Therapeutic Plasma Apheresis as a Treatment for 35 Severely Ill Children and Adolescents with Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections

Latimer, Maya; L’Etoile, Nathan; Seidlitz, Jakob; Swedo, Susan E.

doi:10.1089/cap.2014.0080

Cited by 48 publications

(42 citation statements)

References 26 publications

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“…Milder symptoms of the disease can be treated with the usage of non-steroidal anti-inflammatory drugs, whereas more severe symptoms are treated with intravenous immunoglobulins. Plasma exchange can be applied in cases when symptoms are of such intense severity that may be life-threatening [202]. Application of plasmapheresis may also lead to the stabilization of the basal ganglia volumes, which are altered during the disease [141,[203][204][205].…”

Section: Other Treatment Strategiesmentioning

confidence: 99%

Alterations in the Nervous System and Gut Microbiota after β-Hemolytic Streptococcus Group A Infection—Characteristics and Diagnostic Criteria of PANDAS Recognition

Baj

Sitarz

Forma

et al. 2020

IJMS

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The objective of this paper is to review and summarize conclusions from the available literature regarding Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS). The authors have independently reviewed articles from 1977 onwards, primarily focusing on the etiopathology, symptoms, differentiation between similar psychiatric conditions, immunological reactions, alterations in the nervous system and gut microbiota, genetics, and the available treatment for PANDAS. Recent research indicates that PANDAS patients show noticeable alterations within the structures of the central nervous system, including caudate, putamen, globus pallidus, and striatum, as well as bilateral and lentiform nuclei. Likewise, the presence of autoantibodies that interact with basal ganglia was observed in PANDAS patients. Several studies also suggest a relationship between the presence of obsessive-compulsive disorders like PANDAS and alterations to the gut microbiota. Further, genetic predispositions—including variations in the MBL gene and TNF-α—seem to be relevant regarding PANDAS syndrome. Even though the literature is still scarce, the authors have attempted to provide a thorough insight into the PANDAS syndrome, bearing in mind the diagnostic difficulties of this condition.

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Section: Other Treatment Strategiesmentioning

confidence: 99%

Alterations in the Nervous System and Gut Microbiota after β-Hemolytic Streptococcus Group A Infection—Characteristics and Diagnostic Criteria of PANDAS Recognition

Baj

Sitarz

Forma

et al. 2020

IJMS

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“…A significant fraction of children with PANS have low levels of immunoglobulins, a disorder that is otherwise rare, in addition to autoantibodies Murphy et al 2015a). Medical intervention for children with PANS has therefore included immunomodulatory treatments such as intravenous immunoglobulins (IVIGs) (Allen et al 1995;Perlmutter et al 1999;Kovacevic et al 2015), therapeutic plasmapheresis, or plasma exchange (Allen et al 1995;Perlmutter et al 1999;Latimer et al 2015), as well as antibiotics (Snider and Swedo 2004;Murphy et al 2015a), with mixed reports on efficacy in relieving symptoms.…”

Section: Historical Perspectivementioning

confidence: 99%

A Survey of Pediatric Acute-Onset Neuropsychiatric Syndrome Characteristics and Course

Calaprice¹,

Tona

Parker-Athill

et al. 2017

Journal of Child and Adolescent Psychopharmacology

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This study serves as the first survey of its size to provide insight into the global clinical picture and range of phenotypes of PANS patients. Significant results included the impact of gender and pubertal status on phenotype, affirmation of the role of the immune system in PANS pathology, and the role of timely resolution of infection in clinical outcomes. Understanding how PANS presents in a broad population-based sample, within the limitations of a self-selected and administered online survey, is an important step toward improving diagnosis, creating more targeted treatment options, educating the clinical and research community, and generating hypotheses for future prospective research.

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“…In a randomised placebo-controlled trial of plasma exchange and intravenous immunoglobulin in 29 children with PANDAS, both treatments produced striking improvements in obsessive-compulsive disorder at 1 month after treatment, with a greater improvement in the plasma exchange group than in the intravenous immunoglobulin group 75. In addition, a recent retrospective series 35 patients with PANDAS also found significant improvement in symptoms of obsessive-compulsive disorder, tics and anxiety following plasma exchange 76…”

Section: Introductionmentioning

confidence: 99%

Plasma exchange in neurological disease

et al. 2019

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Plasma exchange is a highly efficient technique to remove circulating autoantibodies and other humoral factors rapidly from the vascular compartment. It was the first effective acute treatment for peripheral disorders such as Guillain-Barré syndrome and myasthenia gravis before intravenous immunoglobulin became available. The recent recognition of rapidly progressive severe antibody-mediated central nervous system disorders, such as neuromyelitis optica spectrum disorders and anti-N-methyl-D-aspartate-receptor encephalitis, has renewed interest in using plasma exchange for their acute treatment also. In this review we explain the principles and technical aspects of plasma exchange, review its current indications, and discuss the implications for its provision in the UK.

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Therapeutic Plasma Apheresis as a Treatment for 35 Severely Ill Children and Adolescents with Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections

Abstract: Therapeutic plasma apheresis is an invasive medical intervention that should be reserved for treatment of children and adolescents who are severely affected by PANDAS. In such patients, it appears to be a safe, well-tolerated, and beneficial treatment option.

Cited by 48 publications

References 26 publications

Alterations in the Nervous System and Gut Microbiota after β-Hemolytic Streptococcus Group A Infection—Characteristics and Diagnostic Criteria of PANDAS Recognition

Alterations in the Nervous System and Gut Microbiota after β-Hemolytic Streptococcus Group A Infection—Characteristics and Diagnostic Criteria of PANDAS Recognition

A Survey of Pediatric Acute-Onset Neuropsychiatric Syndrome Characteristics and Course

Plasma exchange in neurological disease

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