Research

Clinical Features in Patients With PANDAS/PANS and Therapeutic Approaches: A Retrospective Study

Rea I, Guido CA, Spalice A. Clinical Features in Patients With PANDAS/PANS and Therapeutic Approaches: A Retrospective Study. Frontiers in Neurology. Vol. 12, 2021. DOI=10.3389/fneur.2021.741176  

  • 62 patients with a clinical diagnosis of PANDAS/PANS.
    • 15 with PANS. 47 with PANDAS
  • Mean age at onset of PANDAS/PANS symptoms was 6.2 ± 1.2 years
    • 6.2 for PANDAS. 6.0 for PANS
  • Neurological and psychiatric symptoms were mostly evident in both groups with little difference
  • 93.5% had vocal tics
  • 79% had OCD
  • PANS kids had more irritability, aggressivity, and food restriction
  • PANDAS kids had 10 times higher levels of anti-streptolysin O and anti-DNAse B
  • PANS kid had a higher percentage of metabolic disorders
  • Psychotherapy significantly relieved OCD the most and reduced stress in patients and parents
  • Antibiotic prophylaxis was the most frequently used (90%) for acute neurological symptoms

 

 

Postnatal immune activation causes social deficits in a mouse model of tuberous sclerosis: Role of microglia and clinical implications

Manuel F. López-Aranda, Ishanu Chattopadhya, Gayle M. Boxx, Elizabeth R. Fraley, Tawnie K. Silva, Miou Zhou, Miranda Phan, Isaiah Herrera, Sunrae Talomam Rochelle Mandanas, Karen Bach and Michael Gandal and Daniel H. Geschwind, Genhong Cheng, Andrey Rzhetsky and Stephanie A. White, Alcino J. Silva. Postnatal immune activation causes social deficits in a mouse model of tuberous sclerosis: Role of microglia and clinical implications. Science Advances, vol 7. 38, 2021. DOI:10.1126/sciadv.abf2073

There is growing evidence that prenatal viral infections triggering immune activation contributes to neuropsychiatric disorders, including schizophrenia and autism spectrum disorders

Kids who had severe infections and are genetically predisposed to autism were more likely to develop the condition. So, the genetic factors don’t trigger autism but environmental factors play a significant role. One of the scientists said that childhood infections may be linked to higher instances of depression m, anxiety, schizophrenia.
  • Study links significant childhood infections to developing autism later.
  • In mouse models, mice that had an immune response later were no longer able to recognize familiar faces. This study was replicated with a focus on social interactions and the mice whose immune system was activated had increased difficulty communicating.
  • A different study reinforces the mouse model that tracked 3.6 million hospitalized children shoeing that hospitalizations due to infections during early childhood can predict a future diagnosis of ASD
Recent progress on Tourette syndrome

Ueda K, Black KJ. Recent progress on Tourette syndrome. Fac Rev. 2021;10:70. Published 2021 Sep 7. DOI:10.12703/r/10-70

“Recent years have seen increasing information about the relationship between tics and comorbidities and about new genetic findings. Inflammatory processes have also been a topic of continued interest.

“The prevalence and characteristics of tics in patients with encephalitis were reviewed in a systematic study, which found that sporadic cases of tics were associated with encephalitis, particularly during a post-encephalitis period, and with basal ganglia involvement. A case-control autopsy study (of nine individuals with TS) using basal ganglia transcriptome by RNA sequencing in the caudate and putamen found disrupted basal ganglia neuronal signaling. The study also found a significant increase in immune and inflammatory transcripts. These results suggest metabolic alterations and inflammatory involvement in TS pathophysiology.”

“Inflammation has been extensively discussed in tic pathophysiology. A recent review article on immunological mechanisms in the pathophysiology of tic disorders argues that innate and adaptive systemic immune pathways and neuroinflammatory mechanisms play an important role in the pathogenesis of at least some patients with TS.”

“Complementary and alternative medicines—including dietary or nutritional supplements (calcium, magnesium, coenzyme Q10, fish oil, gastrodin, and vitamins B, C, D, and E), chiropractic manipulations, meditation, acupuncture, hypnosis, homeopathy, and biofeedback—have been reported for the treatment of tics,; however, the evidence is limited because of a lack of randomized control studies. The efficacy and safety of a Chinese herbal medicine (5-Ling granule) in the treatment of TS were evaluated in a multicenter, double-blind randomized controlled trial, finding it as effective as tiapride in improving tic symptoms.”

