Strep and OCD

[Brenda]

My daughter who has a mild case of TS, has displayed OCD signs in the past. Recently, she developed a very sore throat and cough. She was put on Keflex antibiotic for it, but wasn't tested for strep, we were travelling at the time and I had to take her to a walk-in-clinic. I had to stop the Keflex because she had terrible stomach cramps from it. She stil complains of her throat hurting and coughs a fair bit, but we have just been treating it with motrin (uncolored) and cough syrup.

 

Since she got sick and started the antibiotics, her OCD has started up again. Has anyone else had this happen. I was thinking of having her tested for strep. Does a strep infection start OCD like it can start tics?

 

Thanks,

Brenda

[Chemar]

Does a strep infection start OCD like it can start tics?

 

Thanks,

Brenda

 

Hi Brenda..........YES strep triggers OCD, and in fact, early PANDAS research focussed far more on the effct of strep on OCD than on tics

 

some of our members have been reporting very positive results using the anitbiotic azithromycin aka zithromax

[Ronnas]

With PANDAS I have read that girls tend to have more OCD behaviors and boys more tics. Did you see an improvement when she was on the Keflex? Could the food colouring etc/additives in the motrin be a trigger? I would have a throat swab done if she still has a sore throat.

[Brenda]

Chemar and Ronnas,

 

Thanks for the info, I will contact her doctor and ask to have the throat swab done. Is there any benefit to having blood work done when testing for strep? I can't say that there was any real improvement to her throat or cough while on the antibiotic. She has taken both colorless motrin and Buckleys cough syrup before with no side-effects.

 

Also, when we were waiting at the walk-in clinic, there was a young man who had a pair of tweezers and was constantly picking at his lip area with them, not pulling out any hair, just picking at his skin. My daughter saw this and questioned what he was doing. Could seeing this behavior trigger OCD?

 

Thanks for your help,

Brenda

[Chemar]

Hi Brenda

 

the comprehensive BLOOD TEST is the ONLY accurate way to test for PANDAS (the throat swab can only detect strep throat, not the stealth strep)

 

as per the NIMH

Be sure to include a throat culture of group A B-hemolytic strep. Ask that the specimen be cultured, not just the rapid test.

MOST IMPORTANTLY do a blood test to assess elevated streptococcal antibodies (Anti-DNAse B and Antistreptolysin titers (ASO)).

 

and yes, seeing other people performing OCD or tics can be a trigger for susceptible people

[Pandamom]

Good luck Brenda,

My daughter has Pandas and her OCD definitely gets worse when she sees things that bother her. Her tics react the most strongly - especially if we are talking about them, they go into high gear. She has never had a positive throat swabe for strep but her blood work shows her titer levels to be really high and just getting higher every time we test her - that's how her doctor diagnosed the pandas through bloodwork.

 

Her ENT suspects the strep is living in her adnoids and tonsils and he is removing them at the end of the month. I'm fairly new to all this, and this forum is a great place for ideas.

 

Hope things get better, tracy

[Brenda]

Goodmorning everyone,

Just thought I'd share an update on my daughter. After the first round of antibiotics she became very sick again with sore throat, fever and nausea. I took her to her doctor who did a throat swab and ordered blood work for strep. He also gave her amoxicillin for a week. Her throat swab came back positive for strep. I don't have the blood work results yet.

 

She has been put on a daily dose of 250 mg amoxicillin for a month to clear her of strep. However, she has been having diarrhea and stomach aches which I am think are from the antibiotics. Should I continue with the anitbiotics or are there any natural ways of getting rid of strep?

 

Since her positive test for strep, I have made a deal with her to not have any junk food (candies, chips, colored drinks) for a month. We are into our second week and what a change in her. She is so much easier to get along with, much less argumentative. Even my husband and her older sister have noticed that she is much happier. I think that her OCD seems to be less, but I'm not sure if it is because she is being treated for strep or cleaning up the diet. Either way, I'm glad to see her doing better.

 

Take care,

Brenda

[Ronnas]

Hi Brenda,

 

I am glad you are noticing an improvement with your daughter. Because your daughter had a positive strep result overall I would recommend asking your doctor for a prescription for azithromycin if she is not tolerating the amoxicillin. Your doctor can determine the dose. My son is 10 years old, and about 80 pounds. He received 500 mg day 1 and then on day 2 to 5 received 250 mg and now we do azithromycin 500 mg once a week. Azithromycin has a very long half life which makes this possible and giving the antibiotic once a day or once a week prophylactically is so much easier. My son can swallow pills...I am not sure if azithromycin is available in liquid at that dose.

 

My son has done remarkably well on the azithromycin since the spring, no side effects and I am not kidding when I say it is the best 6 months we have had in 5 years.

 

Goggle "azithromycin and NIMH and PANDAS" and you should find the lastest research article from the NIMH that you can give to your doctor to support asking for azithromycin.

 

Take Care,

Ronna

[Tessa]

Brenda,

 

She really should also take probiotics to restore her gut flora to normal. I use "Culturelle" with my son twic a day while on the antibiotics and thenonce a day for 2-4 weeks longer. Stoneyfield Farms also has the good yogurt if your daughter eats dairy (my son doesn't).

