Case series: Increased vulnerability to obsessive-compulsive symptoms withrepeated episodes of Sydenham chorea

The association between obsessive-compulsive symptoms (OCS) and Sydenham ch orea (SC) supports the hypothesis of a common neuroimmunological dysfunctio n in basal ganglia associated with group A beta-hemolytic streptococcal inf ection underlying both conditions. Four children with 2 distinct SC episode s were evaluated to assess the course of OCS. All patients developed OCS du ring their second episodes (3 met criteria for obsessive-compulsive disorde r [OCD]), but not in their first episodes (2 developed OCS and met criteria for OCD). These data suggest that the recurrence of SC episodes may result in a cumulative effect, thus increasing the risk of appearance and intensi fication of OCS.