GAPS Nutritional Protocol as a Treatment for PANDAS: A Case Study

Delaunay-Vagliasindi S, Seneff S, Coro S & Campbell-McBride N (2021) GAPS Nutritional Protocol as a treatment for PANDAS: A case study. J Orthomol Med. 36(3). 6 September 2021 

“Growing research is calling attention to the role of poor gut health in autoimmune conditions, psychological conditions, and neurological conditions – all of which are relevant to PANDAS. The gut microbiome is a perfect target for treatment as it is flexible and adapts quickly to changes. Currently, the first-line treatments for PANDAS are antibiotics and mood stabilizers. The GAPS Nutritional Protocol aims to heal the gut lining, and restore microbial balance in the gut flora. After 18 months, George saw all his PANDAS-related symptoms disappear – tics, anxiety, hypersensitivity to noise and odours, sleep issues, concentration issues, fine motor issues, digestive issues, restricted eating habits, and quality of eye-contact – to the point where his diagnosis was officially removed. In addition, the abnormal blood test results that were indicative of the PANDAS condition – EO, NEUT, LYMPH, NLR, MPV – were restored to normal ranges after the GAPS intervention.”

Immune Dysfunction in Obsessive-Compulsive Disorder: From Risk Factors to Multisystem Involvement

Maia A., Barahona-Corrêa B., Oliveira-Maia A.J., Oliveira J. (2021) Immune Dysfunction in Obsessive-Compulsive Disorder: From Risk Factors to Multisystem Involvement. In: Berk M., Leboyer M., Sommer I.E. (eds) Immuno-Psychiatry. Springer, Cham. DOI: 10.1007/978-3-030-71229-7_17

“Immune dysfunction has been proposed as an important component of the pathophysiology of obsessive-compulsive disorder (OCD), motivating innovative research hypotheses with potential clinical interest. In this chapter, we will review published evidence supporting a model for immune dysfunction in OCD as multifactorial, constitutive, and environmental, contributing to illness development, clinical presentation, and multisystem impact. The fact that OCD patients present comorbidity with several systemic illnesses, including auto-immune disorders, and that the majority of recognized risk factors, such as perinatal complications, traumatic life events or childhood infections, induce inflammation, motivated the development of studies trying to achieve a deeper comprehension regarding the association between inflammation and OCD.”

Artificial Neural Networks Analysis of polysomnographic and clinical features in Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS): from sleep alteration to “Brain Fog”

Gagliano A, Puligheddu M, Ronzano N, Congiu P, Tanca MG, Cursio I, Carucci S, Sotgiu S, Grossi E, Zuddas A. Artificial Neural Networks Analysis of polysomnographic and clinical features in Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS): from sleep alteration to “Brain Fog”. Nat Sci Sleep. 2021;13:1209-1224. DOI: 10.2147/NSS.S300818

  • Disordered sleep represents is a cardinal symptom in patients with PANS
  • Polysomnography showed abnormality in 17 out of 23 recruited subjects (73.9%).
  • 8/17 children (47%) had ineffective sleep
  • 10/17 (58.8%) fragmented sleep
  • 8/17 (47.1%) periodic limb movement disorder (PLMD)
  • 11/17 (64.7%) REM-sleep without atonia (RSWA).
  • Most subjects presented more than one sleep disturbance
  • Among the 19/23 patients diagnosed with Tic/Tourette disorder, 8/19 (42.1%) show PLMD and 10/19 (52.6%) RSWA
Lyme Borreliosis and Associations With Mental Disorders and Suicidal Behavior: A Nationwide Danish Cohort Study

Lyme Borreliosis and Associations With Mental Disorders and Suicidal Behavior: A Nationwide Danish Cohort Study. Brian A. Fallon, M.D., M.P.H., Trine Madsen, Ph.D., Annette Erlangsen, Ph.D., Michael E. Benros, M.D., Ph.D. Published Online:28 Jul 2021 https://doi.org/10.1176/appi.ajp.2021.20091347

“Having more than one episode of Lyme borreliosis was associated with increased incidence rate ratios for mental disorders, affective disorders, and suicide attempts, but not for death by suicide. Individuals diagnosed with Lyme borreliosis in the hospital setting had an increased risk of mental disorders, affective disorders, suicide attempts, and suicide. Although the absolute population risk is low, clinicians should be aware of potential psychiatric sequelae of this global disease.”

