The separation of hysterical from variable chorea may be peculiarly
perplexing, as in one of Brissaud's cases, where the patient's
extraordinary mental instability was such as is encountered only in
advanced hysteria, while her disorders of motility were highly
characteristic of what is known as variable chorea.
The condition described as chorea gravidarum may be placed at one time
in the category of hysterical chorea, at another in that of ordinary
chorea. In it there is intense motor restlessness, and accompanying
mental symptoms are not awanting in a majority of instances.
D. Electric Chorea, Bergeron's Chorea, Dubini's Chorea, Fibrillary
Chorea of Morvan
To render the study complete, we may remind ourselves of those still
imperfectly differentiated forms known as electric chorea
(Hénoch-Bergeron) and Dubini's chorea.
Bergeron's chorea affects children chiefly, and is characterised by the
suddenness of its onset and the rapidity with which it attains its
maximum. The movements are abrupt and brief, as though produced by an
electric discharge at regular intervals, but their intensity does not
hinder the execution of voluntary acts. They are sometimes confined to
the head and limbs, most commonly they are generalised, and during sleep
they disappear.
In the opinion of many, Bergeron's chorea is secondary to gastric
disturbance. A cure may be regarded as certain, and indeed frequently
follows the administration of an emetic. Sometimes the effect of the
latter seems to be purely psychical.
Pitres thinks that this condition, as well as the electrolepsy of
Tordeus, is simply a manifestation of infantile hysteria. According to
Noir, there is an affinity between tic and electric chorea, and Ricklin
is inclined to consider the two identical, but further study of the
question is desirable.
Dubini's chorea is ushered in by pains and aches in the region of the
head, neck, and sometimes the loins, and these are succeeded by
electric-like twitches in the segment of a limb, which quickly become
general. Severe convulsive attacks also occur, without loss of
consciousness, entailing actual paresis of the limbs. The duration of
the disease may be days or months, and 90 per cent. of the cases have a
fatal issue. Confusion with tic is impossible.
We need not concern ourselves with so-called paralytic chorea, or with
the fibrillary chorea of Morvan, which is a disease of adolescence,
characterised by fibrillary contractions in the calves and thighs,
passing thence to the trunk muscles and even to the arms; the face and
neck, however, are spared, and during voluntary movement the
fibrillation vanishes. Probably it is merely a variety of the
paramyoclonus of Friedreich.
TIC AND PARAMYOCLONUS MULTIPLEX--TIC AND MYOCLONUS
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