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Precision Medicine: The Role of the MSIDS Model in Defining, Diagnosing, and Treating Chronic Lyme Disease/Post Treatment Lyme Disease Syndrome and Other Chronic Illness: Part 2
Horowitz RI, Freeman PR. Precision Medicine: The Role of the MSIDS Model in Defining, Diagnosing, and Treating Chronic Lyme Disease/Post Treatment Lyme Disease Syndrome and Other Chronic Illness: Part 2. Healthcare (Basel). 2018 Nov 5;6(4):129. doi: 10.3390/healthcare6040129. PMID: 30400667; PMCID: PMC6316761.
A patient symptom survey and a retrospective chart review of 200 patients was therefore performed on those patients with chronic Lyme disease/PTLDS to identify those variables on the MSIDS model with the greatest potential effect on regaining health. Results indicate that dapsone combination therapy decreased the severity of eight major Lyme symptoms, and multiple sources of inflammation (other infections, immune dysfunction, autoimmunity, food allergies/sensitivities, leaky gut, mineral deficiencies, environmental toxins with detoxification problems, and sleep disorders) along with downstream effects of inflammation may all affect chronic symptomatology. In part two of our observational study and review paper, we postulate that the use of this model can represent an important and needed paradigm shift in the diagnosis and treatment of chronic disease.
Figure 1. Percentage of patients with MSIDS abnormalities. Multiple overlapping abnormalities on the MSIDS map were associated with Lyme disease, contributing to ongoing symptomatology.
C-Reactive Protein Response in Patients With Post-Treatment Lyme Disease Symptoms Versus Those With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

Melanie Uhde, Alyssa Indart, Brian A Fallon, Gary P Wormser, Adriana R Marques, Suzanne D Vernon, Armin Alaedini, C-Reactive Protein Response in Patients With Post-Treatment Lyme Disease Symptoms Versus Those With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, Clinical Infectious Diseases, Volume 67, Issue 8, 15 October 2018, Pages 1309–1310, https://doi.org/10.1093/cid/ciy299

The data suggest the presence of different inflammatory mechanisms in ME/CFS compared to PTLDS. This difference may stem from the potentially more diverse causes of ME/CFS symptoms compared to PTLDS. The lack of a significantly elevated CRP response in ME/CFS, despite indications of activation in other inflammatory pathways, requires further investigation.

Allergic Diseases and Immune-Mediated Food Disorders in Pediatric Acute-Onset Neuropsychiatric Syndrome

Rosa JS, Hernandez JD, Sherr JA, Smith BM, Brown KD, Farhadian B, Mahony T, McGhee SA, Lewis DB, Thienemann M, Frankovich JD.
Pediatr Allergy Immunol Pulmonology-2018

Conclusions: The prevalence of allergic and immune-mediated food disorders in PANS is similar to the general population as reported in the literature, with the exception of AR that appears to be more prevalent in our PANS cohort. More research will be required to establish whether diet or allergies influence PANS symptoms.

The Diagnostic Value of Serological Studies in Pediatric Patients with Acute Mycoplasma Pneumoniae Infection

Lin LJ, Chang FC, Chi H, Jim WT, Tsung-Ning Huang D, Kung YH, Chiu NC, Chang L.
Journal of Microbiology, Immunology, and Infection-2018

In the pediatric population, combined serological tests of M. pneumoniae IgA and IgM, offer an accurate method of early diagnosis comparable to that of PCR, and can be an alternative choice for prompt detection of mycoplasma infections when PCR and culture are not available.

Continued Presence of Period Limb Movements During REM Sleep in Patients With Chronic Static Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS)
Santoro JD, Frankovich J, Bhargava S. Continued Presence of Period Limb Movements During REM Sleep in Patients With Chronic Static Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS). J Clin Sleep Med. 2018 Jul 15;14(7):1187-1192. doi: 10.5664/jcsm.7222. PMID: 29991427; PMCID: PMC6040797.
  • Small retrospective PSG study of 9 pediatric PANS patients with chronic, treatment-refractory symptoms (median 4 years after onset).
  • 7 of 9 showed elevated periodic limb movements during REM sleep.
  • 2 also had REM sleep without atonia, though not full REM sleep behavior disorder.
  • Delayed REM onset, reduced total sleep time, and decreased sleep efficiency were common
  • Takeaway: Sleep disruption can persist years into chronic PANS and may contribute to ongoing symptom burden.
Intravenous immunoglobulin for the treatment of autoimmune encephalopathy in children with autism

Kathleen Connery, Marie Tippett, Leanna M. Delhey, Shannon Rose, John C. Slattery, Stephen G. Kahler, Juergen Hahn, Uwe Kruger, Madeleine W. Cunningham, Craig Shimasaki, Richard E. Frye
Transl Psychiatry-2018

In an open-labeled IVIG study in children with comorbid ASD and PANS/ PANDAS, anti-tubulin and anti-D2R (as measured by the Cunningham panel) were associated with responsiveness to IVIG treatment, suggesting that these autoantibodies could be biomarkers to select for positive IVIG treatment outcomes. Research continues to explore serum biomarkers and genetic risk factors that can provide a diagnostic tool and/or complement diagnosis in children with PANS/PANDAS.

Family Impacts Reported By Parents Raising Children With Pediatric Acute-onset Neuropsychiatric Syndrome (PANS)

Marcey Mettica, B.S., M.S
A Dissertation Submitted in Partial Fulfillment of the Requirements for The Degree of Doctor of Family Studies in The Graduate School of The Texas Woman’s University
PDF of Dissertation

This study explored variables that were thought to possiblyinfluence family impact and explored relationships between demographic factors, illness factors, and symptom severity with impact on the family

Borrelia burgdorferi adhere to blood vessels in the dura mater and are associated with increased meningeal T cells during murine disseminated borreliosis

li Divan, Timothy Casselli, S. Anand Narayanan, Sanjib Mukherjee, David C. Zawieja, John A. Watt, Catherine A. Brissette, M. Karen Newell-Rogers, Published: May 3, 2018. https://doi.org/10.1371/journal.pone.0196893

Traditionally, mice haven’t shown neuroborreliosis, mirroring human symptoms, but this study achieved colonization of the central nervous system in mice. Using two strains of B. burgdorferi, researchers infected mice through the skin, consistently detecting spirochetes in the brain membranes 75 days post-infection. Live spirochetes were present, adhering to blood vessels, indicating long-term infection. The presence of CD3+ T cells suggested an immune response. These findings provide new avenues for studying neuroborreliosis and may offer insights into potential treatments for patients.

Gut Microbiota Profiling and Gut-Brain Crosstalk in Children Affected by Pediatric Acute-Onset Neuropsychiatric Syndrome and Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections

Quagliariello A, Del Chierico F, Russo A, Reddel S, Conte G, Lopetuso LR, Ianiro G, Dallapiccola B, Cardona F, Gasbarrini A, Putignani L.
Front Microbiology-2018
PDF

Excerpt: The results obtained from this study suggest that streptococcal infections can alter gut microbial communities leading to a pro-inflammatory state in the gut by selecting for specific bacterial strains that are normally associated with gut inflammation and activation of the immune response. This condition is likely maintained in patients, even after the infection itself has resolved.

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.