ABSTRACT
The classic description of Sydenham's chorea (SC) by Thomas Sydenham in 1686 described a 'change in personality' in addition to a dancing movement disorder. However, two centuries passed before se was associated with rheumatism and rheumatic carditis.! Subsequently, during the 20th century, group A streptococcus was identified as the main disease precipitant. se is now accepted as a major criterion of rheumatic fever (Jones criteria). It is proposed that immune reactivity against the streptococcal organism induces an aberrant autoimmune attack directed against the brain rather than infection of the brain, although the exact pathogenesis remains unknown. Recently, interest in Sydenham's chorea has been re-ignited due to the proposed recognition of a broader spectrum of neuropsychiatric outcomes after streptococcal infection which include tics, obsessivecompulsive disorder and attention deficit hyperactivity disorder.2 This has led to speculations that post-streptococcal neuropsychiatric diseases may be autoimmune models of common childhood diseases, and that even 'idiopathic' Tourette syndrome and obsessive-compulsive disorder could also be secondary to post-streptococcal autoimmunity. 3
We will critically appraise the current understanding of this spectrum of disorders, but start first with historical descriptions over the last four centuries.
