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Chorea induced by oral contraceptives

From the Department of Neurological Sciences (Drs. Nausieda, Koller, Weiner, and Klawans) and the Department of Pharmacology (Drs. Nausieda, Weiner, and Klawans), Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL.

Accepted for publication April 30, 1979. Correspondence should be sent to Dr. Nausieda, 1725 West Harrison, Suite 909, Chicago, IL 60612.

A rare complication of oral contraceptive therapy is the induction of chorea. We here describe five cases of chorea in patients receiving lowor high-dose estrogen-containing contraceptives. All patients were nulliparous, young (average age 19 years), and became symptomatic shortly (average of 5 weeks) after initiation of contraceptive therapy. Two patients previously suffered an episode of Sydenham chorea; one experienced chorea in the course of Henoch-Schonlein purpura; and two had a history of congenital cyanotic heart disease without chorea. Dyskinesia resolved in all patients upon discontinuing the medication. Patients with preexisting striatal abnormalities appear more susceptible to oral contraceptive-induced chorea which is reversible on drug discontinuation. The mechanism of oral contraceptive-induced chorea is unknown, but clinical and experimental data suggest that it involves altered central dopaminergic activity.

This research was supported in part by funds provided by the United Parkinson Foundation and the Boothroyd Foundation.

This paper was presented at the thirty-first annual meeting of the American Academy of Neurology, Chicago, April 1979.

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