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

Murphy, Tanya K.; Sajid, Muhammad; Soto, Ohel; Shapira, Nathan A.; Edge, Paula J.; Yang, Mark C. K.; Lewis, Mark H.; Goodman, Wayne K.

doi:10.1016/s0006-3223(03)00704-2

Cited by 103 publications

(70 citation statements)

References 47 publications

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“…A major shortcoming of the PANDAS hypothesis has been the small number of prospective studies examining the temporal relationship between antecedent GAS infections and the onset or exacerbations of tic and OC symptoms (Luo et al 2004;Murphy et al 2004;Perrin et al 2004;Kurlan et al 2008;Lin et al 2009;Leckman et al, in submission). Only two of these longitudinal studies prospectively identified PANDAS cases, using the published diagnostic criteria proposed by Swedo et al (1998).…”

Section: Serologic and Prospective Studiesmentioning

confidence: 99%

The Immunobiology of Tourette's Disorder, Pediatric Autoimmune Neuropsychiatric Disorders Associated withStreptococcus, and Related Disorders: A Way Forward

Murphy

Kurlan

Leckman

2010

Journal of Child and Adolescent Psychopharmacology

143

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Obsessive-compulsive disorder (OCD) and related conditions including Tourette's disorder (TD) are chronic, relapsing disorders of unknown etiology associated with marked impairment and disability. Associated immune dysfunction has been reported and debated in the literature since the late 80s. The immunologic culprit receiving the most interest has been Group A Streptococcus (GAS), which began to receive attention as a potential cause of neuropsychiatric symptoms, following the investigation of the symptoms reported in Sydenham's chorea (SC) and rheumatic fever, such as motor tics, vocal tics, and both obsessive-compulsive and attention deficit/hyperactivity symptoms. Young children have been described as having a sudden onset of these neuropsychiatric symptoms temporally associated with GAS, but without supporting evidence of rheumatic fever. This presentation of OCD and tics has been termed pediatric autoimmune neuropsychiatric disorders associated with Streptococcus (PANDAS). Of note, SC, OCD, and TD often begin in early childhood and share common anatomic areas-the basal ganglia of the brain and the related cortical and thalamic sites-adding support to the possibility that these disorders might share a common immunologic and/or genetic vulnerability. Relevant manuscripts were identified through searches of the PsycINFO and MedLine databases using the following keywords: OCD, immune, PANDAS, Sydenham chorea, Tourette's disorder Group A Streptococcus. Articles were also identified through reference lists from research articles and other materials on childhood OCD, PANDAS, and TD between 1966 and December 2010. Considering the overlap of clinical and neuroanatomic findings among these disorders, this review explores evidence regarding the immunobiology as well as the relevant clinical and therapeutic aspects of TD, OCD, and PANDAS.

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Section: Serologic and Prospective Studiesmentioning

confidence: 99%

The Immunobiology of Tourette's Disorder, Pediatric Autoimmune Neuropsychiatric Disorders Associated withStreptococcus, and Related Disorders: A Way Forward

Murphy

Kurlan

Leckman

2010

Journal of Child and Adolescent Psychopharmacology

143

View full text Add to dashboard Cite

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“…Current criteria for PANDAS include presence of tic disorder or OCD, onset of tics before puberty, episodic course of tics and obsessive-compulsive symptoms, documented evidence of a recent streptococcal infection, and temporal association between symptom exacerbation and streptococcal pharyngitis. 24,25 Elevated anti-streptococcal antibody and anti-DNase B titers are not formally part of the definition and are not sufficient evidence to initiate antibiotic treatment.…”

Section: Diagnosis Of Ts and Assessment Of Ticsmentioning

confidence: 99%

Contemporary assessment and pharmacotherapy of Tourette syndrome

Scahill

Erenberg

Berlin

et al. 2006

NeuroRX

267

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Summary:To develop a guide to clinical assessment and pharmacotherapy for children and adults with Tourette syndrome (TS), we reviewed published literature over the past 25 years to identify original articles and reviews on the assessment and pharmacological treatment of Tourette syndrome, attention-deficit/hyperactivity disorder (ADHD) and obsessivecompulsive disorder (OCD). The literature search also included a survey of reviews published in book chapters. The assessment section was compiled from several reviews. Pharmacological treatments were classified into those with strong empirical support (as evidenced by two positive placebo-controlled studies for tics, OCD, or ADHD in TS samples); modest empirical support (one positive placebo-controlled study), or minimal support (open-label data only). We conclude that accurate diagnosis, including identification of comorbid conditions, is an essential step toward appropriate treatment for patients with TS. In many patients with TS, symptom management requires pharmacotherapy for tics or coexisting conditions. The evidence supporting efficacy and safety for medications used in patients with TS varies. But this evidence offers the best guide to clinical practice.

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“…In the past, research has focused on the manner of inheritance, or the genetic linkage, with very few contributions coming from association studies. There is growing evidence that both autoimmune and genetic factors are involved in the pathogenesis of TS [28][29][30][31][32] although a study tried but failed to identify such a marker by investigating choline in the red blood cells of TS twins and their parents [33]. Therefore, it is considered a trait marker that is indicative of a genetic susceptibility to Tourette's syndrome [33,34].…”

Section: Introductionmentioning

confidence: 99%

Antineural antibody in patients with Tourette’s syndrome and their family members

Yeh

Wu²,

Tsung³

et al. 2005

J Biomed Sci

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SummaryIt has been proposed that antineural antibodies were present in patients with Tourette's syndrome (TS) and other neuropsychiatric disorders. The purpose of our study was to investigate the presence of antineural antibodies in the individuals with Tourette's syndrome and the family members of TS patients. The sera of four TS patients with no current streptococcal infection, their tic-free family members including father, mother and sibling, and a age-matched control group who were tic free were assayed for antineural antibodies directed against rat tissue and neurons in primary cell culture. There were prominent antineural antibodies present in TS patients and their first-degree family members, but not in the control group. Western blotting showed proteins of about 120 kDa in their sera that were not present in the sera of controls. The preliminary results of our study suggest the importance of genetic vulnerability in the immunological pathophysiology of tic disorders. Future studies should investigate the interactions of genetics, environment, infectious agents, and immunity on symptom expression in families with tic disorders.

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

Cited by 103 publications

References 47 publications

The Immunobiology of Tourette's Disorder, Pediatric Autoimmune Neuropsychiatric Disorders Associated withStreptococcus, and Related Disorders: A Way Forward

The Immunobiology of Tourette's Disorder, Pediatric Autoimmune Neuropsychiatric Disorders Associated withStreptococcus, and Related Disorders: A Way Forward

Contemporary assessment and pharmacotherapy of Tourette syndrome

Antineural antibody in patients with Tourette’s syndrome and their family members

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