There is usually loss of fine motor control, particularly obvious in handwriting if the child is of school age. Speech is often affected (dysarthria), as is walking; legs will suddenly give way or flick out to one side, giving an irregular gait and the appearance of skipping or dancing. Underlying the abnormal movements is often low tone (hypotonia) which may not become obvious until treatment is started to suppress the chorea. In severe cases, the loss of tone and weakness predominate (chorea paralyticum). The severity of the condition can vary from just some instability on walking and difficulty with hand writing, to the extreme of being wholly unable to walk, talk, or eat. Movements cease during sleep. The eye muscles are not affected, curiously.It is a neuropsychiatric disorder, so besides the motor problems there is classically emotional lability (mood swings, or inappropriate mood), anxiety, attention deficit. These can precede the motor symptoms.Non-neurologic manifestations of acute rheumatic fever may be present, namely carditis (up to 70% of cases, often subclinical, so echocardiography required), arthritis, erythema marginatum, and subcutaneous nodules. Differentiating these signs from other involuntary movements such as tics and stereotypies can be difficult, and since these things are not uncommon they can potentially co-exist. Diagnosis is often delayed and attributed to another condition such as tic disorder or conversion disorder. The controversial PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections) hypothesis has overlapping clinical features but Sydenhams chorea is one of the exclusion criteria.
Society and culture
Brand names
In India, Nifedipine is manufactured by JB Chemicals, and comes in brands Nicardia Retard (Nifedipine 10 mg, 20 mg tablets) as well as Nicardia XL 30/60 which are Nifedipine Extended Release Tablets. See also
Cilnidipine
Felodipine
Lacidipine
Nilvadipine
Nimodipine

References
External links
"Nifedipine". Drug Information Portal. U.S. National Library of Medicine.