“Saint Vitus Dance” is a historical term for a mysterious ailment characterized by involuntary, uncontrollable movements. Today, this phrase refers to Sydenham’s chorea, a specific neurological condition. This article explores both the historical context of the name and its modern medical understanding.
The Historical Roots of the Name
The term “Saint Vitus Dance” originated in medieval Europe, describing “dancing mania” or “dancing plagues” sweeping through communities. Individuals would dance uncontrollably for hours, sometimes days, often collapsing from exhaustion. Documented from the 14th to 17th centuries, these occurrences were often attributed to supernatural forces or mass hysteria.
Saint Vitus, a 4th-century Christian martyr, became associated with these events. He was invoked as a patron saint against nervous diseases and epilepsy. People with dancing mania sought healing at his shrines, believing his intercession could offer a cure.
Understanding Sydenham’s Chorea
“Saint Vitus Dance” is now recognized as Sydenham’s chorea, a neurological disorder primarily affecting children and adolescents. This autoimmune complication typically follows an infection with Group A Streptococcus (GAS), the bacteria responsible for strep throat and rheumatic fever. The immune system, fighting the bacterial infection, mistakenly produces antibodies that cross-react with proteins in parts of the brain, particularly the basal ganglia.
This misguided immune response, known as molecular mimicry, leads to inflammation and damage in brain regions controlling movement. Sydenham’s chorea often manifests weeks or months after the initial strep infection, even if mild or unnoticed. It is a major manifestation of acute rheumatic fever, occurring in a significant percentage of patients.
Recognizing the Symptoms
The hallmark of Sydenham’s chorea is the sudden onset of involuntary, rapid, and purposeless jerky movements. These movements can affect various body parts, including the face, arms, legs, and trunk. Facial movements might include grimacing or lip pouting, while hand movements can appear restless or like “piano playing.”
Beyond motor symptoms, individuals may experience muscle weakness, leading to clumsiness, difficulty maintaining grip, stumbling, or problems with speech and swallowing. Neuropsychiatric symptoms are also common, such as emotional lability, mood swings, anxiety, inattention, or obsessive-compulsive behaviors. These varied symptoms can significantly interfere with daily activities like writing, eating, or walking.
Diagnosis and Management
Diagnosing Sydenham’s chorea primarily involves clinical observation of characteristic involuntary movements and a thorough medical history, including recent strep infections. While no single definitive test exists, healthcare providers may use blood tests to detect evidence of a recent Group A Streptococcus infection, such as elevated antistreptolysin O (ASO) or anti-DNAse B titers. These antibody tests indicate the body’s immune response to the bacteria, and it is important to rule out other conditions that can cause similar movements.
Treatment focuses on managing symptoms and preventing future complications. Medications like anti-seizure drugs (e.g., valproic acid, carbamazepine) or antipsychotics (e.g., haloperidol) can help control involuntary movements. Corticosteroids may reduce autoimmune inflammation in the brain. A crucial part of management involves long-term antibiotic prophylaxis, typically with penicillin, to prevent recurrent strep infections and reduce the risk of further rheumatic fever episodes, which can lead to heart damage. Most children make a full recovery, with symptoms often resolving within three to six months, though some may experience symptoms longer or have recurrences.