Key takeaways
- Dystonia and chorea are two types of involuntary movement associated with neurological disorders. Dystonia movements are repetitive, while chorea movements are more random.
- A person with dystonia may experience muscle contractions that last for hours and cause uncomfortable postures. In contrast, chorea involves short, dance-like movements that may flow from one muscle to the next.
- Treatment for dystonia often begins with botulinum toxin (Botox) injections and may also involve other medications, surgery, or physical therapy. Medication can ease the symptoms of chorea, and some types of chorea may resolve without treatment.
Dystonia and chorea are types of sudden, involuntary movement that occur in some neurological disorders. Dystonia movements are repetitive and follow a pattern, whereas chorea movements are random.
People with dystonia often twist into uncomfortable positions and atypical, often painful, postures, sometimes for hours at a time. Chorea causes more fleeting, dance-like movements that seem to flow from one muscle to the next.
This article looks at the similarities and differences between dystonia and chorea. It also explains the causes and risk factors for each condition and the available treatments.
According to the National Organization for Rare Disorders (NORD), there are multiple types of dystonia, but they all involve involuntary muscle contractions that twist the person’s body into unusual positions. The contractions may come and go, or they may last for a longer period.
People with dystonia can experience these muscle contractions anywhere in their body, including the neck, legs, arms, hands, feet, torso, face, eyelids, and vocal cords.
Dystonia usually affects the same group of muscles and causes a person to adopt similar postures during each episode. The symptoms can range in severity from mild to debilitating.
Experts classify dystonia into five types, according to the areas of the body it affects:
- Focal dystonia affects only one part of a person’s body.
- Segmental dystonia affects two or more adjacent body parts, such as the neck and arm, on one side of the body.
- Multifocal dystonia affects two or more body parts that are not adjacent, such as the arm and leg on opposite sides of the body.
- Hemidystonia affects one side of the body.
- Generalized dystonia affects more parts of the body than segmental or multifocal dystonia but fewer than hemidystonia.
Experts may also classify dystonia according to how each episode begins or how the symptoms vary:
- Persistent dystonia lasts throughout the day without improvement.
- Diurnal dystonia varies in severity throughout the day and may become less severe at night.
- Task-specific dystonia occurs only after a repetitive activity, such as writing or playing an instrument.
- Paroxysmal dystonia involves short episodes that are often caused by a trigger.
Chorea involves irregular, jerking, dance-like movements that do not usually last long. Typically, the movements stop when the person is asleep.
Chorea is usually a symptom of an underlying health condition. It is a characteristic symptom of Huntington’s disease and some metabolic and thyroid diseases.
It
The following table lists some differences between dystonia and chorea.
| Dystonia | Chorea | |
|---|---|---|
| Nature of movement | • involuntary muscle contractions • twist the body into unusual positions | • fleeting, dance-like movements • may flow from one muscle to the next |
| Patterns | may be repetitive and follow a pattern | random movements |
| Duration | may last for hours or be permanent | usually brief |
| Causes | • results from basal ganglia malfunction • can be inherited or acquired • can occur without a known cause | • results from dopamine overactivity • can be inherited or acquired • can result from an underlying condition |
| Treatment | not curable, but treatment can manage symtoms | may be treatable or resolve without treatment, depending on the type |
The biggest difference is that people with chorea make random movements, while people with dystonia usually move in predictable patterns.
The movements also differ in duration. Chorea movements are short, jerky, and dance-like, while dystonia movements can last for hours or even be permanent.
Dystonia results from the malfunctioning of the basal ganglia (the part of the brain that coordinates and controls movement), while chorea results from
One similarity between dystonia and chorea is that a person can inherit either of these conditions or acquire either one during their lifetime.
Symptoms of both dystonia and chorea can range from mild to severe and will vary depending on which part of the body they affect.
Common symptoms of dystonia
- foot cramps, which often cause the foot to turn inward
- changes in the way a person walks or runs
- a tendency to drag one leg, especially after walking a long distance
- difficulty speaking
- twisting of limbs that follows a regular pattern over time
- rapid and uncontrollable blinking
While chorea shares some of these symptoms, the muscle contractions it causes are
Symptoms of chorea include:
- restlessness or fidgeting
- an unstable gait, which leads to dance-like movements
- exaggerated gestures
- muscle contractions that seem to flow from one muscle to the next
Basal ganglia malfunction causes symptoms of both dystonia and chorea, but genetics and environmental factors can also play a role.
Chorea is a key feature of Huntington’s disease, a genetic condition in which toxic proteins build up in the brain. Some people with rheumatic fever develop a type of chorea called Sydenham chorea. People with thyroid diseases may also have
Doctors use the term “acquired dystonia” to describe dystonia that results from an injury, a health condition, or another non-genetic cause. Possible causes of acquired dystonia
- brain injuries during birth, including a lack of oxygen
- carbon monoxide poisoning
- stroke
- a head injury
- medication side effects
Treatment can ease the symptoms of dystonia but not cure it, and the treatment options depend on the severity of the symptoms. Possible treatments include:
- injections of botulinum toxin (Botox) to stop muscle contractions in focal dystonia
- medications that block certain chemicals in the brain
- surgery to implant electrodes into the parts of the brain that control movement
- speech therapy
- physical therapy, to improve a person’s posture
- mechanical devices, such as splints, to hold a person’s limbs in alignment
Chorea is usually associated with an underlying disease, and healthcare professionals may be able to ease the symptoms while treating the cause.
If chorea occurs as a side effect of medication, doctors may be able to treat the symptoms by changing the prescription.
Healthcare professionals can also prescribe medications to ease the symptoms of chorea. For example, they can treat Sydenham chorea with antibiotics.
Other medications that doctors may prescribe to treat chorea symptoms
- antipsychotics such as olanzapine, risperidone, or aripiprazole
- VMAT2 inhibitors such as tetrabenazine, valbenazine, or deutetrabenazine (particularly for chorea related to Huntington’s disease)
- antiseizure medications such as valproic acid or levetiracetam
Although there are no specific tests to diagnose dystonia or chorea, doctors will look at a person’s family history and medical records. They may recommend genetic testing to find out whether the person has an inherited condition.
According to NORD, doctors sometimes recommend that people see a movement disorder specialist for dystonia since some types of the condition have characteristic symptoms.
Doctors may also recommend tests to help them rule out other conditions. For example, they may use blood tests and MRI scans to rule out tumors.
The outlook for people with chorea or dystonia depends on the underlying cause or the type they have.
If Huntington’s disease is the cause of a person’s chorea, the symptoms are likely to continue as the disease progresses.
People with dystonia may have only
Sometimes, involuntary movements cause fixed postures.
This section answers some frequently asked questions about dystonia and chorea.
What is the difference between chorea and athetosis?
Doctors
People with athetosis may find it difficult to hold their posture and may appear unstable.
Some people with chorea also experience athetosis.
Does a person with dystonia or chorea have tics?
The
Tics are different from dystonia and chorea movements in that they often occur in a predictable pattern, with different tic movements regularly following each other.
Characteristically, each tic takes the same length of time every time it happens.
Doctors more commonly associate tics with Tourette syndrome and obsessive-compulsive disorder.
What is the difference between dystonia and dyskinesia?
“Dyskinesia” is a medical term for any involuntary and uncontrollable movement disorder.
Dystonia and chorea are types of dyskinesia.
Dystonia and chorea are two types of involuntary muscle movement that result from neurological disorders.
People with dystonia
Chorea movements are more random and seem to flow between muscles more quickly.
There is not yet a cure for either condition, but treatment may ease the symptoms.