Anti-Basal Ganglia Antibodies and Streptococcal Infection in ADHD

2015 ◽  
Vol 22 (9) ◽  
pp. 864-871 ◽  
Author(s):  
Sergio Aguilera-Albesa ◽  
Nerea Crespo-Eguílaz ◽  
José Luis Del Pozo ◽  
Pablo Villoslada ◽  
Rocío Sánchez-Carpintero
Keyword(s):  
Basal Ganglia ◽  
Group A Streptococcus ◽  
Tic Disorders ◽  
Healthy Children ◽  
Cognitive Measures ◽  
Dynamic Nature ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Additional Group ◽  
Group A

Objective: Group A Streptococcus has been associated with ADHD, tic disorders (TD), and obsessive–compulsive disorder (OCD) through anti-basal ganglia antibodies (ABGA). Method: We investigated the association between ABGA and streptococcal exposure with behavioral, motor, and cognitive measures in 38 children with ADHD not comorbid to OCD or TD (nc-ADHD) and in 38 healthy children. An additional group of 15 children with TD and/or OCD was examined. Results: ABGA titers were present in 3% of nc-ADHD patients and controls but in 27% of TD and/or OCD patients. Evidence of streptococcal exposure was similar between ADHD patients and controls living in the same urban area. Behavioral, motor, and cognitive measures were not associated with anti-streptococcal antibodies. Conclusion: ABGA do not distinguish nc-ADHD from controls. The differences in the frequency of streptococcal exposure in previous studies are determined by the dynamic nature of the infection rather than the behavioral phenotype of ADHD.

The PANDAS Subgroup: Recognition and Treatment

CNS Spectrums ◽  
2001 ◽  
Vol 6 (5) ◽  
pp. 419-426 ◽  
Author(s):  
Susan E. Swedo ◽  
Marjorie Garvey ◽  
Lisa Snider ◽  
Charlotte Hamilton ◽  
Henrietta L. Leonard
Keyword(s):  
Controlled Trial ◽  
Neuropsychiatric Symptoms ◽  
Sudden Onset ◽  
Tic Disorders ◽  
Temporal Association ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Treatment And Prevention ◽  
Group A ◽  
Immunomodulatory Therapies

AbstractA subgroup of patients with childhood-onset obsessive-compulsive disorder (OCD) has been identified who share a common clinical course characterized by dramatic symptom exacerbations following Group A beta-hemolytic streptococcal (GABHS) infections. The term PANDAS has been applied to the subgroup, to indicate the postulated etiology of their symptoms: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections. Five clinical characteristics define the PANDAS subgroup: presence of OCD and/or tic disorder, prepubertal symptom onset, sudden onset or abrupt exacerbations (sawtooth course), association with neurological abnormalities (presence of adventitious movements or motoric hyperactivity during exacerbations), and temporal association between symptom exacerbations and GABHS infections. Post-streptococcal symptom exacerbations are typically quite dramatic, with patients reporting that their symptoms “…came on overnight” or “…appeared all of a sudden a few days after I had a sore throat.” The post-streptococcal inflammatory nature of the neuropsychiatric symptoms provides novel opportunities for treatment and prevention, including immunomodulatory therapies such as therapeutic plasma exchange (TPE) and intravenous immunoglobulin (IVIG). A recently completed placebo-controlled trial revealed that both IVIG and TPE were effective in reducing neuropsychiatric symptom severity (40% to 55% reductions, respectively) for a group of severely ill children with OCD and/or tic disorders. Further research is required to determine why the treatments are helpful, as well as to ascertain whether or not antibiotic prophylaxis can help prevent post-streptococcal symptom exacerbations.

scholarly journals Association of Group A Streptococcus Exposure and Exacerbations of Chronic Tic Disorders

Neurology ◽  
2021 ◽  
Vol 96 (12) ◽  
pp. e1680-e1693 ◽  
Author(s):  
Davide Martino ◽  
Anette Schrag ◽  
Zacharias Anastasiou ◽  
Alan Apter ◽  
Noa Benaroya-Milstein ◽  
...  
Keyword(s):  
Symptom Severity ◽  
Failure Time ◽  
Group A Streptococcus ◽  
Tic Disorders ◽  
Active Management ◽  
Contributing Factors ◽  
Obsessive Compulsive ◽  
Group A ◽  
Chronic Tic Disorders ◽  
Gas Exposure

