Research

Maternal thyroid autoimmunity associated with acute-onset neuropsychiatric disorders and global regression in offspring
Jones HF, Ho ACC, Sharma S, Mohammad SS, Kothur K, Patel S, Brilot F, Guastella AJ, Dale RC; Immune-Neurodevelopment (Imm-Nd) Study Group. Maternal thyroid autoimmunity associated with acute-onset neuropsychiatric disorders and global regression in offspring. Dev Med Child Neurol. 2019 Aug;61(8):984-988. doi: 10.1111/dmcn.14167. Epub 2019 Feb 5. PMID: 30720202.

Abstract: Epidemiological studies, animal models, and case–control studies indicate maternal immune activation may be an important factor involved in disease expression of autism spectrum disorder (ASD), Tourette syndrome, and obsessive–compulsive disorder (OCD). We report eight children (mean age 6y 6mo [range 4–15y]; six males and two females) referred over a 2‐year period with at least one of these neurodevelopmental disorders plus a maternal history of thyroid autoimmunity…

PANDAS and PANS: Clinical, Neuropsychological, and Biological Characterization of a Monocentric Series of Patients and Proposal for a Diagnostic Protocol

Gamucci A, Uccella S, Sciarretta L, D’Apruzzo M, Calevo MG, Mancardi MM, Veneselli E, De Grandis E.
J Child Adolesc Psychopharmacology-2019

Conclusions: Despite these limitations, this study presents clinical, biological, and psychological features of a group of patients fulfilling the PANS and PANDAS criteria and discusses these results in comparison with patients with SC, a well-established clinical condition. Moreover, it adds notable findings to the existing little literature on neuropsychological functioning in youth diagnosed with these disorders, in particular PANS and PANDAS…

Psychometric Properties of the Pediatric Acute-Onset Neuropsychiatric Syndrome Global Impairment Score in Children and Adolescents with Pediatric Acute-Onset Neuropsychiatric Syndrome

Leibold C, Thienemann M, Farhadian B, Willett T, Frankovich J.
J Child Adolesc Psychopharmacololgy-2019

Results: The GIS shows excellent discriminant validity, distinguishing patients with PANS from healthy controls. The scores on the GIS show an acceptable level of agreement with the clinician-reported CGAS. The regression line in the Bland–Altman plot had a positive slope, indicating that parents tend to report higher disease severity than clinicians at higher levels of disease severity. Correlation was higher during disease remissions than during disease flares (r = −0.69 vs. r = −0.48). All disease severity scales predicted GIS in the expected direction

European Advocacy Organizations Response to PANDAS/PANS Article

Gerland Gunilla, Mogyorosi-Post, Anita, Cafferky Karen, Galardini Giuliana, Granli Kristin, Tuckey Georgia.
Journal of Pediatrics-2018
PDF

As representatives of the pediatric acute-onset neuropsychiatric syndrome (PANS)/pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) organizations in Europe, we have concerns about the commentary by Gilbert et al,1 given its potential to negatively influence the treatment of children suffering from these devastating conditions.

Reduction in Obsessive Compulsive Disorder and Self-Injurious Behavior With Saccharomyces boulardii in a Child with Autism: A Case Report
Kobliner V, Mumper E, Baker SM. Reduction in Obsessive Compulsive Disorder and Self-Injurious Behavior With Saccharomyces boulardii in a Child with Autism: A Case Report. Integr Med (Encinitas). 2018 Dec;17(6):38-41. PMID: 31043927; PMCID: PMC6469440.

This case report describes the effective use of Saccharomyces boulardii in a boy with autism spectrum disorder, obsessive compulsive disorder (OCD), and self-injurious behavior (SIB). Gastrointestinal dysfunction and OCD are frequent comorbidities in autism, which may share a common etiology resulting from a disturbance in normal gut microbiota. Alterations in microbial diversity influence neuroinflammation and are linked to mood disorders, abdominal pain, and SIB. S boulardii is a nonpathogenic probiotic yeast that supports a healthy microbiome, enhances immune function, and reduces diarrhea. Treatment with S boulardii successfully reduced OCD and SIB symptoms in this child.

The Burden of Caring for a Child or Adolescent With Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS): An Observational Longitudinal Study

Frankovich J, Leibold CM, Farmer C, Sainani K, Kamalani G, Farhadian B, Willett T, Park JM, Sidell D, J
Clin Psychiatry-2018

Conclusions: PANS caregivers suffer high caregiver burden. Neuropsychiatric disease severity predicts increased caregiver burden. Caregiver burden tends to decrease over time in a group of patients undergoing clinical treatment at a specialty PANS clinic. This decrease could be independent of clinical treatment.

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.