Research

ENT involvement and orobuccal movements’ disorders in Pandas patients: assessment and rehabilitations tools

S. Cocuzza, S. Marino, A. Gulino, E. Pustorino, P. Murabito, A. Maniaci, L. Sabino, R. Taibi, M. Di Luca, R. Falsaperla, G. Campione, M. Vecchio, P. Pavone
Eur Rev Med Pharmacol Sci-2019

Findings from our study show that respiratory diseases, characterizing a group of patients with pandas, are the direct consequences of the malformed or hypertrophic condition and suggesting in these conditions surgical therapy as an approaching tool.

Altered frequencies of Th17 and Treg cells in children and adolescents with obsessive-compulsive disorder

Natalia Rodrígueza, Astrid Morerbgh, Azucena González-Navarrocg, Carles Serra-Pages, Daniel Bolo, Teresa Torrese, Albert Martinez-Pinteñoe, Sergi Ma, Amalia Lafuenteegh, Patricia Gassóeg, LuisaLázarobdgh
Brain, Behavior, and Immunity-2019

Highlights
•Th17 cells are increased in children and adolescents with OCD.
•Percentages of Treg cells are reduced in OCD patients.
•Increased levels of Th17 cells are associated with higher severity of OCD symptoms.
•Increased levels of Th17 cells are associated with longer duration of disease.
•Reduced percentatges of Treg cells are associated with longer duration of disease.

Association of Streptococcal Throat Infection With Mental Disorders Testing Key Aspects of the PANDAS Hypothesis in a Nationwide Study

Sonja Orlovska, MD; Claus Høstrup Vestergaard, MS; Bodil Hammer Bech, PhD; Merete Nordentoft, DrMed; Mogens Vestergaard, PhD; Michael Eriksen Benros, PhD
JAMA Psychiatry-2017

The findings reported in this research study represent one of the largest retrospective studies conducted to date on the association between streptococcal infections and PANDAS. Children with a previously positive streptococcus test had an 18% higher risk of any mental disorder, 51% higher risk of OCD, and 35% higher risk of tic disorders, which are diagnostic criteria for PANDAS. Study findings support the association of streptococcal and non-streptococcal infections in the diagnosis of pediatric acute-onset neuropsychiatric syndrome.

A Pediatric Infectious Disease Perspective on Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infection and Pediatric Acute-Onset Neuropsychiatric Syndrome

Wald, Ellen
The Pediatric Infectious Disease Journal-2019

In 2013, a PANS Consensus Conference was convened at Stanford University, and several consensus statements have been published in recent years. The existence of PANDAS has been controversial from the time of its first publication. For those of us familiar with the sequelae of streptococcal disease and the concerns of community physicians faced with the care of children with these neuropsychiatric symptoms, the controversy has proven to be a disservice to both pediatricians and families. It has fostered a dismissive attitude toward important clinical observations.

Bidirectional relationship between eating disorders and autoimmune diseases
Hedman A, Breithaupt L, Hübel C, Thornton LM, Tillander A, Norring C, Birgegård A, Larsson H, Ludvigsson JF, Sävendahl L, Almqvist C, Bulik CM. Bidirectional relationship between eating disorders and autoimmune diseases. J Child Psychol Psychiatry. 2019 Jul;60(7):803-812. doi: 10.1111/jcpp.12958. Epub 2018 Sep 3. PMID: 30178543.

Conclusions: The interactions between EDs and autoimmune diseases support the previously reported associations. The bidirectional risk pattern observed in women suggests either a shared mechanism or a third mediating variable contributing to the association of these illnesses.

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.
Clinical-Serological Characterization and Treatment Outcome of a Large Cohort of Italian Children with Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infection and Pediatric Acute Neuropsychiatric Syndrome

Gemma Lepri, Donato Rigante, Silvia Bellando Randone, Antonella Meini, Alessandra Ferrari, Giusyda Tarantino, Madeleine W. Cunningham,Fernanda Falcini
JCAP-2019

Our study has confirmed the usefulness of the preliminary diagnostic criteria for PANDAS and PANS, revealing also the importance of early diagnosis to reduce the risk of evolution toward disabling chronic neurologic sequelae. Long-term antibiotic prophylaxis has resulted in a substantial benefit to reduce neurological symptoms for the majority of PANDAS and PANS patients over a 7-year period.

Association of Exposure to Infections in Childhood With Risk of Eating Disorders in Adolescent Girls
Breithaupt L, Köhler-Forsberg O, Larsen JT, Benros ME, Thornton LM, Bulik CM, Petersen L. Association of Exposure to Infections in Childhood With Risk of Eating Disorders in Adolescent Girls. JAMA Psychiatry. 2019 Aug 1;76(8):800-809. doi: 10.1001/jamapsychiatry.2019.0297. Erratum in: JAMA Psychiatry. 2019 May 8;: PMID: 31017632; PMCID: PMC6487907.

In a Danish population-based cohort study of 525 643 adolescent girls, a prior infection in childhood was associated with an increased risk of later anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified.

The findings suggest that hospital-treated infections and less severe infections treated with anti-infective agents are associated with increased risk of subsequent anorexia nervosa, bulimia nervosa, and eating disorders not otherwise specified and that future studies should investigate whether these associations are causal and identify the exact mechanisms between infections and subsequent inflammatory processes with eating disorders.

Immunoneuropsychiatry: novel perspectives on brain disorders

Katrin Pape, Ryad Tamouza, Marion Leboyer & Frauke Zipp 
Nature Reviews Neurology-2019

  • Chronic inflammation and latent infections can cause higher-order network disturbances, resulting in cognitive and behavioural impairment.
  • Psychosocial stress correlates with inflammatory processes in the CNS.
  • Immune dysregulation plays a key role in psychiatric disorders
  • Immune treatments are emerging as therapeutic options
A minority of children diagnosed with Lyme disease recall a preceding tick bite
Nigrovic LE, Neville DN, Balamuth F, Bennett JE, Levas MN, Garro AC; for Pedi Lyme Net. A minority of children diagnosed with Lyme disease recall a preceding tick bite. Ticks Tick Borne Dis. 2019 Apr;10(3):694-696. doi: 10.1016/j.ttbdis.2019.02.015. Epub 2019 Feb 26. PMID: 30853264.

Out of 1770 children evaluated in the emergency department for Lyme disease, 362 (20.5%) were diagnosed with the condition. Among those with a documented tick bite history, only a small percentage (18.5%, 95% confidence interval 14.6-23.0%) of Lyme disease cases were associated with a recognized tick bite. Therefore, the absence of a tick bite history does not reliably rule out Lyme disease.

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.”