ObjectiveTo examine prospectively the association between group A Streptococcus (GAS) pharyngeal exposures and exacerbations of tics in a large multicenter population of youth with chronic tic disorders (CTD) across Europe.MethodsWe followed up 715 children with CTD (age 10.7 ± 2.8 years, 76.8% boys), recruited by 16 specialist clinics from 9 countries, and followed up for 16 months on average. Tic, obsessive-compulsive symptom (OCS), and attention-deficit/hyperactivity disorder (ADHD) severity was assessed during 4-monthly study visits and telephone interviews. GAS exposures were analyzed using 4 possible combinations of measures based on pharyngeal swab and serologic testing. The associations between GAS exposures and tic exacerbations or changes of tic, OC, and ADHD symptom severity were measured, respectively, using multivariate logistic regression plus multiple failure time analyses and mixed effects linear regression.ResultsA total of 405 exacerbations occurred in 308 of 715 (43%) participants. The proportion of exacerbations temporally associated with GAS exposure ranged from 5.5% to 12.9%, depending on GAS exposure definition. We did not detect any significant association of any of the 4 GAS exposure definitions with tic exacerbations (odds ratios ranging between 1.006 and 1.235, all p values >0.3). GAS exposures were associated with longitudinal changes of hyperactivity–impulsivity symptom severity ranging from 17% to 21%, depending on GAS exposure definition.ConclusionsThis study does not support GAS exposures as contributing factors for tic exacerbations in children with CTD. Specific workup or active management of GAS infections is unlikely to help modify the course of tics in CTD and is therefore not recommended.

Bipolar disorder and comorbid obsessive-compulsive disorder is associated with higher rates of anxiety and impulse control disorders

2010 ◽  
Vol 22 (2) ◽  
pp. 81-86 ◽  
Author(s):  
Cilly Klüger Issler ◽  
Emel Serap Monkul ◽  
José Antonio de Mello Siqueira Amaral ◽  
Renata Sayuri Tamada ◽  
Roseli Gedanke Shavitt ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Obsessive Compulsive Disorder ◽  
Impulse Control ◽  
Severe Form ◽  
Impulse Control Disorders ◽  
Tic Disorders ◽  
Obsessive Compulsive ◽  
Residual Symptoms ◽  
Compulsive Disorder ◽  
Depressive Episodes

Issler CK, Monkul ES, Amaral JAMS, Tamada RS, Shavitt RG, Miguel EC, Lafer B. Bipolar disorder and comorbid obsessive-compulsive disorder is associated with higher rates of anxiety and impulse control disorders.Objective:Although bipolar disorder (BD) with comorbid obsessive-compulsive disorder (OCD) is highly prevalent, few controlled studies have assessed this comorbidity. The objective of this study was to investigate the clinical characteristics and expression of comorbid disorders in female BD patients with OCD.Method:We assessed clinically stable female outpatients with BD: 15 with comorbid OCD (BD+OCD group) and 15 without (BD/no-OCD group). All were submitted to the Structured Clinical Interview for DSM-IV, with additional modules for the diagnosis of kleptomania, trichotillomania, pathological gambling, onychophagia and skin picking.Results:The BD+OCD patients presented more chronic episodes, residual symptoms and previous depressive episodes than the BD/no-OCD patients. Of the BD+OCD patients, 86% had a history of treatment-emergent mania, compared with only 40% of the BD/no-OCD patients. The following were more prevalent in the BD+OCD patients than the BD/no-OCD patients: any anxiety disorder other than OCD; impulse control disorders; eating disorders; and tic disorders.Conclusion:Female BD patients with OCD may represent a more severe form of disorder than those without OCD, having more depressive episodes and residual symptoms, and being at a higher risk for treatment-emergent mania, as well as presenting a greater anxiety and impulse control disorder burden.

scholarly journals Complex phonic tic and disinhibition in Tourette syndrome: case report

2001 ◽  
Vol 59 (3A) ◽  
pp. 587-589 ◽  
Author(s):  
Débora Palmini Maia ◽  
Francisco Cardoso
Keyword(s):  
Breast Cancer ◽  
Case Report ◽  
Basal Ganglia ◽  
Obsessive Compulsive Disorder ◽  
Tourette Syndrome ◽  
Limbic Cortex ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Behavioral Abnormalities ◽  
Motor Tics

Tourette syndrome (TS) is a neuropsychiatric disorder characterized by a combination of multiple motor tics and at least one phonic tic. TS patients often have associated behavioral abnormalities such as obsessive compulsive disorder, attention deficit and hyperactive disorder. Coprolalia, defined as emission of obscenities or swearing, is one type of complex vocal tic, present in 8% to 26% of patients. The pathophysiology of coprolalia and other complex phonic tics remains ill-defined. We report a patient whose complex phonic tic was characterized by repetitively saying "breast cancer" on seeing the son of aunt who suffered from this condition. The patient was unable to suppress the tic and did not meet criteria for obsessive compulsive disorder. The phenomenology herein described supports the theory that complex phonic tics result from disinhibition of the loop connecting the basal ganglia with the limbic cortex.

