Research

Implementing dietary changes with children affected by PANS/PANDAS

Khimani, Kynza & Abadía-Barrero, César & LaRusso, Maria. (2024). Implementing dietary changes with children affected by PANS/PANDAS. Children’s Health Care. 1-19. 10.1080/02739615.2024.2338763.

  • 64.7% of the 467 survey participants indicated that a healthcare provider recommended dietary changes as part of PANS/PANDAS treatment.
  • 55.7% of the families did implement dietary changes
  • 69.6% reported at least one diet to be somewhat effective in helping with PANS/PANDAS symptoms
  • 36% reported dietary changes to be very effective, particularly gluten-free and sugar-free diet
  • Some parents and clinicians highlighted children’s resistance to new diets and concerns about worsening OCD and food-restrictive disorders as barriers to implementing dietary changes

 

 

Inflammation as the Common Pathophysiology Linking Stress, Mental Illness, Autoimmunity and Chronic Disease: Implications for Public Health Policy

Kinderlehrer DA. Inflammation as the Common Pathophysiology Linking Stress, Mental Illness, Autoimmunity and Chronic Disease: Implications for Public Health Policy. J Biomed Res Environ Sci. 2024 Mar 28; 5(3): 242-255. doi: 10.37871/jbres1889, Article ID: JBRES1889, Available at: https://www.jelsciences.com/articles/jbres1889.pdf

  • The article discusses the interplay between genetics, epigenetics, stress, trauma, inflammation, mental illness, autoimmunity, and chronic disease.
  • While modern medicine has made significant advances in disease care,
    it appears that lifestyle intervention, early childhood intervention, and socioeconomic
    investment and have the potential to make an even greater impact on the mental and
    physical well-being of the population.
  • An individual’s genetic makeup influences susceptibility to conditions, but environmental factors like stress and trauma can modify this through epigenetics.
  • Chronic stress and trauma can induce epigenetic changes and dysregulate immune responses, leading to inflammation, mental illness, autoimmunity, and chronic disease.
  • Lifestyle changes like exercise, diet, and toxin management can reduce inflammation and risks of mental and physical illness. Stress is a key factor and reducing stress through mindfulness, meditation, and exercise can decrease inflammation. Loneliness is a significant stressor and healthy social connections are important.
Enuresis as a presentation of Paediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus (PANDAS)

Poster: Enuresis as a presentation of Paediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus (PANDAS)

Author: Ying Xin Wong, Ubhi Tim

Presented: The Royal College of Paediatrics and Child Health Annual Meeting, March 2023.

  • Out of the total cohort of 109 children, 56 patients (51%) had enuresis as a presenting symptom alongside their PANDAS symptoms.
  • Enuresis is a common presentation of children with PANDAS (observed in 51% of cases). Early recognition of enuresis is important in promptly identifying PANDAS cases allowing prompt investigation and treatment.
    PANDAS coexisting with gastrointestinal and cerebellar manifestation

    Aftab Ahmed, Fatima Bint Sajid, Zaib Un Nisa Mughal, Wajeeha Binte Sajid, Abdul Haseeb,
    PANDAS coexisting with gastrointestinal and cerebellar manifestation, Journal of Medicine, Surgery, and Public Health, Volume 2, 2024,100086, ISSN 2949-916X, DOI: /10.1016/j.glmedi.2024.100086.

    We wish to bring attention to the importance of PANDAS in pediatric patients, as it can have a detrimental impact on their academic and social development. The scarcity of PANDAS cases in Pakistan may be attributed due to lack of awareness and interdisciplinary communication. Enhanced cross-referral between pediatricians and psychiatrists can help alleviate the morbidity and disability associated with this condition. This case highlights the need to recognize atypical PANDAS presentations that exhibit unique neurological and gastrointestinal symptoms. A multidisciplinary approach is crucial for accurate diagnosis and effective management in these intricate cases.

