, no consensus exist on which should be the first choice.
• Immunomodulant strategies are gaining increasingly attention given the autoimmune pathogenesis of SC, with promising results.
• There are numerous gaps and unmet needs in SC management and treatment, which highlights the necessity of a deeper comprehension of its pathogenesis and sizable controlled studies to define standardized guidelines.