Relationship of Movements and Behaviors to Group A Streptococcus Infections in Elementary School Children

Murphy, Tanya K.; Snider, Lisa A.; Mutch, P. Jane; Harden, Elaine; Zaytoun, Annette M.; Edge, Paula J.; Storch, Eric A.; Yang, Mark C. K.; Mann, Giselle; Goodman, Wayne K.; Swedo, Susan E.

doi:10.1016/j.biopsych.2006.08.031

Cited by 63 publications

(48 citation statements)

References 29 publications

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“…This type of lag is consistent with the finding that OCD symptoms precede the appearance of any motoric manifestation by days or weeks in patients with RF (Mercadante et al 2000). The presence of neurological soft signs, such as choreiform movements and pronator sign/drift, are a frequently observed comorbidity among childhood onset OCD, tics, and ADHD; the significance of neurological soft signs in relationship to GAS infections has never been prospectively examined until recently (Murphy et al 2007). In addition to choreiform movements, other subtle signs of neurological impairment have been reported to be associated with PANDAS (Swedo et al 1998); however, neuropsychological dysfunction is commonly reported with OCD/tics (Kuelz et al 2004;Bloch et al 2006) and those with PANDAS may not have differentiating neuropsychological profile when compared with youth with typical (non-PANDAS) OCD and TD (Hirschtritt et al 2009).…”

Section: Neurological and Cardiac Concernssupporting

confidence: 79%

“…Potential sequelae of frequent GAS infections are not limited to OCD/tic symptoms. In one study that followed 693 school age children with monthly strep cultures and behavioral observations, an increase in behavioral and motoric symptoms was seen especially in children who had repeated strep infections (Murphy et al 2007). These findings suggest that a cumulative threshold of antibody is needed to trigger symptoms in some patients.…”

Section: Serologic and Prospective Studiesmentioning

confidence: 99%

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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

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144

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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: Neurological and Cardiac Concernssupporting

confidence: 79%

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

Self Cite

144

View full text Add to dashboard Cite

show abstract

“…As GAS infections in youth are common and possibly coincidental in this population, it is also difficult to establish causality in those patients who test positive. However, there has been a substantial body of literature linking GAS infections with OCD, eating restriction, and movement disorders including chorea and tics (Husby et al 1976;Swedo et al 1989Swedo et al , 1993Swedo et al , 1998Mercadante et al 2000;Leonard and Swedo 2001;Kirvan et al 2003;Hoffman et al 2004;Singer et al 2004;Kirvan et al 2006Kirvan et al , 2007Murphy et al 2007;Yaddanapudi et al 2010;Brimberg et al 2012;Lotan et al 2014;Toufexis et al 2014;Williams and Swedo 2014). …”

mentioning

confidence: 99%

Multidisciplinary Clinic Dedicated to Treating Youth with Pediatric Acute-Onset Neuropsychiatric Syndrome: Presenting Characteristics of the First 47 Consecutive Patients

Frankovich

Thienemann

Pearlstein

et al. 2015

Journal of Child and Adolescent Psychopharmacology

101

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Background: Abrupt, dramatic onset obsessive-compulsive disorder (OCD) and/or eating restriction with at least two coinciding symptoms (anxiety, mood dysregulation, irritability/aggression/oppositionality, behavioral regression, cognitive deterioration, sensory or motor abnormalities, or somatic symptoms) defines pediatric acute-onset neuropsychiatric syndrome (PANS). Descriptions of clinical data in such youth are limited. Methods: We reviewed charts of 53 consecutive patients evaluated in our PANS Clinic; 47 met PANS symptom criteria but not all met the requirement for ''acute onset.'' Patients meeting full criteria for PANS were compared with patients who had a subacute/insidious onset of symptoms. Results: Nineteen of 47 (40%) patients in the study had acute onset of symptoms. In these patients, autoimmune/inflammatory diseases and psychiatric disorders were common in first-degree family members (71% and 78%, respectively). Most acuteonset patients had a relapsing/remitting course (84%), prominent sleep disturbances (84%), urinary issues (58%), sensory amplification (66%), gastrointestinal symptoms (42%), and generalized pain (68%). Inflammatory back pain (21%) and other arthritis conditions (28%) were also common. Suicidal and homicidal thoughts and gestures were common (44% and 17%, respectively) as were violent outbursts (61%). Group A streptococcus (GAS) was the most commonly identified infection at onset (21%) and during flares (74%). Rates of the abovementioned characteristics did not differ between the acute-onset group and the subacute/insidious-onset groups. Low levels of immunoglobulins were more common in the subacute/insidious-onset group (75%) compared with the acute-onset group (22%), but this was not statistically significant ( p = 0.06). Conclusions: In our PANS clinic, 40% of patients had acute onset of symptoms. However, those with and without acute onset of symptoms had similar symptom presentation, rates of inflammatory conditions, somatic symptoms, and violent thoughts and behaviors. GAS infections were the most commonly identified infection at onset and at symptom flares. Because of the wide variety of medical and psychiatric symptoms, youth with PANS may require a multidisciplinary team for adequate care management.

