Headaches, lethargy, and a return of tics

[becjonz]

10 yr DS dx w/ PANDAS in 2/10. Symptoms began in 7/09 included tics, anxiety, ADHD, behavior changes including irritability and aggression, sleep changes and suddenly "caught everything" in a kid who previously never seemed sick.

 

Titers:

3/3/10 - ASO neg/ Anti DNAse B 480

5/10/10- ASO 229/ MP 2.26/ wrong AntiDNA run (flare up week previous to this)

5/24/10- Anti DNAse B 480

week of 5/24 strep exposure and flare up

5/27/10 ASO 237/ strep culture negative

 

In March Matt was on amox HD for 10 days, switched to low dose> hives, penicillin>hives,zith>hives

taken off prophylactic abx (he was supposed to remain on through June) for fear of allergy

Left on sertraline for anxiety and guanfacine. Guanfacine for a week but tired all the time, seemed drugged switched to Risperidone for tics.

 

In begininning of May he was referred to allergist (appt. is June 10th) and risperidone was doubled (total was.25mg) for tics for two weeks. No abx since allergy is still in question.

Flare up last week, no abx given still due to allergy despite my begging and willingness to deal w/ consequences, but instead sertraline doubled to 50mg, risperidone doubled for 5 days, and Intuniv ER 1mg added for tics.

 

He started that regimen on 5/29, he reported he felt better, school was better, noticeable change in ADHD and tics but not tired or overly medicated seeming. Reduced risperidone Monday. Tuesday at school tics increased so much he was unable to do school work since it was his writing hand. Today had a headache, said he felt weak and fell asleep in class, motrin didn't help, brought him home and he has been sleeping for the past few hours.

 

He was embarrassed to even tell me about school yesterday, and unable to even report out about how he is feeling. Do I just need to hold out until abx question is solved or can anyone think of something else I should be doing for him or questions I should be asking the doctor. I hate for him to be over medicated but I don't even feel clear on that- he has not been consistently lethargic since med change. Ideas?