Speculations on Antineuronal Antibody-Mediated Neuropsychiatric Disorders of Childhood

PEDIATRICS ◽  
1994 ◽  
Vol 93 (2) ◽  
pp. 323-326 ◽  
Author(s):  
Susan E. Swedo ◽  
Henrietta L. Leonard ◽  
Louise S. Kiessling
Keyword(s):  
Sleep Disturbances ◽  
Obsessive Compulsive ◽  
Behavioral Disturbances ◽  
Obsessive Compulsive Symptoms ◽  
Antineuronal Antibodies ◽  
Compulsive Disorder ◽  
Clinical Observations ◽  
Neurological Abnormalities ◽  
Group A ◽  
The Central Nervous System

Several converging lines of evidence suggest that some behavioral and neurological abnormalities of childhood may be mediated through antineuronal antibodies.1-3 These antineuronal antibodies appear to arise in response to group A [beta]-hemolytic streptococcal (GABHS) infections and to cross-react with cells within the central nervous system (CNS).4 Based on clinical observations of children with Sydenham's chorea, Tourette's syndrome (TS), and/or obsessive-compulsive disorder (OCD), we hypothesize that neuroimmunological dysfunction secondary to anti-neuronal antibodies may result in behavioral disturbances, such as anxiety, emotional lability, obsessive compulsive symptoms, hyperactivity, and sleep disturbances; and neurological abnormalities, such as motor and phonic tics, ballismus, chorea, and choreiform movements.

A-67 Measuring Regional Cerebral Blood Flow with Single-Photon Emission Computed Tomography (SPECT) in Obsessive–Compulsive Disorder

2021 ◽  
Vol 36 (6) ◽  
pp. 1109-1109
Author(s):  
Sophia G Perez ◽  
Bailey McDonald ◽  
Samantha Spagna ◽  
Charles J Golden ◽  
Kristen Willeumier ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Basal Ganglia ◽  
Limbic System ◽  
Regional Cerebral Blood Flow ◽  
Healthy Controls ◽  
Regional Cerebral Blood ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
The Right

Abstract Objective To identify regional cerebral blood flow (rCBF) differences between individuals with Obsessive–Compulsive Disorder (OCD) and healthy controls. Mehtods: Healthy controls (n = 81, Mage = 41.9, 53.0% female, 42.0% Caucasian) and persons diagnosed by psychiatric examination with OCD (n = 1020, Mage = 34.8, 33.6% female, 66.3% Caucasian) were selected from a deidentified adult clinical outpatient database. Those with comorbid diagnoses were included. Significant differences (alpha = 0.001) were found for age [t(1099) = −4.4], gender [χ2(2) = 25.7], and race [χ2(12) = 30.1] between groups and therefore were controlled for. Significant rCBF differences were noted in the cerebellum [left:F(1,1096) = 21.6; right:F(1,1096) = 18.3], limbic system [left:F(1,1096) = 12.2; right:F(1,1096) = 10.4], and basal ganglia [left:F(1,1096) = 18.6; right:F(1,1096) = 18.3]. Results Group means comparisons indicated higher perfusion in the cerebellum for the OCD group. Lower perfusion was found in the limbic system and basal ganglia in the OCD group. This study found higher perfusion in the cerebellum among the OCD group. Previous research found increased rCBF in the left cerebellum in OCD before pharmacotherapy. In the right cerebellum, increased rCBF was found among participants with early-onset OCD. Conclusion Overall, there is limited research on the cerebellum because of its use as a reference point. No research was found regarding the limbic system in OCD using SPECT; however, other neuroimaging found increased amygdala reactivity to emotional face stimuli. This study found lower perfusion in the basal ganglia among the OCD group. Previous research found hypoperfusion in the right; however, hypoperfusion in the left was not significant. Updated OCD and rCBF research with SPECT are needed. Limitations included the inclusion of comorbidities and use of DSM-IV-TR rather than DSM-5 diagnosis criteria.

scholarly journals Inflammation in Tic Disorders and Obsessive-Compulsive Disorder: Are PANS and PANDAS a Path Forward?

2019 ◽  
Vol 34 (10) ◽  
pp. 598-611 ◽  
Author(s):  
Donald L. Gilbert
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Tic Disorders ◽  
Published Data ◽  
Clinical Practices ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Scientific Questions

This review and commentary is the product of an invited lecture called “Autoimmunity: PANS/PANDAS” presented at the 2018 Neurobiology of Diseases in Children Symposium in Chicago, IL. The talk addressed clinical and scientific questions and recently published data. At this time, among highly experienced and respected clinicians and researchers spanning relevant disciplines, there is substantial controversy regarding a role for inflammation in producing tics and obsessive-compulsive disorder. This commentary summarizes these controversies, discusses reasons for opposing views on best clinical practices, and concludes with suggestions for pathways forward.

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