Article about TS and PANDAS

[Kayanne]

Was this already posted?

 

Beth Maloney Referred to it in today's email update. I haven't seen it before, so I figured I would post it. I also haven't had a chance to read it yet.

 

The Immunobiology of Tourette’s Disorder, Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus, and Related Disorders: A Way Forward

 

http://www.liebertonline.com/doi/pdfplus/10.1089/cap.2010.0043

 

From:

 

JOURNAL OF CHILD AND ADOLESCENT PSYCHOPHARMACOLOGY

Volume 20, Number 4, 2010

ª Mary Ann Liebert, Inc.

Pp. 317–331

DOI: 10.1089/cap.2010.0043

[Kayanne]

This link will give you access to all of the articles in that issues (I think):

 

http://www.liebertonline.com/toc/cap/20/4

[JAG10]

"On the other hand, other virulence factors may be responsible for an increase in incidence of strep infections that present with minimal symptoms of pharyngitis (Krause 2002)."

 

Can someone explain this?

 

Why does very infectious result in minimal throat symptoms?

[Phasmid]

This means that the bacteria can take up residence in mucosal linings, reproduce, and survive without causing much in the way of outward symptoms. These are various physiologic mechanisms and adaptations of the cell wall.

[Phasmid]

This is a very complete review paper- summing up what has been published to date.

[Kayanne]

I just finished reading it (note: I tend to skim the scientific details because my eyes just glaze over because I don't understand it.), and I think overall it is pretty positive. Especially since Kurlan is listed as a co-author, and the article did point out the problems in Kurlan and Singer's studies. I liked this quote in reference to their work:

 

"The reasons for this discrepancy are not clear, but suggest that the PANDAS cases identified by these studies may not be the same as the PANDAS cases studied by Swedo and colleagues."

 

I don't like that they are still suggesting that SSRI's and CBT are the way to go still...but I can understand why they have to say that if there is still not good enough studies on antibiotic, and immune therapies.

 

Here is also another quote I really liked:

 

"In our view, the diagnostic criteria and the assessment methodologies used to identify PANDAS need to be refined to focus on the broad range of psychopathology ostensibly associated with PANDAS. Specifically, in PANDAS, the period of increased tic or OC symptom worsening is also associated with a sudden increase in the severity of psychiatric comorbidity including emotional lability, intense anxiety, cognitive deficits, oppositional behaviors, frequent urination, motoric hyperactivity, and/or dysgraphia (Swedo et al. 1998; Murphy and Pichichero 2002). This is not adequately captured if the criteria for an exacerbation focus simply on the change in OC or tic symptoms."

Edited November 10, 2010 by Kayanne

[Fixit]

Thank you for finding and posting this!!!!!!

[JAG10]

I just finished reading it (note: I tend to skim the scientific details because my eyes just glaze over because I don't understand it.), and I think overall it is pretty positive. Especially since Kurlan is listed as a co-author, and the article did point out the problems in Kurlan and Singer's studies. I liked this quote in reference to their work:

 

"The reasons for this discrepancy are not clear, but suggest that the PANDAS cases identified by these studies may not be the same as the PANDAS cases studied by Swedo and colleagues."

 

I don't like that they are still suggesting that SSRI's and CBT are the way to go still...but I can understand why they have to say that if there is still not good enough studies on antibiotic, and immune therapies.

 

Here is also another quote I really liked:

 

"In our view, the diagnostic criteria and the assessment methodologies used to identify PANDAS need to be refined to focus on the broad range of psychopathology ostensibly associated with PANDAS. Specifically, in PANDAS, the period of increased tic or OC symptom worsening is also associated with a sudden increase in the severity of psychiatric comorbidity including emotional lability, intense anxiety, cognitive deficits, oppositional behaviors, frequent urination, motoric hyperactivity, and/or dysgraphia (Swedo et al. 1998; Murphy and Pichichero 2002). This is not adequately captured if the criteria for an exacerbation focus simply on the change in OC or tic symptoms."

 

YES!!!!

Especially for the sound-bite media!!!

[SarahJane]

Great article. THANKS! I'm going to copy it & take it to our new doctor who has read all the PANDAS stuff I gave him...including Saving Sammy. Yay!

[thereishope]

Thank you for posting this!

[norcalmom]

Thanks for the post - at first I was thinking it was "the white paper" (and I was disappointed)...but it was published Aug 2010 (according to what I found). so it can't be. And it looks like the summary is basically saying "we need a white paper on dx and treatment" ...interesting that Kurlan's name is on it...

 

love the "pros, cons and inconclusive" chart of research supporting an infections/immune association with tics and ocd!!

[ShannonOtown]

Thank you for the link! It will go on top of the others in my notebook

 

Thank goodness for great doctors like Dr. Murphy, et al, that continue to study this disorder. I know one day it will be a common for doctors to recognize the symptoms (as easy as the forum parents can spot PANDAS) and diagnose our children.... One day hopefully soon.

[SarahJane]

Hey Kayanne...you posted a goldmine. This PANDAS article was also in that issue...found it following the 2nd link you provided. It's a Journal of Child and Adolescent Pharmacology...Special Issue on Obsessive-Compulsive Disorder and Tourette's Disorder. Good stuff!

 

http://www.liebertonline.com/doi/pdfplus/10.1089/cap.2010.0034

Comparison of Clinical Characteristics of Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections and Childhood

Obsessive-Compulsive Disorder

Gail A. Bernstein, M.D.,1 Andrea M. Victor, Ph.D.,2 Allison J. Pipal, M.A.,1 and Kyle A. Williams, M.D.3

 

This article gives the PANDAS characteristics as opposed to non-PANDAS OCD to help differentiate. Says more study is needed, but maybe docs will ask about strep or illness or other symptomatic responses to help identify PANDAS kids vs. just treating OCD. There's a good chart with characteristics (use it to check off the symptoms of your child...mine had almost all of them).

 

I don't recognize these authors, but maybe some of y'all do. And maybe this is old stuff, but it's new to me. Are these the articles that needed to be published before the white paper comes out? Wasn't there something about that from Dr. L a while back? Hope so!

[JAG10]

Table 4 is AWESOME and accentuates the point made in the other article about the over-emphasis on OCD and Tics in PANDAS rather than the broader range of associated neuro-psychiatric dysfunction that so frequently accompanies the OCD and Tics in our kids.

 

I was surprised there was not a wider difference in the age of onset.

[Phasmid]

Interesting passages:

Dr. Laurence Selling made one of the earliest reported cases of this potential correlation between the onset of tics and infectious disease in 1929 when he described three cases of tics associated with sinusitis (Selling 1929).

 

In 1998, a group from the National Institute of Mental Health further characterized (in a 50 patient case series) an entity they called pediatric autoimmune neuropsychiatric disorders associated with Streptococcus (PANDAS). Careful reading of these case series suggests that GAS is the inciting trigger and that future exacerbations are activated not only by GAS infection but also by GAS exposure and viral illness as well.

.