CHOREA ELECTRICA This term has been applied to various morbid conditions. The affection described by Duhini does not appear to have been observed outside of Italy and may be omitted, as its characteristics have not been sufficiently defined.
lIenoch and Bergeron apply the term chorea eicctrica to a condition characterized chiefly by- lightning-like contractions in certain definite muscle groups. IIenoch gives the following description of the disease in his text-book:— "Front time to time only twitching movements occur, particularly in the muscles of the back of the neck and of the shoulders (sterno cleidomastoid, levatores anguli scapul,e, pectorals and trapezius), but also in other parts of the body, which present the greatest similarity to the contractions produced by an induction current of moderate strength. As a rule, the contractions are feeble and of such short dura tion that it soznetimes requires very careful observation to notice them at all. In all, I have seen at least 30 cases of this kind, which occurred both in boys and in girls, all of them between the ages of nine and fifteen years. When the clothing is removed, the rapid twitching of the indi vidual muscles is distinctly seen and felt in the nude body, and when the tongue is protruded, vermicular movements similar to those seen in ordi nary chorea are occasionally observed. Each contraction lasts only 9,n instant, but the intervals are quite variable—from only a few seconds in some cases to several minutes in others, particularly if the patient's attention is distracted. Speech is not disturbed, nor is there any inter ferenee with writing, sewing, and the like, unless the act happens to be interrupted by twitching of the arm. One half of the body is some times more markedly attacked than the other. In a girl fifteen years of age, the twitchings were confined to the right half of the body and face, and recurred at such short intervals as to interfere with writing and other work performed with the right hand. The motility was perfectly normal, and other symptoms were absent except for an irregularity- of the heart which was occasionally- observed. In one case the twitchings persisted during sleep, although with less intensity and at longer intervals. In all the others the choreic movements ceased entirely during sleep, as in ordinary chorea.
In a boy ten years of age, whose entire body was convulsed by these lightning-like twitching movements, while the head escaped almost completely, every convulsive jerk was followed by a convulsive inspira tion, indicating involvement of the diaphragm and perhaps also of the glottis; while in a girl, twelve years of age, the twitching movements were frequently accompanied by the utterance of one or two inarticulate sounds (vocal spasm). The child's psychic powers were never impaired
any more than the speech, which at the most would be interrupted at the instant of the concussion.
Bergeron makes practically the same statement as Henoch about his eases of chorea electrica, which also occurred in children between the ages of twelve and fourteen. ;;;4onie of them were amemic or nervous, The only difference between Bergeron's eases and those reported by Henoch is that the former rapidly terminated in recovery, while Henoch reports that in his cases treatment was usually without effect. After a critical analysis of all the statements found in the literature, and on the strength of his own experience, Bruns recently suggested that the syndrome described by the term chorea electrica may be divided into three pathogenically different conditions: .1. chorea electrica in the strict sense of the term; (2) hysterical; and )3) a form belonging to epilepsy.
Chorea clectrica proper is included by Bruns among the tics which are not pure motor neuroses, since they rest on a foundation of nervous degeneration, and are closely related to hysteria, although not genuine hysteria nor offering the same favorable chance.s: of recovery.
It is in this latter respect that chorea electrica proper, which is to be regarded as a subvariety of tie, differs from the hysterical form. The fact that Bruns' eas:es rapidly ended in recovery permits us to classify them as hysteria. The therapeutic indications which result from this diagnosis are mentioned in the chapter on Hysteria.
A third variety belong, to epilepsy. The diagnosis is possible only if, along with the isolated lightning-like muscular twitchiugs, there are or have been typical insults, or such insults develop later. Treat ment is then directed against the underlying epilepsy, and in view of the impossibility of differentiating the two first-named varieties from the outset, Bruns quite properly advises that the cases should first be treated as though they were hysterical, i.e., by isolation and "intentional neglect." Hysterical patients almost regularly recover under this treatment, which, on the other hand, does no harm whatever if the patient is) a degenerate suffering from a variety of tic. In fact, the diag nosis of hysteria is finally confirmed only by the effects of treatment.