ASOT - PANDAS

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Hi there,

 

My son was diagnosed with PANDAS in August, with a sudden, severe onset of vocal and motor tics - my story is under New Here so I will not go into it. At the time of the diagnosis his ASOT were at 700 - normal is below 200 I think. Last week when we got some other blood work done we also checked his ASOT - it was last Tuesday and he was essentially tic free at the time. I was shocked today to get the results of 1200 for ASOT, I was assuming he would be in the normal range - he is on prophylactic antibiotics right now --interestingly last night he complained of a sore throat but says it is fine today, ( the only other time I ever remember his complaining about a sore throat was a week before the PANDAS outbreak in August, we gave him advil and he did not mention it again) there was a very subtle increase in tics Friday and Sat a.m. that I had contributed to computer lab. I have seen no tics this am or at lunch. Has anyone had any experience with this? Would it be that his body is fighting a strep but now that it is much stronger thanks to the supplements etc. that he is fighting it without the result of the antibodies attacking his basal ganglia. I will be watching him like a hawk for any increases and get him to the doctor immediately. My doctor told me just to watch him and should there be a change to bring him in for an exam - he does not want to treat based on numbers which seems to make sense to me.

 

Thanks in advance for any info.

[Ronnas]

Allison...yeesh I just lost a long reply I was leaving...I will try and redo some of it...some of this is a repeat of what I posted on the anti-DNAse B thread but more specific to you.

 

Overall it is recommended to use anti-DNAse B titers to confirm previous or recurrent strep infections but this test is not very accessible in Canada and is only done at certain centers, therefore a ASOT is used here.

 

A throat culture is the most important test for confirming a strep throat infection.

 

Neither a streptozyme (this test is essentially useless) nor a ASOT are appropriate for the diagnosis of acute streptococcal thoat infections.

 

An elevated anti-strep titer such as an ASO or DNAse-B Antibody means the child has had a strep infection sometime within the past few months, and his body created antibodies to fight the strep. bacteria. Some children create lots of antibodies and have very high titers (up to 2,000), while others have more modest elevations. The height of the titer elevation doesn’t matter. Further, elevated titers are not a bad thing. They are measuring a normal, healthy response – the production of antibodies to fight off an infection. The antibodies stay in the body for some time after the infection is gone, but the amount of time that the antibodies persist varies greatly between different individuals. Some children have "positive" antibody titers for many months after a single infection.

 

Streptolysin O Antibody (ASO): The ASO test is used to provide serologic evidence of previous group A streptococcal infection in patients suspected of havinga non-suppurative complications, such as acute glomerulonephritis or acute rheumatic fever. Use of the ASO for diagnosis of an acute group A streptococcal infection is rarely indicated unless the patient has received antibiotics that would render the culture negative. An ASO performed on serum obtained during the presentation of a non-suppurative complication that shows a titer two dilutions above the upper limit of normal is evidence for an antecedent streptococcal infection. It is recommended, however, to use a second test such as the anti-DNAse B to confirm antecedent infections.

 

After being at this for nearly 4 years it has been over 2 years since my son has had bloodwork. I am biased in certain areas. I do not have Kurt on prophylactic antibiotics. We went through the exact same thing of the see saw effect on antibiotics. On them he did well...off he was worse. Probably a turning point was when we treated Kurt with clindamycin which is used to erradicate strep if you are a carrier. Kurt at no point ever responded to peniclllin though. Over the last 2 years I have probably had to treat Kurt with antibiotics 3-4 times for an increase in symptoms...he has always responded well within a few days. I think your doctor is correct in not treating based on #'s...just watch your son.

 

You know after all of my time spend learning and reading about PANDAS I think it is inevitable that they do still tic sometimes...just last night Kurt was ticcing (some new ones at that) while watching TV and it is no big deal and he does not seem to care. It is my general feeling he will outgrow this as he get older. I post alot on the TS forum b/c I don't just see my son as having just PANDAS anymore. I guess what I am trying to say is that with time it will be easier.

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Hi Ronna,

 

Now I know why I would get so confused trying to follow posts in the past!! Some answers on some posts and others found elsewhere - we were posting at the same this afternoon. Anyway, thanks for the info. In the summer my son was tested for both ASO and DNAse - and both were elevated, I am not sure why the doctor only did the ASO last week. I guess the test we had in August at 700 was when his body was beginning to fight the infections and maybe he is just a kid who has lots of antibodies? and the increased amount found last week at 1200 is left over from several months back? I guess it is a who knows kind of thing - and in a way who cares if he is doing well. I do know that the first time off the antibiotics when he had a huge increase in tics after a few days his throat culture did come back negative but we gave antibiotics anyway and within 3 days there was a 80% improvement.

 

So glad you and baby are doing well, you will be getting into the hopefully wonderful middle trimester.

 

Thanks again for the info.

 

 

 

PS I think I read recently on the braintalk site that you stopped the full supplements and went to a multivitamin, but then started back on the supplements, is this correct? Still no tics from my son this afternoon after school, and his says his throat does not hurt.