LETTER

Severe chorea with positive anti-basal ganglia antibodies after herpesencephalitis

I Marschitz¹, S Rödl¹, U Gruber-Sedlmayr¹, A Church², G Giovannoni², G Zobel³, C J Mache³, J Raith⁴ and B Plecko⁵

¹ Department of Pediatrics, Medical University Graz, Graz, Austria
² Neuroimmunology Laboratory, Institute of Neurology, London, UK
³ Department of Pediatrics, Medical University Graz, Graz, Austria
⁴ Department of Pediatric Radiology, Medical University Graz, Graz, Austria
⁵ Department of Pediatrics, Medical University Graz, Graz, Austria

Correspondence to:
Correspondence to:
B Plecko
Department of Pediatrics, Medical University Graz, Auenbruggerplatz 30, A-8036 Graz, Austria;barbara.plecko@meduni-graz.at

The first 150 words of the full text of this article appear below.

Chorea has been described as an initial sign of relapse in children with herpes simplex virus encephalitis. We describe the detection of anti-basal ganglia antibodies (ABGA) in plasma and cerebrospinal fluid (CSF) of a 2.3-year-old girl with severe chorea 3 weeks after acute herpes simplex virus (HSV) encephalitis. Although common neuroleptic and antidopaminergic drugs were ineffective, plasmapheresis combined with immunosuppression was followed by rapid and complete neurological recovery. These findings suggest a post-infectious, immune-mediated mechanism in this case of chorea after HSV encephalitis.

HSV encephalitis accounts for 10–20% of all viral encephalitis in the US.¹ Occasionally, chorea has been described as an initial sign of relapse with often poor prognosis. At least three pathogenic mechanisms are possible: occurence of late-onset symptoms of the initial viral infection, recurrence of viral replication (owing to incomplete treatment of the initial HSV encephalitis or by selection of clones of aciclovir-resistant virus), or induction of . . . [Full text of this article]

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This article has been cited by other articles:

• Kullnat, M. W., Morse, R. P. (2008). Choreoathetosis After Herpes Simplex Encephalitis With Basal Ganglia Involvement on MRI. Pediatrics 121: e1003-e1007 [Abstract] [Full Text]  
• Wild, E J, Tabrizi, S J (2007). The differential diagnosis of chorea. PN 7: 360-373 [Abstract] [Full Text]