Prednisolone Does Not Cause Chorea—It Treats It
Prednisolone is a therapeutic agent for chorea, not a causative one. The available evidence consistently demonstrates that corticosteroids, including prednisolone, are used to treat chorea in various inflammatory and autoimmune conditions, with no documentation of prednisolone inducing chorea as an adverse effect.
Evidence for Prednisolone as Treatment for Chorea
Sydenham's Chorea
- Corticosteroids produce rapid and dramatic improvement in Sydenham's chorea, with marked reduction of involuntary movements within 24-48 hours and complete resolution within 7-12 days of treatment initiation 1.
- Intravenous methylprednisolone pulse therapy followed by oral prednisone is effective and safe in severe acute Sydenham's chorea, including complicated cases with chorea paralytica or neuroleptic-induced parkinsonism 2.
- The clinical rating score in severe Sydenham's chorea drops significantly (from 63.7±10.2 to 33.5±10.6) within the first month of methylprednisolone pulse therapy 2.
- Corticosteroid therapy is effective across different clinical presentations including chorea paralytica, distal chorea, hemichorea, and classic chorea, with excellent tolerability and no significant side effects 3.
Lupus-Associated Chorea
- In systemic lupus erythematosus (SLE), glucocorticoids in combination with immunosuppressive agents are used to control chorea and other movement disorders 4.
- A case of primary antiphospholipid antibody syndrome with severe bilateral chorea showed gradual improvement with mega-dose intravenous methylprednisolone followed by daily maintenance prednisolone 5.
Documented Psychiatric Effects of Prednisolone (Not Chorea)
The psychiatric adverse effects of corticosteroids are well-characterized, but chorea is not among them:
- Corticosteroid-induced psychiatric disease occurs in 10% of patients treated with prednisone ≥1 mg/kg and manifests primarily as mood disorder (93%) rather than psychosis 4.
- Psychiatric symptoms typically emerge within 2-4 weeks of initiating prednisone and include mood disturbances, euphoria, depression, and frank psychosis—but not movement disorders 6.
- Severe psychiatric effects occur in approximately 15% of patients on >20 mg/day for >18 months, presenting as psychosis, mood instability, or agitation 6.
Case Report Clarification
One case report describes a patient with SLE who developed chorea during prednisolone treatment, but this was attributed to the underlying lupus disease process itself, not the medication 7. The chorea occurred despite no signs of increased disease activity, and the lupus anticoagulant was negative, suggesting an alternative SLE-related mechanism rather than drug causation 7.
Clinical Bottom Line
There is no evidence that prednisolone causes chorea at any dose. The extensive literature on corticosteroid adverse effects documents psychiatric manifestations, hyperglycemia, osteoporosis, hypertension, and other complications, but movement disorders like chorea are conspicuously absent 4, 6.
If a patient on prednisolone develops chorea, investigate underlying autoimmune conditions (particularly SLE or antiphospholipid syndrome), structural brain lesions, or other causes—the prednisolone itself is not the culprit and may actually be part of the treatment solution 4, 5.