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Pediatric de novo movement disorders and ataxia in the context of SARS-CoV-2

Wilpert, NM., de Almeida Marcelino, A.L., Knierim, E. et al. Pediatric de novo movement disorders and ataxia in the context of SARS-CoV-2. J Neurol 270, 4593–4607 (2023). https://doi.org/10.1007/s00415-023-11853-5

Our data suggest that children with de novo movement disorders, and cerebellar inflammation can benefit from immune-modulating therapy, especially methylprednisolone, despite negative results in clinical investigations.

PANDAS – a rare but severe disorder associated with streptococcal infections; Awareness is needed, Acta Oto-Laryngologica Case Reports,
Karin Frånlund & Charbél Talani (2023) PANDAS – a rare but severe disorder associated with streptococcal infections; Awareness is needed, Acta Oto-Laryngologica Case Reports, 8:1, 104-107, DOI: 10.1080/23772484.2023.2231146
“We present a case of PANDAS with the aim of raising awareness of its diagnosis. PANDAS is a rare condition with an impact on the patient’s quality of life; thus, awareness is needed. A multidisciplinary team is needed for diagnosis and treatment. Otorhinolaryngologists may play an important role in the well-being of these patients when performing tonsillectomy.”
Autoantibodies in patients with obsessive-compulsive disorder: a systematic review
Denzel D, Runge K, Feige B, Pankratz B, Pitsch K, Schlump A, Nickel K, Voderholzer U, Tebartz van Elst L, Domschke K, Schiele MA, Endres D. Autoantibodies in patients with obsessive-compulsive disorder: a systematic review. Transl Psychiatry. 2023 Jul 3;13(1):241. doi: 10.1038/s41398-023-02545-9. PMID: 37400462; PMCID: PMC10318087.

Emerging evidence suggests that biological components, especially autoimmune processes, may be associated with some cases of OCD and treatment resistance. Therefore, this systematic literature review summarizing all case reports/case series as well as uncontrolled and controlled cross-sectional studies investigating autoantibodies in patients with OCD and obsessive-compulsive symptoms (OCS) was performed. In summary, the available case reports suggest an association between OCD and autoantibodies in rare cases, which has been supported by initial cross-sectional studies. However, scientific data is still very limited. Thus, further studies on autoantibodies investigated in patients with OCD compared with healthy controls are needed.

  • Nine case reports with autoantibody-associated OCD/OCS were identified: five patients with anti-neuronal autoantibodies (against N-methyl-D-aspartate-receptor [NMDA-R], collapsin response mediator protein [CV2], paraneoplastic antigen Ma2 [Ma2], voltage gated potassium channel complex [VGKC], and “anti-brain” structures) and four with autoantibodies associated with systemic autoimmune diseases (two with Sjögren syndrome
  • one with neuropsychiatric lupus
  • one with anti-phospholipid autoantibodies).
  • Six patients (67%) benefited from immunotherapy.
  • In addition, eleven cross-sectional studies (six with healthy controls, three with neurological/psychiatric patient controls, and two uncontrolled) were identified with inconsistent results, but in six studies an association between autoantibodies and OCD was suggested.
Evaluation of C4 gene copy number in Pediatric Acute Neuropsychiatric Syndrome

Kalinowski A, Tian L, Pattni R, Ollila H, Khan M, Manko C, Silverman M, Ma M, Columbo L, Farhadian B, Swedo S, Murphy T, Johnson M, Fernell E, Gillberg C, Thienemann M, Mellins ED, Levinson DF, Urban AE, Frankovich J. Evaluation of C4 gene copy number in Pediatric Acute Neuropsychiatric Syndrome. Dev Neurosci. 2023 Jun 28. doi: 10.1159/000531707. Epub ahead of print. PMID: 37379808.

Pediatric acute-onset neuropsychiatric syndrome (PANS) is an abrupt-onset neuropsychiatric disorder. PANS patients have an increased prevalence of comorbid autoimmune illness, most commonly arthritis. In addition, an estimated one-third of PANS patients present with low serum C4 protein, suggesting decreased production or increased consumption of C4 protein. To test the possibility that copy number (CN) variation contributes to risk of PANS illness, we compared mean total C4A and total C4B CN in ethnically matched subjects from PANS DNA samples and controls (192 cases and 182 controls). Longitudinal data from the Stanford PANS cohort (n = 121) were used to assess whether the time to juvenile idiopathic arthritis (JIA) or autoimmune disease (AI) onset was a function of total C4A or C4B CN. Lastly, we performed several hypothesis-generating analyses to explore the correlation between individual C4 gene variants, sex, specific genotypes, and age of PANS onset. Although the mean total C4A or C4B CN did not differ in PANS compared to controls, PANS patients with low C4B CN were at increased risk for subsequent JIA diagnosis (hazard ratio = 2.7, p value = 0.004). We also observed a possible increase in risk for AI in PANS patients and a possible correlation between lower C4B and PANS age of onset. An association between rheumatoid arthritis and low C4B CN has been reported previously. However, patients with PANS develop different types of JIA: enthesitis-related arthritis, spondyloarthritis, and psoriatic arthritis. This suggests that C4B plays a role that spans these arthritis types.

Exploring the Complex Associations Between Prenatal and Early-Life Infections and Obsessive-Compulsive and Tic-Related Disorders
Hirschtritt ME, Mathews CA. Exploring the Complex Associations Between Prenatal and Early-Life Infections and Obsessive-Compulsive and Tic-Related Disorders. Biol Psychiatry. 2023 Jun 1;93(11):959-961. doi: 10.1016/j.biopsych.2023.03.003. PMID: 37197834.
“techniques led to an understanding that autoimmunity induced by streptococcal
throat infection caused damage to multiple organ systems in … posited a diagnostic
entity named pediatric autoimmune neuropsychiatric disorders associated with …”