Evaluation, Diagnosis, and Treatment of Sydenham Chorea: Consensus Guidelines

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.

Authors

Institutions

Publication Details

Journal
PEDIATRICS
Published
2025-11-21
DOI
https://doi.org/10.1542/peds.2025-072466
Citations
1
Primary Topic
Obsessive-Compulsive Spectrum Disorders
Type
article
Field-Weighted Citation Impact
2.31
Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

Evaluation, Diagnosis, and Treatment of Sydenham Chorea: Consensus Guidelines

Jo M. Wilmshurst, Donald L. Gilbert, Antonio Clavenna, Ming Lim et al.
1 citations
PEDIATRICS
Obsessive-Compulsive Spectrum Disorders
2.31
article

Evaluation, Diagnosis, and Treatment of Sydenham Chorea: Consensus Guidelines

Jo M. Wilmshurst, Donald L. Gilbert, Antonio Clavenna, Ming Lim, Sheffali Gulati, Susan E. Swedo, Hanène Benrhouma, Rachel Webb, Emanuela Ferrarin, Margherita Nosadini, Sameer M. Zuberi, Hilla Ben‐Pazi, Leon Dure, Russell C. Dale, Alessandro Ascani Orsini, Natalija Krajnc, Michael Morton, Adrian Sie, Terrence Thomas, Michael Eyre, Hannah Jones, Thaís Armangué, Tamsin Newlove‐Delgado, Yuwu Jiang, Shekeeb S. Mohammad, Ahmet Yaramış, Francisco Cardoso, Sanem Yılmaz, Suvasini Sharma
article en
1 citations

Abstract

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.

PEDIATRICSVol. 156(6)
Lady Hardinge Medical College (IN), Cincinnati Children's Hospital Medical Center (US), Hospital Sant Joan de Déu Barcelona (ES), University of Padua (IT), University of Auckland (NZ), King's College London (GB), Mario Negri Institute for Pharmacological Research (IT), Guy's and St Thomas' NHS Foundation Trust (GB), Peking University (CN), University of Exeter (GB), Royal Hospital for Children (GB), Assuta Medical Center (IL), Hospital for Sick Children (CA), NHS Lanarkshire (GB), Children's Hospital at Westmead (AU), University of Alabama at Birmingham (US), Ege University (TR), Diyarbakır Askeri Hastanesi (TR), KK Women's and Children's Hospital (SG), Centro di Riferimento Oncologico (IT), Peking University First Hospital (CN), Hospital das Clínicas da Universidade Federal de Minas Gerais (BR), Šolski center Slovenj Gradec (SI), Starship Children's Health (NZ), Evelina London Children's Healthcare (GB), Red Cross War Memorial Children's Hospital (ZA), National Institute of Neurology Mongi-Ben Hamida (TN), National Institute of Mental Health (US), Città della Speranza Foundation (IT), Azienda Ospedaliera Universitaria Pisana (IT), National Institute of Mental Health (CZ), Tunis El Manar University (TN), All India Institute of Medical Sciences (IN), University of Glasgow (GB)
Openalex Percentile: Top 9%
Obsessive-Compulsive Spectrum Disorders
2.31
DOIOpen Access PDFOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.