Penicillin Management of<unk>  is based on the following principles: # Eliminate the streptococcus – it may not be of any use for the index patient but further spread of that specific clone will be prevented. # Treat the movement disorder # Immunosuppression # Prevention of relapses and further cardiac damage # Manage the disability There is a UFMG rating<unk> ale for<unk> , from Brazilian Universidade Federal de Minas Gerais (UFMG), for research purposes, but it only looks at motor function not psychiatric/behavioural symptoms. Occupational therapy and physiotherapy is useful for maintaining function and muscle tone. Treatment with sodium valproate is effective for controlling symptoms, but it doesn’t speed up recovery. Haloperidol was used previously, but caused serious side effects e.g. tardive dyskinesia. Case reports exist to support carbamazepine and levetiracetam; other drugs tried include pimozide, clonidine, and phenobarbitone. Immunosuppression Immunosuppression is used inconsistently in<unk> . The model of an autoimmune disorder would support its use. One randomized controlled trial of steroids from Paz, Brazil in 2006 (22 cases) showed remission reduced to 54 days from 119 days. Various other reports of use of oral or IV steroids from Israel, Italy and Brazil . Immunoglobulin has been used in Holland and South Africa. Some improvement can be seen within a few days of IV steroids. In Italy, prednisolone reduced average duration of symptoms from 9 weeks to 4 weeks, and these were severe cases. South African group found less neuropsychiatric complications at 6 months with IVIG treatment (IVIG preferred due to fear of TB reactivation). A course of penicillin is usually given at diagnosis to definitively clear any remaining streptococci, but there is no evidence that this is an effective treatment. Active infection is usually cleared by diagnosis. Penicillin prophylaxis, on the other hand, is essential to treat cardiac features of rheumatic fever, even if subclinical (American Heart Association guideline). If the case is of isolated<unk> , it is arguable whether cardiac risk justifies prophylaxis or not, however it is likely to reduce recurrence. There are several historical case series reporting successful treatment of<unk>  by inducing fever.
Sydenham's chorea
Huntington's disease
Benign hereditary chorea
Parkinson-plus syndrome
Wernicke–Korsakoff syndrome
Huntington's disease-like syndrome
X-linked dystonia parkinsonism
Stratton Parker syndrome