Posts by:
Gabriella True

Biria, M., Banca, P., Healy, M.P. et al. Cortical glutamate and GABA are related to compulsive behaviour in individuals with obsessive compulsive disorder and healthy controls. Nat Commun 14, 3324 (2023). https://doi.org/10.1038/s41467-023-38695-z

A Cambridge neuroimaging study found that compulsive behavior is associated with glutamate–GABA imbalance, particularly elevated glutamate, across both individuals with OCD and healthy controls. Using ultra–high field MRS, the authors show that compulsivity maps to excitatory–inhibitory imbalance in brain regions involved in habit formation and control. These findings support a mechanism-based view of compulsive symptoms, while underscoring the need for caution when targeting glutamatergic systems clinically due to their broader downstream effects. The findings are particularly relevant given increasing clinical interest in glutamate-modulating medications, which are sometimes used off-label in OCD and neuroimmune conditions. At the same time, the study reinforces the need for caution: altering glutamatergic systems can have complex downstream effects, especially in conditions where dopamine and immune signaling may also be involved. This work strengthens the rationale for mechanism-focused research while underscoring why individualized, carefully monitored treatment remains essential.

Howe de la Torre, S., Parlatini, V., & Cortese, S. (2023). Long-term central nervous system (CNS) consequences of COVID-19 in children. Expert Review of Neurotherapeutics, 23(8), 703–720. https://doi.org/10.1080/14737175.2023.2239500

Read a deeper dive into Pediatric Long COVID: Neurological and Neuropsychiatric Symptoms

• Neurological and neuropsychiatric symptoms are commonly reported in children and adolescents with long COVID, including headache, fatigue, cognitive difficulties, mood changes, and sleep problems
• Reported prevalence varies widely due to study heterogeneity, small sample sizes, and limited long-term follow-up
• Beyond mood and sleep issues, many neuropsychiatric conditions remain underexamined in pediatric long COVID
• Persistent symptoms may significantly affect daily functioning and well-being

• Many of our patients often have “dry” arthritis (no effusions found on physical exam) but subtle effusions detected by imaging and features of spondyloarthritis, enthesitis, and synovitis. Joint capsule thickening, not previously reported in children, is a common finding in the presented cases and in psoriatic arthritis in adults.
• Due to the severity of psychiatric symptoms in some cases, which often overshadow joint symptoms, and concomitant sensory dysregulation (making the physical exam unreliable in the absence of effusions), we rely on imaging to improve sensitivity and specificity of the arthritis classification.
• We also report the immunomodulatory treatments of these 7 patients (initially nonsteroidal anti-inflammatory drugs and disease-modifying antirheumatic drugs with escalation to biologic medications) and note any coincidental changes to their arthritis and psychiatric symptoms while on immunomodulation.
• Patients with overlapping psychiatric syndromes and arthritis may have a unifying cause and pose unique challenges; a multi-disciplinary team can utilize imaging to tailor and coordinate treatment for this patient population.

Pisetsky, D.S. Pathogenesis of autoimmune disease. Nat Rev Nephrol 19, 509–524 (2023). https://doi.org/10.1038/s41581-023-00720-1

• Autoimmune diseases lead to diverse patterns of inflammation and organ dysfunction.
• Autoantibodies are valuable markers for diagnosis, classification and of disease activity.
• Although T cells play a key part in disease, their assessment is challenging.
• Autoimmune disease reflects the interplay of genetic and environmental factors.
• Pre-clinical autoimmune disease provides a window of time for early or preventive treatment.