    Silent Infections are not So Silent: The Emerging Role of Combined Infections, Inflammation, and Vitamin Levels in OCD
    Marazziti D, Massa L, Carbone MG, Palermo S, Arone A, D’Angelo G, Schulz Bizzozzero Crivelli N, Gurrieri R, Perrone P, Palagini L, Dell’Osso L. Silent Infections are not So Silent: The Emerging Role of Combined Infections, Inflammation, and Vitamin Levels in OCD. Clin Neuropsychiatry. 2024 Feb;21(1):7-21. doi: 10.36131/cnfioritieditore20240101. PMID: 38559435; PMCID: PMC10979795.

    Conclusions: 

    • The findings of our study show an association between Epstein-Barr infection and hypovitaminosis D and the overall severity and specific symptom patterns of OCD.
    • The laboratory measures used in this study are useful, cheap and easy parameters that should be routinely assessed in patients with OCD.
    • Further studies are needed to clarify their role in OCD pathophysiology and outcomes, as well as the potential therapeutic impact of vitamins and antibiotics/immunomodulatory agents in OCD and other psychiatric conditions.
    Postacute Sequelae of SARS-CoV-2 in Children

    Suchitra Rao, MBBS, MSCS; Rachel S. Gross, MD, MS; Sindhu Mohandas, MD; Cheryl R. Stein, PhD; Abigail Case, MD; Benard Dreyer, MD; Nathan M. Pajor, MD; H. Timothy Bunnell, PhD; David Warburton, MD; Elizabeth Berg, MD; Jonathan B. Overdevest, MD; Mark Gorelik, MD; Joshua Milner, MD; Sejal Saxena, BA; Ravi Jhaveri, MD; John C. Wood, MD, PhD; Kyung E. Rhee, MD, MSc, MA; Rebecca Letts, BA; Christine Maughan, BS; Nick Guthe, BA; Leah Castro-Baucom, MA; Melissa S. Stockwell, MD, MPH. Postacute Sequelae of SARS-CoV-2 in Children. AAP Publications, Feb 7, 2024, https://doi.org/10.1542/peds.2023-062570

    • The COVID-19 pandemic has had far-reaching impacts on health, society, and the economy, with some individuals experiencing lingering effects beyond the acute phase.
    • Emerging data on post-acute sequelae of SARS-CoV-2 infection (PASC) in children, or long COVID, is shedding light on persistent symptoms, new manifestations, and exacerbation of underlying conditions.
    • Children may develop new conditions such as postural orthostatic tachycardia syndrome (POTS), myalgic encephalomyelitis/chronic fatigue syndrome, autoimmune conditions, and multisystem inflammatory syndrome in children.
    • The review summarizes current knowledge on PASC in children, including its children, prevalence, epidemiology, risk factors, clinical characteristics, underlying mechanisms, and functional outcomes. It presents a framework based on NIH-funded research to understand PASC’s effect on children and young adults to guide treatments and prevention efforts. This research uses electronic health records and longitudinal studies to evaluate disease impact, progression, and clinical outcomes.

    Section on Mental Health

    • The COVID-19 pandemic resulted in multiple mental health conditions among children, including anxiety, stress, depression, panic, irritability, impulsivity, sleep problems, emotional lability, posttraumatic stress disorder, eating disorders, and suicidal behavior.
      Research is needed to understand whether these conditions are directly related to the virus or influenced by pandemic-related factors like social distancing and school closures.
    • Large EHR cohort studies have shown a higher incidence of neurologic or psychiatric diagnoses in children in the 6 months after SARS-CoV-2 compared with those without confirmed infection.
    • A COVID-19 diagnosis is associated with experiencing a new mental health condition (within a median of 33 days after infection) compared with negative controls in children.
    • The common mental health issues seen in children post-COVID-19 infection are anxiety, attention-deficit/hyperactivity disorder, and trauma-related disorders. Additionally, there are reports of acute-onset neuropsychiatric syndrome in children following COVID-19 infection.
    • There have also been case reports of pediatric acute-onset neuropsychiatric syndrome in children after SARS-CoV-2 infection.72,73 
    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, 111. 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.

       

       

      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.