On the 24th of June, 1374, an outbreak of St. John’s Dance, or St. Vitus’ Dance, occurred in Aachen. People began to hallucinate then jump and twitch uncontrolably until the collapsed from exhaustion. Since a physician, Manuel Nuñez, appeared in Called to Account, the fourth book in my Sir Anthony Standen Adventures, I have taken an intererest in Renaissance medicine and diseases.
St. Vitus’ Dance, known medically as Sydenham’s chorea, is a neurological disorder characterised by rapid, uncoordinated jerking movements primarily affecting the face, hands, and feet. The name “St. Vitus’ Dance” originates from the Middle Ages, when people believed that dancing before the statue of St. Vitus would protect them from the affliction. Over time, this became associated with the involuntary movements seen in those suffering from the condition.
The term “St. Vitus’ Dance” has roots in both medical history and folklore. In medieval Europe, outbreaks of what was perceived as “dancing mania” occurred, with groups of people dancing erratically in public spaces. These episodes, poorly understood at the time, were often attributed to supernatural causes, including possession or divine punishment. St. Vitus, the patron saint of dancers, was invoked for protection against these mysterious symptoms.
Interestingly, dancing mania and Sydenham’s chorea are not the same, though they share similarities in involuntary movements. Dancing mania likely had sociocultural and psychological causes, while Sydenham’s chorea has a neurological basis linked to specific infections.
Sydenham’s chorea is often a complication of rheumatic fever, which can occur following an untreated streptococcal throat infection. The condition typically affects children between the ages of 5 and 15, with a higher incidence in females. The immune system’s response to the streptococcal bacteria can mistakenly target the basal ganglia—a part of the brain responsible for regulating movement—leading to the characteristic symptoms.
Risk factors include: A history of streptococcal infections; Family history of rheumatic fever & Inadequate treatment of strep throat
The hallmark of St. Vitus’ Dance is involuntary, rapid, and irregular jerking movements that can affect various parts of the body. These movements often worsen with stress and disappear during sleep. Other symptoms include: Muscle weakness; difficulty with fine motor tasks; emotional instability, such as sudden bouts of laughter or crying; irritability and mood swings, & slurred speech. These symptoms can be distressing, both for the individual and their family, due to the sudden onset and the impact on daily activities.
Diagnosing Sydenham’s chorea involves a combination of clinical evaluation and medical history. A doctor will assess the involuntary movements, inquire about recent strep infections, and may order tests to support the diagnosis, such as: throat culture or rapid strep test; blood tests for streptococcal antibodies; electrocardiogram (ECG) to check for rheumatic heart disease, & brain imaging (rarely needed unless other neurological conditions are suspected)
Treatment focuses on addressing the underlying infection, managing symptoms, and preventing recurrence. Common approaches include: Antibiotics to treat any lingering streptococcal infection and prevent further episodes; anti-inflammatory medications (Corticosteroids may be prescribed to reduce inflammation in the brain). Medications such as valproic acid or carbamazepine can help control severe movement symptoms. Physical therapy may assist in regaining motor skills, while counselling can help manage emotional and psychological effects. In most cases, Sydenham’s chorea resolves within a few months, although some individuals may experience residual symptoms or relapses.
The prognosis for St. Vitus’ Dance is generally good, especially with early diagnosis and treatment. However, individuals who have had Sydenham’s chorea are at risk of recurrent rheumatic fever, which can lead to rheumatic heart disease. Regular follow-up with a healthcare provider is essential to monitor heart health and prevent complications.
St. Vitus’ Dance serves as a reminder of how far medical science has come in separating myth from medicine. From medieval Europe’s dancing plagues to modern neurology, our understanding has transformed, offering hope and healing where once there was fear and confusion. Recognising the signs and seeking timely medical care remain crucial steps in managing this intriguing neurological disorder.