Sydenham's chorea: a possible presynaptic dopaminergic dysfunction initially.

A 10-year-old white girl showed chorea with elevated antibody titers indicative of an earlier group A streptococcal infection. Prior to treatment, cerebrospinal fluid homovanillic acid levels were markedly elevated. Haloperidol caused minimal improvement. She was then treated with reserpine alone, which resulted in remarkable improvement within one week. A repeat lumbar puncture one month after reserpine was started showed moderate reduction of homovanillic acid levels. When reserpine was discontinued, symptoms recurred. The data suggest presynaptic dopaminergic overactivity.