Methods of assessing therapy in chorea with special reference to the use of A.C.T.H.

Like other manifestations of the rheumatic state chorea is subject to spontaneous remissions and relapses which make the assessment of the action of any particular therapy notoriously difficult. Furthermore, objective measurements of the degree of chorea seem necessary to confirm clinical impressions of an increase or decrease of chorea. With this in mind certain objective methods of assessing the action of therapy in chorea have been worked out, and are presented together with some results of their application to the treatment of chorea with A.C.T.H. Treatment may alter the severity of the duration of chorea. Its severity has been estimated in three ways: first, by clinical grading, secondly, by dexterity tests, thirdly, by means of a kinetic bed. In addition, certain permanent records of the choreic state have been developed which facilitate subsequent assessment of changes. Clkal Grading The following clinical grades are based on daily observation, with special attention to movement of outstretched hands, steadiness of grip, speech and emotional lability :-Grade O=no chorea; grade 1=just discernible chorea; grade 2=all cases of chorea between grades 1 and 3; grade 3=severe chorea where the patient is crippled by involuntary movements and cooperates with difficulty or not at all in the writing and dexterity tests.