Tics - new symptom - after long period of recovery

[Rain]

My DS who is almost 14 has suddenly developed a mild facial tic (about a month ago). Tics were never part of his PANS presentation. It is not debilitating, and hardly noticeable. He is currently on prophylactic augmentin, but no other medicines. We increased antibiotics for 10 days with no change. We also got his blood tested, and all levels are normal, and strep titers are at an all-time low.

 

Background:

 

Around October 2010, DS developed sudden OCD. In April of 2011, he had not improved with CBT and EPRT - so medication was recommended. Almost as an afterthought before writing the prescription, his psychiatrist said, "And we've ruled out strep, right?" DS got a rapid swab that day - which was positive - and our lives were suddenly changed forever. We tried antibiotics, saw some improvement, but the improvement did not last. Ultimately we found our way to Dr. K, who recommended IVIG. Our treating pediatrician ordered the IVIG at a local hospital using Dr. K's protocol. It seemed to work for about 8 months. He then relapsed in May 2012 due to a pneumonia infection. He got a second IVIG in Sept 2012 (this time administered by Dr. K). Though the second IVIG took longer to "work," since about March of 2013, DS has been 90% symptom free. He is well into puberty (voice lower, and he is 6 feet tall).

 

Questions:

So what do we do about this tic? He does not notice it, and it is most pronounced at night. He has no other PANS symptoms. Is it worth doing anything when it still almost completely OK? Do you think this is an indicator of a different infection?

 

Thank you for any guidance you can offer!

 

 

 

 

 

 

 

 

[qannie47]

call dr. K

[Missmom]

Could be stress from school starting, less sleep due to having to get up earlier also don't rule out any seasonal allergies. Try giving an antihistamine like benedril before bed. It will help him sleep better and relax his system as well as help with seasonal allergies.

[dasu]

Do you know if he is around any strep carriers? I realize this is a gray area but we have noticed that PANS symptoms seem to be aggravated when around strep carriers.

[Rain]

Thanks all.

 

Re Dr. K - I have been trying to contact Dr. K. In response to my email, he said my son's file is closed,and I have to call his office. I have called the office a few times, and keep getting the answering service. I think I will get more aggressive about calling.

 

Re stress from school/allergies - maybe. It started a couple weeks before school started. He was having allergies at that time, but the allergies have subsided, and the tics remain. They may even be getting worse - but it is hard to say because they vary from day to day.

 

Re strep carriers - I don't think so. Everyone in the house gets tested "all the time." No one new has been around, and no new animals. He did start school - but that was after the tics started.

 

He seems so happy and otherwise healthy. I would leave it alone, but I have am terrified of a full scale relapse.

 

Thanks again for your thoughts.

[Rain]

Update - I did talk with Dr. K. He recommended the "Streptozyme" test. After the negative ASO and AntiDNASE, the streptozyme WAS POSITIVE. I feel like I should know by now that it is always strep, even if we never get a positive test result.

 

Now we will treat for strep (again - we already did one course of treatment) then do a 5-day steroid course (per Dr. K). Dr. K thinks the tics will resolve in 2-3 weeks.