 

Other may have other probiotic suggestions.

 

Good luck,

Tessa

[gremlin44]

My son can swallow pills...I am not sure if azithromycin is available in liquid at that dose.

 

My 34 pound 4 year old is on a once a week (1 1/4 tsp two times that day) dose of the liquid azithromycin.

[dominique]

Good luck Brenda,

My daughter has Pandas and her OCD definitely gets worse when she sees things that bother her. Her tics react the most strongly - especially if we are talking about them, they go into high gear. She has never had a positive throat swabe for strep but her blood work shows her titer levels to be really high and just getting higher every time we test her - that's how her doctor diagnosed the pandas through bloodwork.

 

Her ENT suspects the strep is living in her adnoids and tonsils and he is removing them at the end of the month. I'm fairly new to all this, and this forum is a great place for ideas.

 

Dear Pandamom.

My sons titer level is also high and his tonsils, and especially his adnoids, seem to be the concern.

Did your daughters removal surgery cure, or greatly benefit her condition?

Thanks for your help! Dominique

[dominique]

Hello pandamom, Im new at this so i hope im doing this correctly. I too have a child with Pandas

and just went to the ent. He wants my sons tonsils and adnoids removed asap do to the fact he feels

that the strep toxins could be harboring there. How did you daughters operation go? Did they test

her tonsil and adnoid tissue when removed for the bacteria. Has she had any strep episodes since

this was done? Im scheduled to have his operation very soon and would love to hear your results

and feelings on this procedure. Is tonsils acutually looked very good no scarring but his adnoids were

gigantic and blocking. As far as i know my son has only had one case of the strep A in the past and

had a severe onset of symptoms Today he his pretty much symptom free although he woke up this

morning with a sore throat. If going thru with this surgery did help to prevent another strep episode

i guess it would be well worth it. Did you find any articles on the results of culturing the specimens after

words whether or not they were positve for strep bacteria??

I hope to hear from you soon

 

 

Best to you and your daughter

Dominique.

[Ronnas]

Pediatric Autoimmune Neuropsychiatric Disorders and Streptococcal Infections: Role of Otolaryngologist.

 

Triological Society Papers

 

Laryngoscope. 111(9):1515-1519, September 2001.

Orvidas, Laura J. MD; Slattery, Marcia J. MD

Abstract:

Objective: To increase awareness and understanding of the putative role of streptococcal infection in the development of neuropsychiatric disorders in children and to discuss therapeutic options in this group of patients.

 

Methods: Case illustration and literature review.

 

Results: Two siblings, one with obsessive-compulsive disorder (OCD) and one with a tic disorder, had tonsillectomy for recurrent streptococcal pharyngitis. At the latest follow-up visit (11 mo postoperatively), both patients exhibited significant improvement in their psychiatric illnesses. We discuss these cases as well as the diagnosis, pathophysiology, and treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS).

 

Conclusion: PANDAS is an active area of research investigating the relationship between streptococcal infections and the development of obsessive-compulsive disorder or tic disorders (or both) in children. The etiopathogenesis of PANDAS is thought to reflect autoimmune mechanisms and involvement of the basal ganglia of susceptible hosts. Because otolaryngologists evaluate a large portion of pediatric patients with recurrent streptococcal pharyngitis, it is important to be aware of this association and to manage these patients appropriately.

 

PANDAS (Paediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infection).Lynch NE, Deiratany S, Webb DW, McMenamin JB.

Department of Paediatrics, Royal College of Surgeons in Ireland Medical School, Dublin.

 

PANDAS (Paediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infection) is a rare condition first described in 1998. It describes the presence of obsessive-compulsive disorder (OCD) or tics with an episodic course, and a temporal relationship to Group A beta haemolytic streptococcal infection (GABHS). Recurrent episodes can be disruptive and upsetting for a child, but the best way to treat the condition has yet to be established. Penicillin prophylaxis has not proved effective, and other therapies are experimental. There is some evidence in the literature to support the role of tonsillectomy in improving the condition. We report a case of a 6-year-old boy who presented with tic and hemi-chorea associated with GABHS throat infection. He had a recurrence of his symptoms associated with a further GABHS infection, but has had no further symptoms following tonsillectomy. This case report lends further evidence to the role of tonsillectomy in the management of PANDAS.

 

These are a few articles supporting tonsillectomy for PANDAS. The NIMH does not recommend removing the tonsils for PANDAS but it something that comes up lots with parents with children with PANDAS, especially on the PANDAS message boards through Yahoo...I wish I had answers for all of your questions. I understand how confusing it all can be. If your son's doctor thought it was appropriate to have his tonsils out then it could be the way to go. Since your son is symptom free at the time hopefully having his tonsils out wil prevent future strep infections and you will not have any further tics, etc. Only time will tell...what I can tell you is that with time things will get easier. In our situation my son is doing really well on azithromycin and at the age of 10 seems to be outgrowing some of this. Take care, Ronna