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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

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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.

The Intricate Dance of Infections and Autoimmunity: An Interesting Paradox

Rao, A.P., Patro, D. The Intricate Dance of Infections and Autoimmunity: An Interesting Paradox. Indian J Pediatr (2023). https://doi.org/10.1007/s12098-023-04928-8

Besides genetic susceptibility, infections due to viruses, bacteria and protozoa have been implicated in the development of autoimmune diseases (AD). AD can be triggered in a genetically susceptible individual by infections that disrupt immunological tolerance towards self-antigens. Pathogens can initiate autoimmunity by way of molecular mimicry, bystander activation, epitope spreading or persistent infection with polyclonal activation. This review covers two main topics: (i) the mechanisms by which an infectious agent can trigger or worsen autoimmunity; and (ii) the correlation between specific infectious agents and AD in humans with special emphasis on multisystem inflammatory syndrome in children (MIS-C).

Concurrent Infection of the Human Brain with Multiple Borrelia Species
Golovchenko M, Opelka J, Vancova M, Sehadova H, Kralikova V, Dobias M, Raska M, Krupka M, Sloupenska K, Rudenko N. Concurrent Infection of the Human Brain with Multiple Borrelia Species. Int J Mol Sci. 2023 Nov 29;24(23):16906. doi: 10.3390/ijms242316906. PMID: 38069228; PMCID: PMC10707132.
  • Lyme disease (LD) spirochetes invade tissues, including the brain.
  • Immune evasion tactics: immune suppression, tolerance, antigenic variation, intracellular hiding, biofilms, and persistent forms.
  • Immune-privileged site invasion (e.g., brain) shields spirochetes from immune response and antibiotics.
  • Case study: Spirochetal DNA found in multiple brain regions of a deceased LD patient.
  • Co-infection detected: Borrelia burgdorferi and Borrelia garinii in distinct, non-overlapping brain areas.
  • Atypical spirochete morphology observed in both human and experimentally infected mouse brain tissue.
Caregiver Burden, Stress, and Relationship Cohesion Among Self-Identified Caregivers of Children with PANS
Tona JT, Ash J, Brown E, Campagna C, Kostek K, Lawton E, Rieth A, Tomita M. Caregiver Burden, Stress, and Relationship Cohesion Among Self-Identified Caregivers of Children with Pediatric Acute-Onset Neuropsychiatric Syndrome. J Child Adolesc Psychopharmacol. 2023 Nov;33(9):378-386. doi: 10.1089/cap.2023.0030. PMID: 37966363; PMCID: PMC10771873.
  • Among the 216 respondents, 79.6% exceeded the CBI threshold, indicating a need for respite in adult care receiver populations. On the CSAQ, 72.9% expressed high distress, 80.5% reported feeling overwhelmed, and 58.1% reported crying spells, meeting cutoffs for support/respite used in adult care receiver populations.
  • The majority of caregivers (85.5%) reported not having the desired degree of cohesion with their child on the IOS. Parents of children with more severe PNSS symptoms performed significantly worse on all measures (CBI: H = 57.83; CSAQ: F = 29.26; IOS: H = 38.04; p < 0.001 for all).

Common Comment Themes

  1. Severe caregiver and/or family emotional distress and trauma.
  2. Caregivers wondering what happened to their child.
  3. Lack of awareness and support among health and education professionals.
  4. Relationship strain with family, friends, and significant others.
  5. Financial and/or legal struggles due to their child’s diagnosis.

“Conclusion: There is strong need for support and respite for children with PANS and their families. Long-term effects including posttraumatic stress symptoms among family members should be studied.”

Transcranial magnetic stimulation for developmental neuropsychiatric disorders with inflammation

Vaishnavi S. Transcranial magnetic stimulation for developmental neuropsychiatric disorders with inflammation. Developmental Neuroscience. 2023;45(6):342–348. doi:10.1159/000535103

  • Reviews transcranial magnetic stimulation (TMS) as a noninvasive technique that induces electrical changes in the brain via magnetic fields.Describes how repetitive TMS can modulate synaptic and network-level plasticity.

  • Notes that inflammation negatively affects synaptic plasticity and that TMS may help address inflammation-related dysfunction.

  • Summarizes evidence suggesting TMS may directly downregulate inflammatory processes.

  • Highlights potential utility of TMS for neuropsychiatric symptoms in inflammatory neurodevelopmental disorders, including autism, Tourette syndrome, and OCD.

  • Emphasizes that TMS is best viewed as a technology platform for modulating dysfunctional brain networks and may expand as understanding of network dysfunction grows