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Folate Receptor Alpha Autoantibodies in the Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) Population

Wells L, O’Hara N, Frye RE, Hullavard N, Smith E. Folate Receptor Alpha Autoantibodies in the Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) Population. Journal of Personalized Medicine. 2024; 14(2):166. https://doi.org/10.3390/jpm14020166

Folate receptor alpha autoantibodies (FRAAs) are linked to two conditions: cerebral folate deficiency (CFD) and autism spectrum disorder (ASD). These conditions share similarities with Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) and Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS).

  • The research suggests that FRAAs might play a role in PANS/PANDAS symptoms.
  • Blood samples from 47 young patients diagnosed with PANS/PANDAS were sent for FRAA analysis.
  • 63.8% of these patients had FRAAs, with various types present.
  • Surprisingly, lower FRAA levels were associated with ASD, while higher levels were linked to severe tics.
  • A case study shows treatment with leucovorin improved symptoms in a FRAA-positive PANS/PANDAS patient.
  • These findings suggest that FRAAs are linked to PANS/PANDAS and that issues with folate metabolism might contribute to symptoms. Further research on leucovorin’s potential in treating PANS/PANDAS is necessary, offering a promising alternative treatment option
Sensory processing in children with Paediatric Acute-onset Neuropsychiatric Syndrome
Newby, M. J., Lane, S. J., Haracz, K., Tona, J., Palazzi, K., & Lambkin, D. (2024). Sensory processing in children with Paediatric Acute-onset Neuropsychiatric Syndrome. Australian Occupational Therapy Journal, 1–11. https://doi.org/10.1111/1440-1630.12935
Conclusion:
  • Children with PANS experience significant sensory reactivity differences during exacerbation and remission across multiple sensory domains, with a decline in performance during exacerbation.
  • Where occupational performance challenges exist, occupational therapists should consider administering sensory assessments so that effective intervention plans can be developed to address the unique sensory reactivity needs of children with PANS.
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.
    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.