a new PANS study, a survey

[jan251]

J Child Adolesc Psychopharmacol. 2017 Jan 31. doi: 10.1089/cap.2016.0105. [Epub ahead of print]

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

Calaprice D1, Tona J2, Parker-Athill EC3, Murphy TK3,4.

 

http://online.liebertpub.com/doi/10.1089/cap.2016.0105 (full text link)

https://www.ncbi.nlm.nih.gov/pubmed/28140619

Abstract

OBJECTIVE:

To date, studies in the area of pediatric acute-onset neuropsychiatric syndrome (PANS; including pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection [PANDAS] and pediatric infection-triggered neuropsychiatric disorder [PITAND]) have been relatively small and hence unable to comprehensively address questions of disease heterogeneity (e.g., by age, gender), comorbidities, and progression. In this study, we investigated an internet survey sample to more fully characterize the phenotypic traits; medical, family, and developmental history; functional challenges; and clinical course associated with PANS.

METHODS:

Six hundred and ninety-eight patients with clinical diagnoses of PANS were included in this study. Participants, who included parents and legal guardians (for minors) or the PANS patients themselves (for those ages 18 and older), were asked to complete a 146-question survey designed to ascertain medical, developmental, and family history; PANS symptomatology; medical and nonmedical interventions for PANS; PANS course; PANS outcomes; and access to PANS care.

RESULTS:

Our results agree with previous findings concerning the core symptoms of PANS as well as its male predominance (65% in this survey) and infection-triggered onset, thus validating the study population. Infection was implicated as the primary inciting factor in 65% of patients; 54% of patients reported an association with group A streptococcus specifically. The results of this survey also revealed new findings, including a surprisingly strong impact of gender and pubertal status on symptom course and chronicity, a high rate of medical comorbidity suggesting generalized immune dysfunction, a profound impact of PANS episodes on functional status, and a role for early resolution of infection through antibiotic treatment in disease course.

CONCLUSIONS:

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.

Edited February 28, 2017 by jan251

[jan251]

adding another new study: https://www.ncbi.nlm.nih.gov/pubmed/28121463

 

http://online.liebertpub.com/doi/10.1089/cap.2016.0031 (full text link)

 

J Child Adolesc Psychopharmacol. 2017 Jan 25. doi: 10.1089/cap.2016.0031. [Epub ahead of print]

Prevalence of Acute-Onset Subtypes in Pediatric Obsessive-Compulsive Disorder.

Jaspers-Fayer F1,2, Han SH3, Chan E1, McKenney K4, Simpson A4, Boyle A4, Ellwyn R1, Stewart SE1,2,5,6,7.

 

RESULTS:

Among 136 youth with a lifetime OCD diagnosis, 5% (n = 7; 95% adjusted Wald interval: 1%-10%) met proposed criteria for PANDAS and/or PANS, of whom two met PANDAS criteria, four met PANS criteria, and one met criteria for both. Those in the PANDAS/PANS subgroup were more likely to have autoimmune illness, less likely to report symmetry factor symptoms, and had greater OCD-related family impairment during their worst OCD episode.

CONCLUSION:

A small yet significant percentage of pediatric OCD outpatients met criteria for PANDAS and/or PANS, justifying routine screening and attention to related characteristics during assessment and management. Longitudinal studies of these putative subtypes are warranted.

KEYWORDS:

neuropsychiatric

 

Edited February 28, 2017 by jan251

[jan251]

and a third: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5174185/ (full text link)

 

J Immunol Res. 2016;2016:8606057. doi: 10.1155/2016/8606057. Epub 2016 Dec 7.

Microglial Dysregulation in OCD, Tourette Syndrome, and PANDAS.

Frick L1, Pittenger C2.

Author information

Abstract

There is accumulating evidence that immune dysregulation contributes to the pathophysiology of obsessive-compulsive disorder (OCD), Tourette syndrome, and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS). The mechanistic details of this pathophysiology, however, remain unclear. Here we focus on one particular component of the immune system: microglia, the brain's resident immune cells. The role of microglia in neurodegenerative diseases has been understood in terms of classic, inflammatory activation, which may be both a consequence and a cause of neuronal damage. In OCD and Tourette syndrome, which are not characterized by frank neural degeneration, the potential role of microglial dysregulation is much less clear. Here we review the evidence for a neuroinflammatory etiology and microglial dysregulation in OCD, Tourette syndrome, and PANDAS. We also explore new hypotheses as to the potential contributions of microglial abnormalities to pathophysiology, beyond neuroinflammation, including failures in neuroprotection, lack of support for neuronal survival, and abnormalities in synaptic pruning. Recent advances in neuroimaging and animal model work are creating new opportunities to elucidate these issues.

Edited February 28, 2017 by jan251

[MomWithOCDSon]

Thanks, Jan!