Detecting pediatric autoimmune neuropsychiatric disorders associated with streptococcus in children with obsessive-compulsive disorder and tics

2004 ◽  
Vol 55 (1) ◽  
pp. 61-68 ◽  
Author(s):  
Tanya K Murphy ◽  
Muhammad Sajid ◽  
Ohel Soto ◽  
Nathan Shapira ◽  
Paula Edge ◽  
...  
2014 ◽  
Vol 205 (1) ◽  
pp. 8-16 ◽  
Author(s):  
Daniel M. Pearlman ◽  
Haily S. Vora ◽  
Brian G. Marquis ◽  
Souhel Najjar ◽  
Lauren A. Dudley

BackgroundAutoimmune-mediated basal ganglia dysfunction is implicated in the pathophysiology of neuropsychiatric disorders commonly manifesting with obsessive–compulsive features (e.g. Sydenham chorea). The relationship between autoimmunity and primary obsessive–compulsive disorder (OCD), however, is less clear.AimsTo pool data on serum and cerebrospinal fluid (CSF) anti-basal ganglia antibody (ABGA) positivity in primary OCD (without neurological or autoimmune comorbidity) relative to controls or neuropsychiatric disorders previously associated with increased odds of ABGA positivity.MethodWe performed electronic database and hand-searches for studies meeting pre-specified eligibility criteria from which we extracted data using a standardised form. We calculated pooled estimates of ABGA positivity using a random-effects model.ResultsSeven case–control studies totalling 844 participants met the eligibility criteria. Meta-analysis showed that a significantly greater proportion of those with primary OCD were ABGA seropositive compared with various controls (odds ratio (OR) = 4.97, 95% CI 2.88–8.55, P<0.00001). This effect was not associated with heterogeneity or publication bias, and remained significant after stratifying the analysis by age, gender, disease severity, illness duration, immunostaining methodology, study quality, publication type, kind of control group, and sample size. There were no significant differences in ABGA seropositivity for comparisons between primary OCD and Tourette syndrome, attention-deficit hyperactivity disorder or paediatric acute-onset neuropsychiatric syndrome. Results of one study testing CSF samples showed that a significantly greater proportion of participants with primary OCD were ABGA CSF-positive compared with healthy controls (OR = 5.60, 95% CI 1.04–30.20, P = 0.045).ConclusionsOdds of ABGA seropositivity are increased fivefold in primary OCD compared with controls, but are comparable to those associated with disorders previously associated with ABGA, providing circumstantial evidence of autoimmunity in a subset of those with primary OCD. Further experimental studies are needed to ascertain whether this relationship is causal.


2020 ◽  
Vol 25 (1) ◽  
pp. 61-63
Author(s):  
Paul Blankenship ◽  
Kenneth Kurek

Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) is a type of pediatric obsessive-compulsive disorder with an acute symptom onset and periodic recurrence that is triggered by streptococcal infection. Due in part to the multifaceted assessment involved in the diagnosis of PANDAS and lack of consensus on the best treatment, management of these cases is complex. A background and case of PANDAS exacerbation in an adolescent patient, who presented with visuomotor impairment and was treated with azithromycin (Zithromax, Pfizer, New York, NY) prophylaxis to prevent further clinical deterioration, is described here.


CNS Spectrums ◽  
2007 ◽  
Vol 12 (5) ◽  
pp. 359-375 ◽  
Author(s):  
Naomi A. Fineberg ◽  
Sanjaya Saxena ◽  
Joseph Zohar ◽  
Kevin J. Craig

ABSTRACTThe boundaries between obsessive-compulsive disorder (OCD) and other neuropsychiatric disorders remain unresolved and may well differ from one disorder to another. Endophenotypes are heritable, quantitative traits hypothesized to more closely represent genetic risk for complex polygenic mental disorders than overt symptoms and behaviors. They may have a role in identifying how closely these disorders are associated with another and with other mental disorders with which they share major comorbidity. This review maps the nosological relationships of OCD to other neuropsychiatric disorders, using OCD as the prototype disorder and endophenotype markers, such as cognitive, imaging, and molecular data as well as results from demographic, comorbidity, family, and treatment studies. Despite high comorbidity rates, emerging evidence suggests substantial endophenotypic differences between OCD and anxiety disorders, depression, schizophrenia, and addictions, though comparative data is lacking and the picture is far from clear. On the other hand, strong relationships between OCD, Tourette syndrome, body dysmorphic disorder, hypochondriasis, grooming disorders, obsessive-compulsive personality disorder, and pediatric autoimmune neuropsychiatric disorders associated with streptococcus are likely. Studies designed to delineate the cause, consequences, and common factors are a challenging but essential goal for future research in this area.


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