COVID-19 Infection: A Neuropsychiatric Perspective

Theodora A. Manolis, M.D., Evdoxia J. Apostolopoulos, B.Sc., Antonis A. Manolis, M.S., B.Sc., Helen Melita, M.D., Antonis S. Manolis, M.D., COVID-19 Infection: A Neuropsychiatric Perspective.

“In addition to acute neuropsychiatric manifestations, COVID-19 may also produce late neuropsychiatric sequelae as a function of the psychoneuroimmunological cascade that it provokes. The present article presents a state-of-the-science review of these issues through an integrative review and synthesis of case series, large-cohort studies, and relevant meta-analyses. Heuristics for evaluation and further study of the neuropsychiatric manifestations of SARS-CoV-2 infection are offered.”

Allergic diseases influence symptom severity and T lymphocyte subgroups of children with tic disorders
Liu X, Wang X, Zhang X, et al. Allergic diseases influence symptom severity and T lymphocyte subgroups of children with tic disorders.
  • Reviews the severity of tics and T lymphocyte subgroups in patients with tic disorders and allergic diseases
  • 85 children (ages 6-10)- Compared TD but no allergic disease with chronic allergic diseases (including allergic rhinitis, atopic dermatitis, asthma) and tic disorders (TD)
  • Children with TD plus allergic diseases have heavier motor and vocal tic symptoms
  • Children with TD plus allergic diseases had significantly lower levels of CD3, CD4, and CD4:CD8 than those with TD without allergic diseases
  • Allergic disease aggravates imbalance of T lymphocyte subsets and cellular immune

    dysfunction in children with TD
  • Allergic diseases increased illness severity and cellular immune function is increased in children with TD
  • Treat and prevent allergic diseases in children starting at diagnosis of TD
Breastfeeding in Pediatric Acute-Onset Neuropsychiatric Syndrome: An Italian Observational Study

Murciano M, Biancone DM, De Luca F, Piras MD, Guido CA, Spalice A. Breastfeeding in Pediatric Acute-Onset Neuropsychiatric Syndrome: An Italian Observational Study. Frontiers in Pediatrics. Vol 9. 2021. DOI:10.3389/fped.2021.682108

  • Looks at neurodevelopmental evolution and problems among 52 children with PANS who were Human Milk only (HMO), received formula, or had mixed feedings
  • PANS patients fed HMO reported fewer cases of growth problems, school performance problems or the need for school support, and a delay in the age of babbling/speaking compared to the other patients
  • Further studies needed to investigate the mechanisms underlying PANS role HMO may play in their short- and long-term neurodevelopment

 

DIAGNOSTICS, DIFFERENTIAL DIAGNOSTICS AND TREATMENT OF PANDAS SYNDROME: DESCRIPTION OF THE CASE

DIAGNOSTICS, DIFFERENTIAL DIAGNOSTICS AND TREATMENT OF PANDAS SYNDROME: DESCRIPTION OF THE CASE. Mukhtorjonova Khusnigul Nodirbekovna, Elmurodova Zarina Aslanovna. Matkarimova Dilnoza Doniyorovna, Tashkent Pediatric Medical Institute. ISSN: 2776-0960 Volume 2, Issue 6, June 2021

The analysis of this clinical case demonstrates the existence of a group of patients with a good therapeutic response to the administration of immunoglobulins and antibiotics. The mechanisms of development and course of this condition are not fully understood and require further research.

Obsessive-Compulsive Disorders and Functional Urinary Disorders: A Fortuitous Association?

Ng QX, Lim YL, Loke W, Yeo WS, Chee KT. Obsessive-Compulsive Disorders and Functional Urinary Disorders: A Fortuitous Association? Behavioral Sciences. 2021; 11(6):89. DOI: 10.3390/bs11060089

  • Patients with OC symptoms appeared to have increased occurrence of functional urinary symptoms, e.g., overactive bladder, increase in urgency, frequency, incontinence and enuresis.
  • This is even more common amongst patients with PANS and PANDAS, as only OCD