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Gabriella True

Case report: Diagnosis and intervention of a non-24-h sleep–wake disorder in a sighted child with a psychiatric disorder

Carla Estivill-Domènech, Carla Estivill-Domènech. Case report: Diagnosis and intervention of a non-24-h sleep–wake disorder in a sighted child with a psychiatric disorder. Front. Psychiatry, 05 January 2024. Sec. Sleep Disorders. Volume 14 – 2023 | https://doi.org/10.3389/fpsyt.2023.1129153

Overview:

  • Circadian Rhythm Sleep-Wake Disorders (CRSWD) are sleep issues linked to circadian function. These disorders cause insomnia or excessive sleepiness due to the circadian pacemaker not aligning with a 24-hour light/dark cycle. Free-running disorder or Hypernycthemeral Syndrome (N24SWD) leads to a prolonged sleep-wake cycle, often seen in blind individuals. N24SWD is rare among those with healthy vision but affects 70% of blind individuals. In sighted cases, it mostly occurs in young men (80%), with 28% having a psychiatric disorder.

Specific Case:

  • The patient, a 14-year-old boy with psychiatric pathology and PANDAS syndrome, experienced sudden intense anxiety, mood swings, and obsessive-compulsive-like issues associated with a streptococcal A infection. He also had a non-24-hour sleep-wake disorder (N24SWD), leading to severe insomnia and irregular sleep patterns.
  • The patient’s irregular sleep pattern worsened daily routines, including school attendance, and exacerbated psychiatric symptoms.
  • The association of PANDAS and N24SWD in the same case is unique and not previously reported in the literature.

Treatment:

  • The initial treatment focused on acute infection and psychiatric symptoms.
  • Sleep pathology was addressed with light therapy and melatonin.
  • After 8 months of various trials, a treatment plan normalized symptoms, established a regular sleep pattern, and reduced daytime anxious symptoms
    Tafenoquine-Atovaquone Combination Achieves Radical Cure and Confers Sterile Immunity in Experimental Models of Human Babesiosis

    Pratap Vydyam, Anasuya C Pal, Isaline Renard, Meenal Chand, Vandana Kumari, Joseph C Gennaro, Choukri Ben Mamoun, Tafenoquine-Atovaquone Combination Achieves Radical Cure and Confers Sterile Immunity in Experimental Models of Human Babesiosis, The Journal of Infectious Diseases, 2024;, jiad315, https://doi.org/10.1093/infdis/jiad315

    • The 8-aminoquinoline antimalarial drug tafenoquine inhibits the growth of different Babesia species in vitro, is highly effective against Babesia microti and Babesia duncani in mice and protects animals from lethal infection caused by atovaquone-sensitive and -resistant B. duncani strains.
    • A combination of tafenoquine and atovaquone achieves cure with no recrudescence in both models of human babesiosis.
    • The elimination of B. duncani infection in animals following drug treatment also confers immunity to subsequent challenge.
    • The data demonstrate superior efficacy of tafenoquine plus atovaquone combination over current therapies for the treatment of human babesiosis and highlight its potential in providing protective immunity against Babesia following parasite clearance.
    Autism-Like Presentation of Possible Autoimmune Encephalitis With Complete Recovery After Immunotherapy
    Kim Y, Jang Y, Lee S, Chu K. Autism-Like Presentation of Possible Autoimmune Encephalitis With Complete Recovery After Immunotherapy. J Clin Neurol. 2024 Jan;20(1):97-99. doi: 10.3988/jcn.2023.0245. PMID: 38179638; PMCID: PMC10782083.
    • No autoantibodies detected.
    • Rapid psychiatric symptoms, including staring and visual hallucinations, pointed to autoimmune encephalitis.
    • Recovery: Complete improvement with immunotherapy suggests an autoimmune origin.
      • Careful diagnosis is crucial, as early signs of autism and autoimmune encephalitis can overlap. Further research needed on autoimmune encephalitis antibodies in autism.
      Microbes and Mental Illness: Past, Present, and Future
      Bransfield RC, Mao C, Greenberg R. Microbes and Mental Illness: Past, Present, and Future. Healthcare (Basel). 2023 Dec 29;12(1):83. doi: 10.3390/healthcare12010083. PMID: 38200989; PMCID: PMC10779437.

