title: Patience is the key: Contraceptive induced chorea in a girl with Down Syndrome.
abstract: BACKGROUND
  Isolated (sub)acute chorea in young patients is a relatively rare movement disorder with a broad differential diagnosis, including drug-induced, post-infectious, auto-immunological and vascular aetiologies.
  
  
  METHODS
  We describe an adolescent girl with Down's syndrome presenting with chorea due to oral contraceptive usage. After discontinuation of the oral contraceptive it took several months before the symptoms disappeared. Although generally well recognised, it is important to realise this delayed effect. Rejecting the diagnosis too soon may lead to unnecessary treatment for other possible underlying aetiologies, especially in patients with Down Syndrome, known to be vulnerable for autoimmune disorders.
  
  
  CONCLUSIONS
  We plead for discontinuation for at least three months before exclusion of oral contraceptives as cause of chorea.
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of Neurology, Hanzeplein 1, 9700 RB Groningen, The Netherlands.
authors.forename: Hendriekje
authors.initials: H
authors.lastname: Eggink
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of Neurology, Hanzeplein 1, 9700 RB Groningen, The Netherlands.
authors.forename: Anouk
authors.initials: A
authors.lastname: Kuiper
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of Neurology, Hanzeplein 1, 9700 RB Groningen, The Netherlands.
authors.forename: Cathérine C S
authors.initials: CC
authors.lastname: Delnooz
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of Neurology, Hanzeplein 1, 9700 RB Groningen, The Netherlands.
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Sival
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of Neurology, Hanzeplein 1, 9700 RB Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Pediatrics, Hanzeplein 1, 9700 RB Groningen, The Netherlands.
authors.forename: Tom J
authors.initials: TJ
authors.lastname: de Koning
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of Neurology, Hanzeplein 1, 9700 RB Groningen, The Netherlands. Electronic address: m.a.j.de.koning-tijssen@umcg.nl.
authors.forename: Marina A J
authors.initials: MA
authors.lastname: Tijssen
mesh_terms: D001327:Autoimmune Diseases / Q000175:diagnosis; D002819:Chorea / Q000139:chemically induced* / Q000175:diagnosis; D003276:Contraceptives, Oral / Q000009:adverse effects*; D003937:Diagnosis, Differential; D004314:Down Syndrome / Q000150:complications*; D005260:Female; D006801:Humans; D008599:Menstruation Disturbances / Q000150:complications / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D003276:Contraceptives, Oral
keywords: Chorea; Down Syndrome; Oral contraceptives