Agaricus. For true cerebral chorea Agaricus stands at the head of the list It has in its pathogenesis a long list of symptoms of muscular twitchings, among which are twitchings and spasms of the eyeballs and eyelids ; it has angular choreic movements and spasmodic motions of the extremities, which are not confined to one side of the body, but affect the upper half on one side of the body and the lower half on the other. In spasmodic twitchings of the eyes and lids, Agaricus will most frequently be the proper remedy. If there be itching spots on the skin resembling chilblains, or if the child have an idiotic expression of the face, then Agaricus is all the more indicated. Agaricus is especially useful in mild cases and in epidemic cases, and is a precise simile to the idiopathic form. The spine in Agaricus cases is apt to be sensitive to pressure, especially in the lumbar region, there is weak- ness and coldness of the limbs and unsteady gait, and as the disease progresses there is emaciation.
Cimicifuga is applicable to chorea affecting the left side, and when associated with rheumatism or myalgia, or occurring reflexly in uterine affections. The twitchings in Agaricus also occur during sleep but are more severe while awake. With this drug, there is considerable congestion to the head, dilated pupils, flushed face, and the twitching is said to be worse during a thunderstorm.
Tarantula. When the choreic movements affect the right arm and right leg, and when the movements continue even at night, and are brought on by fright, grief, etc., the Tarentula Hispana becomes the remedy. The patient is restless and compelled to keep constantly in motion, the spine is sensitive, and there is trembling. The patient can run better than he can walk, and in chorea major with rigidity it is the remedy when diversion of the mind, especially music, relieves.
Ignatia is especially the remedy in chorea of young girls when, of emotional origin, the marked impressionability of the nervous system is characteristic. In very stubborn cases Arsenic will be found useful ; it has much uneasiness in the legs, must change position and walk about for relief, and it corresponds to chorea in debilitated children.
Zizia has restless choreic movements during sleep. Sepia^ too, has relieved chorea-like symptoms.
Laurocerasus is useful in emotional chorea after fright ; there are fearful contortions when awake ; sleep restless, can neither sit, stand nor lie down on account of incessant motions. Speech is indistinct
Crocus is also a remedy in chorea with hysterical symptoms, twitching of single muscles. It corresponds well to symptoms of hysteria.
Zincum. Constant motions of the feet, which may continue during sleep, and it is especially the remedy when the chorea is brought on by suppressed eruptions or by fright and the general health is involved, right side most affected much depression of spirits and irritability, worse from wine. Zincum is more adapted to the chronic form, and Zincum valerianate has also been successfully used in chorea.
Opium has emotional chorea with trembling and spasmodic jerkings of the flexors ; the arms are thrown out at right angles with the body. Cimicifuga. When the movements affect the left side and are associated with myalgic or rheumatic ailments, or when reflex from uterine derangements, then
Cimicifuga is the remedy. There is sensitiveness of the spine and entire muscular system, and if mental depression be present it is an additional indication. Cimicifuga is especially indicated in chorea in young girls, about the age of puberty, with menstrual disorders. Fright chorea and chorea with loss of power of swallowing indicate the remedy.
Calcarea carbonica. Chorea is only local in its simplest form ; there is always some constitutional dyscrasia underly- ing established cases, and therefore much reliance must be placed on constitutional remedies in most cases. Calcarea is a remedy to correct the malnutrition and is one of the best basic remedies ; it often assists materially in securing a recovery. When chorea occurs in Calcarea children, and is brought on by fright or onanism, the remedy will be well indicated.
Cuprum. Baehr claims that Cuprum will cure most cases of chorea, and that the disease will rarely last more than three or four weeks under its administration. It is indicated where the choreic movements start in the muscles of the fingers and toes and extend to the limbs ; the patient is better or more quiet during sleep, but when awake the terrible contortions and awkward movements are excessive. Saltatory spasm may occur. When spasms occur in choreic children.
Nux vomica is the remedy for spinal chorea ; there is unsteady gait and dragging of the feet ; there are crawling sensations in the parts attacked and constipation.
Cocculus follows well when paralysis remains.
Natrum muriaticum. Chronic cases of chorea due to fright, or to chronic eruptions about the face, will sometimes indicate Natrum muriaticum. There are paroxysms of jumping up or of jerking of the right side of the face, worse during the full moon.
Pulsatilla may come in for chorea due to amenorrhoea or dysmenorrhoea, and Silica is a remedy for chorea complicated with hysteria, and the movements are confined to the lower extremities ; the feet and legs jump and dance in spite of all efforts to prevent them. Belladonna. Belladonna is useful in what the French term La Grande Choree where there are constrictions, hyperesthesias, and much bodily inquietude. The patient cannot remain in one position for any length of time ; the jerking is predominately backwards, the head is bored into the pillow. It is distinguished from all other remedies by the intensity of its symptoms.
Veratrum viride is useful in chorea when in addition to twitching there is violent congestion to the nerve centers and excited pulse Belladonna suits also choreas reflex from dentition or pregnancy.
Stramonium. Stramonium is especially the remedy when the brain is affected. The movements, as in Belladonna are characterized by great violence affecting the whole body; the patient leaps grotesquely — saltatoric spasm — rotates the arm, clasps the hands over the head. Other symptoms of Stramonium are, a continual changing of the features — now he laughs, now he appears astonished, protrudes his tongue rapidly, head thrown alternately backwards and forwards, extremities in constant motion. Stammering may be present, patient easily frightened.
Hyoscyamus has jerking and angular motions; the patients are weak; they have an abnormal perception of distances. Bartlett claims that Hyoscyamus gives better results in twitchings of the eyelids than Agaricus.
Mygale. It is quite characteristic of the spider poisons to produce spasmodic diseases. Mygale according to Farrington, is one of our best remedies in uncomplicated cases of chorea ; the patient is low spirited and depressed, the muscles of the face twitch constantly, the mouth and eyes open and close in rapid succession, the head is jerked to one side, usually the right, control over the muscles seems to be lost. If the patient attempts to put his hand to his head it is jerked backwards violently, and words are jerked out in talk- ing. The legs are in motion while sitting, and dragged while attempting to walk. Dr. Clarence Barlett speaks of this remedy as especially valuable.
Causticum. Jahr, in his ” Forty Years’ Practice,” lauds Causticum in chorea. The symptoms calling for its use are these: The right side is more afiFected than the left, the muscles of the face, tongue, arm, and leg are all involved ; words are jerked out when talking, patient continually changes his position, throws himself about until he falls asleep exhausted. During sleep legs and arms are ” on the go;” the child is unable to articulate because of excessive nervousness ; indisposition to talk because of weakness of the throat and tongue muscles. It is especially adapted to rheumatic cases brought on from cold or exposure.
Cina. Chorea produced by a foul stomach, or by irritation from worms, calls for Cina. The movements often commence with a shriek. Asafoetida has chorea from irritation of abdominal nerves from gastric troubles, worms, etc.
Chamomilla is useful in those children possessing the characteristic Chamomilla fretfulness.