      The review highlights five infectious diseases linked to mental illness: toxoplasmosis, COVID-19, Lyme borreliosis, and streptococcal infections/PANDAS/PANS. It emphasizes the significant role of indirect infection mechanisms, such as inflammation, neuroinflammation, autoimmunity, and neurophysiological changes, in the development and progression of some mental illnesses. The persistence of these processes can lead to chronic effects on brain structure and function. Recognizing the microbial impact on mental health is crucial, and understanding this association may lead to increased use of antimicrobial and immune-modulating agents in psychiatric treatment, preventing and reducing mental illness morbidity, disability, and mortality. Clinicians must consider infectious diseases in explaining mental health symptoms, especially in cases of treatment-resistant conditions.

      Treatment approaches must be individualized and often involve a multidisciplinary strategy to include three fundamental areas: addressing infections or contributors, implementing immune interventions, and managing resulting symptoms. Intervention choices depend on understanding the disease process, the interplay of disease contributors, and the primary driver of disease perpetuation and progression. Consider antimicrobials in cases of inadequate psychotropic response and potential infection. Immune-modulating interventions may be necessary for immune-mediated symptoms from active or prior infections or non-infection immune provocation. Factors like immune suppression, excessive inflammation, autoimmunity, and adaptive immunity failure influence immune intervention choices. Non-infection environmental factors, including toxin exposure, should be considered and minimized. For relapses, revisit effective past treatments; treatment-resistant cases may require exploring unused options. Regular treatment revisions are essential, guided by symptom improvement or disease changes. Ongoing assessment is crucial, recognizing that the initial cause may differ from what perpetuates the condition, leading to necessary treatment approach adjustments.

       

       

      A Paradigm Shift in the Utilization of Therapeutic Plasmapheresis in Clinical Practice

      Kiprov DD, A Paradigm Shift in the Utilization of Therapeutic Plasmapheresis in Clinical Practice.
      Ann Clin Med Case Rep. 2023; V12(5): 1-7. ISSN 2639-8109 Volume 12

      Read Conceptual Paper

      We report our experience in treating patients with TPE on an outpatient basis with several different medical conditions (Alzheimer’s disease, Long Covid, PANDAS) and prophylactically in older individuals for the attenuation of inflammaging.

      PANDAS is another condition that is the result of postinfectious autoimmunity mediated through cross-reactive antibodies produced against molecular “mimics” or epitopes on the GAS cells that resemble host antigens [24]. Removal of these autoantibodies with TPE should result in symptomatic improvement.

      We treated 7 patients with PANDAS over a period of 2 years. Patients were referred for TPE because they had severe symptoms with marked impairment of function at home, at school
      and with peers, and had not responded to treatment with antibiotics, corticosteroids, and high dose IVIG.

       

       

      Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) Syndrome: A 10-Year Retrospective Cohort Study in an Italian Centre of Pediatric Rheumatology

      La Bella S, Attanasi M, Di Ludovico A, Scorrano G, Mainieri F, Ciarelli F, Lauriola F, Silvestrini L, Girlando V, Chiarelli F, et al. Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) Syndrome: A 10-Year Retrospective Cohort Study in an Italian Centre of Pediatric Rheumatology. Microorganisms. 2024; 12(1):8. https://doi.org/10.3390/microorganisms12010008

      PANDAS syndrome, a rare condition in prepubertal children, presents with sudden tic disorders and/or OCD following a documented GAS infection. Current classification criteria lack specificity, resulting in misdiagnosis. In our study, 61 patients were screened by the Pediatric Rheumatology unit for suspected PANDAS, but only 19 met the criteria. Tic disorders, especially in the eyes and head/neck, were predominant, with common vocal tics and less documented OCD. Treatment with antibiotics often led to clinical improvement. Larger, controlled studies are essential to understanding PANDAS characteristics and therapeutic responses comprehensively.