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“…Curiosamente, um estudo recente do grupo do NIMH não verificou relação entre a presença de tiques e história de infecção estreptocócica 38 . O estudo, que envolveu quase 700 crianças, contraria os achados de Hoekstra et al 39 que constataram associação entre infecções e tiques em crianças, mas não em adultos.…”

Section: Construção Da Hipótese Auto-imune Pós-estreptocócica Na Síndunclassified

“…O estudo, que envolveu quase 700 crianças, contraria os achados de Hoekstra et al 39 que constataram associação entre infecções e tiques em crianças, mas não em adultos. No entanto, Murphy et al 38 demonstraram associação entre infecções estreptocócicas de repetição e alterações comportamentais como TDAH. Outros pesquisadores já haviam encontrado tal associação entre TDAH e infecção estreptocócica atual ou passada, sem que haja necessariamente CS 40,41 .…”

Section: Construção Da Hipótese Auto-imune Pós-estreptocócica Na Síndunclassified

Neurobiologia da síndrome de Tourette: a hipótese auto-imune pós-estreptocócica

Dias¹,

Kümmer²,

Hounie³

et al. 2008

Rev. psiquiatr. clín.

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ResumoContexto: A síndrome de Tourette (ST) caracteriza-se pela presença de tiques motores e pelo menos um tique fônico. Algumas semelhanças clínicas com a coréia reumática ou de Sydenham (CS) incentivaram a formulação da hipótese da existência de um grupo de transtornos neuropsiquiátricos associados a processo auto-imune decorrente de infecção estreptocócica (PANDAS). Objetivo: Revisar a literatura quanto às evidências em relação à hipótese de que mecanismos auto-imunes pós-estreptocócicos estão envolvidos na etiopatogênese da ST. Métodos: Revisão sistemática na base de dados MedLine com os termos "Tourette", "tic", "PANDAS", "antibodies", "streptococcal" e "rheumatic". Resultados: Retornaram 238 artigos da busca. Selecionaram-se 53 trabalhos, os quais tiveram suas referências bibliográficas também revisadas. São apresentados os resultados de estudos que avaliaram aspectos imunes na ST, incluindo anticorpos antiestreptocócicos e antinúcleos da base, e sua terapêutica imunebaseada, discutindo a validade do conceito de PANDAS. Conclusões: As evidências ainda não são satisfatórias no que tange a uma base auto-imune pós-estreptocócica para a ST. Um aprimoramento dos métodos investigativos e na seleção das amostras pode trazer maiores contribuições à questão. FMV, et al. / Rev Psiq Clín. 2008;35(6):228-35 Palavras-chave: Síndrome de Tourette, coréia de Sydenham, infecção estreptocócica, auto-imune, PANDAS, febre reumática, tiques. Dias AbstractBackground: Tourette's syndrome (TS) is characterized by the presence of motor tics and at least one phonic tic. Some clinical similarities with Sydenham's chorea (SC) lead to the hypothesis of a new group of disorders associated with an autoimmune process due to a streptococcal infection (PANDAS). Objective: To review the literature in search of evidence on the existence of post-streptococcal autoimmune mechanisms involved with the etiopathogenesis of TS. Methods: A systematic review with the terms "Tourette", "tic", "PANDAS", "antibodies", "streptococcal" and "rheumatic" was carried on using the MedLine. Results: The search found 238 articles. Fifty and three articles were selected which also had their references reviewed. The results of studies that investigated autoimmune aspects of TS, including anti-streptococcal and anti-basal ganglia anti-bodies, and immune-based therapy, were presented and discussed. Discussion: The evidences to date are not satisfactory regarding a post-streptococcal auto-immune process in ST. The improvement on investigative methods and sample selection might contribute to this question.

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Relationship of Movements and Behaviors to Group A Streptococcus Infections in Elementary School Children

Cited by 63 publications

References 29 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

Multidisciplinary Clinic Dedicated to Treating Youth with Pediatric Acute-Onset Neuropsychiatric Syndrome: Presenting Characteristics of the First 47 Consecutive Patients

Neurobiologia da síndrome de Tourette: a hipótese auto-imune pós-estreptocócica

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