Orsini A, Foiadelli T, Magistrali M, et al. - A high treatment heterogeneity was revealed in this national retrospective multicenter cohort of pediatric patients with Sydenham's Chorea (SC; a neuropsychiatric disorder and a major manifestation of acute rheumatic fever). Findings demonstrated that immunomodulatory therapy failed to display higher efficacy at medium term but it was related to a slightly lower risk of relapse than symptomatic therapy.

• A total of 171 patients (<18-years old) with SC were retrospectively analyzed; 66% had generalized chorea and 34% hemichorea; and 81% had carditis (subclinical in 65%).

• Anxiety disorder/depression (77%) were most commonly presented psychiatric manifestations.

• At 6 months, 93% of the patients achieved neurological remission; relapse occurred in 9%.

• Penicillin alone was given to 11% of patients, immunomodulatory therapy to 37%, symptomatic drugs (i.e. anti-seizure medication, dopamine antagonists) were administered in 16% and both symptomatic and immunomodulatory treatment in 37%.

• No difference in neurological outcome was observed between groups.

• Multivariate analysis revealed a higher risk of relapse in patients taking symptomatic drugs.