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Functional Brain Imaging in Sydenham's Chorea and Streptococcal Tic Disorders

Department of Pediatric Neurology Gazi University Medical Faculty Ankara, Turkey

Kivilcim Gücüyener

Department of Pediatric Neurology Gazi University Medical Faculty Ankara, Turkey

Nese Ilgin Karabacak

Department of Nuclear Medicine, Gazi University Medical Faculty Ankara, Turkey

Ayse Serdaroglu

Department of Pediatric Neurology, Gazi University Medical Faculty Ankara, Turkey

Cetin Okuyaz

Department of Pediatric Neurology, Gazi University Medical Faculty Ankara, Turkey

Kursad Aydin

Department of Pediatric Neurology, Gazi University Medical Faculty Ankara, Turkey

Group A streptococcal infections cause a wide range of neuropsychiatric disorders, such as Sydenham's chorea, tics, obsessive-compulsive disorders, and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). Structural (computed tomography and magnetic resonance imaging) and functional (positron emission tomography, single-photon emission computed tomography) imaging studies in patients with Sydenham's chorea have suggested reversible striatal abnormalities. The objective of this study was to investigate the cerebral perfusion patterns of the subcortical structures by using hexamethylpropylenamine oxime single-photon emission computed tomography (HMPAO-SPECT) in seven cases of Sydenham's chorea and two cases of streptococcal tic disorder. HMPAO-SPECT studies revealed a hyperperfusion pattern in two and a hypoperfusion pattern in five of the chorea patients and in two patients with tic disorder. The results are discussed in relation to the duration and severity of the symptoms and the response to therapy. Functional imaging findings can be variable in Sydenham's chorea, and hyperperfusion of the striatum and thalamus could be an indicator of the response to therapy and the severity of symptoms. However, the number of cases so far investigated by either SPECT or positron emission tomography is still too limited to draw any firm conclusions. (J Child Neurol 2004;19:387-390).

Journal of Child Neurology, Vol. 19, No. 5, 387-390 (2004)
DOI: 10.1177/088307380401900513


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