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Brain-Immune Alterations and Mitochondrial Dysfunctions in a Mouse Model of Paediatric Autoimmune Disorder Associated with Streptococcus: Exacerbation by Chronic Psychosocial Stress

Ajmone-Cat MA, Spinello C, Valenti D, Franchi F, Macrì S, Vacca RA, Laviola G. Journal of Clinical Medicine. 2019; 8(10):1514. DOI: 10.3390/jcm8101514

  • Adverse psychosocial experiences have been shown to modulate individual responses to immune challenges and affect mitochondrial functions.
  • Results show chronic psychosocial stress altered the expression of neuroinflammatory markers in the hippocampal and hypothalamic regions, exacerbated the neuroinflammatory alterations induced by experimental GAS exposures in the same areas.
  • Psychosocial stress exacerbated individual response to GAS administrations whereby mice exposed to both treatments exhibited altered cytokine and immune-related enzyme expression in the hippocampus and hypothalamus.
  • Showed impaired mitochondrial respiratory chain complexes IV and V, and reduced adenosine triphosphate (ATP) production by mitochondria and ATP content.
  • These brain abnormalities, observed in GAS-Stress mice, were associated with blunted titers of plasma corticosterone.
  • Present data support the hypothesis that challenging environmental conditions, in terms of chronic psychosocial stress, may exacerbate the long-term consequences of exposure to GAS processes through the promotion of central immunomodulatory and oxidative stress.
Eye movement desensitisation and reprocessing (EMDR) treatment associated with parent management training (PMT) for the acute symptoms in a patient with PANDAS syndrome: a case report
Guido CA, Zicari AM, Duse M, Spalice A. Eye movement desensitisation and reprocessing (EMDR) treatment associated with parent management training (PMT) for the acute symptoms in a patient with PANDAS syndrome: a case report. Ital J Pediatr. 2019 Jun 26;45(1):74. doi: 10.1186/s13052-019-0667-1. PMID: 31242942; PMCID: PMC6595549.
Conclusions: Following eight sessions of EMDR, preceded by training sessions with the parents, the child showed a significant reduction in symptoms and disappearance of the exacerbation. These results indicate the possibility of improving the treatment outcomes of patients with PANDAS by a combined approach using both antibiotic and EMDR therapies.
Family Quality of Life When Raising a Child with Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infection (PANDAS)
Barbara B. Demchick, Julia Ehler, Shelly Marramar, Alison Mills & Amanda Nuneviller (2019) Family Quality of Life When Raising a Child with Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infection (PANDAS), Journal of Occupational Therapy, Schools, & Early Intervention, 12:2, 182-199, DOI: 10.1080/19411243.2019.1592052

“PANDAS is characterized by rapid onset of Obsessive Compulsive Disorder and/or tics following streptococcal infection in a previously healthy child. PANDAS is frequently misdiagnosed and misunderstood, which affects family quality of life (FQOL). A qualitative phenomenological design was used to examine FQOL in six families with a child with PANDAS. Data were collected through an audiotaped semi-structured interview and a phone interview to confirm findings. After rigorous data analysis, five themes emerged: Life Suddenly Turned Upside Down, My Child is Not Crazy, Emotional Distress within the Family, Major Life Alteration, and School Drastically Influences FQOL. Findings suggest that occupational performance and FQOL are severely restricted when a child has PANDAS. Implications for occupational therapy are discussed.”

PANDAS and anorexia nervosa-a spotters’ guide: Suggestions for medical assessment
Vincenzi B, O’Toole J, Lask B. PANDAS and anorexia nervosa–a spotters’ guide: suggestions for medical assessment. Eur Eat Disord Rev. 2010 Mar;18(2):116-23. doi: 10.1002/erv.977. PMID: 20148396.
Conclusion: Given the current state of knowledge, diagnosingPANDAS is extraordinarily difficult. However, extrapolating from knowledge aboutSydenham’s choreaandPANDAS–OCD and PANDAS–tics/TS, a heightened index of suspicion for the existence of an auto-immune reaction in the brain response to environmental infectious agents culminating in ‘anorexia nervosa’ should be maintained.