Benefits of IVIG in Pediatric Acute-Onset Neuropsychiatric Syndrome
Benefits of IVIG in Pediatric Acute-Onset Neuropsychiatric Syndrome (2411)

Isaac Melamed, Roger Kobayashi, Maeve O’Connor, Ai Lan Kobayashi, Andrew Schechterman, Melinda Heffron, Sharon Canterberry, Holly Miranda, Nazia Rashid Neurology Apr 14 2020, 94

“Conclusions: In PANS, which may be associated with an underlying immune dysregulation, IVIG [Octagam 5%] successfully ameliorated psychological symptoms and dysfunction, with sustained benefits for at least 8 weeks, and up to 46 weeks, following the final infusion. In addition, baseline immune and autoimmune profiles demonstrated significant elevations in a majority of subjects, which requires further evaluation, characterization, and study to clarify the potential immune dysfunction by which PANS manifests and progresses.”


Immuno-moodulin: A new anxiogenic factor produced by Annexin-A1 transgenic autoimmune-prone T cells

GiuseppaPiras, LorenzaRattazzi
Brain, Behavior, and Immunity, 29 February 2020

Patients with obsessive compulsive disorder (OCD) have increased levels of Immuno-moodulin (Imood), a protein in their lymphocytes, a type of immune cell.

Anxious mice returned to normal in a couple of days after being given an antibody that blocked Imood. Twenty-three people with OCD and twenty healthy people without OCD were tested; Imood expression was about six times higher in those with OCD. Additional research indicates the same protein, Immod, is elevated in ADHD.


Anti-lysoganglioside and other anti-neuronal autoantibodies in post-treatment Lyme Disease and Erythema Migrans after repeat infection

Anti-lysoganglioside and other anti-neuronal autoantibodies in post-treatment Lyme Disease and Erythema Migrans after repeat infection

Brian A.Fallon, BarbaraStrobino, SeanReim, JulieStoner, Madeleine W.Cunningham Brain, Behavior, & Immunity – Health, Volume 2, February 2020, 100015.

This study examines molecular mimicry targeting neural tissue after Borrelia burgdorferi (Bb) infection. Patients with Lyme disease have a greater frequency of specific anti-neuronal autoantibodies and functional neuronal activation compared to community controls without a history of Lyme disease.


  • The EM ​+ ​prior LD group had significantly elevated anti-neuronal antibodies.
  • The EM ​+ ​prior LD group had significantly elevated CaM Kinase activation.
  • Anti-Lysoganglioside Antibodies are significantly elevated in the PTLS group.
  • Prior infection may lead to immune priming and increased autoantibodies.”
Cellular Mechanisms of Neurovascular Breakdown and Neuronal Dysfunction Following Recurrent Group A Streptococcus Infections in Mice

Platt, Maryann P.
Columbia Academic Commons-2019 Theses Doctoral

Taken together, these data demonstrate the pivotal role of Th17 lymphocytes in brain pathology and olfactory processing deficits after recurrent GAS infections in our mouse model. Our intranasal inoculation model supports the conclusion that post-infectious BGE is autoimmune in nature, despite the absence of behavioral symptoms in this model. Using multiple mouse models of post-infectious BGE may allow us to study distinct facets of disease pathogenesis. Finally, this work underscores the ability of T cells to incite neuroinflammation, provides a useful clinical diagnostic test in olfactory functional assessments, and lends support to T cell immunotherapy strategies in patients with post-infectious BGEs.

Molecular Mimicry, Autoimmunity, and Infection: The Cross-Reactive Antigens of Group A Streptococci and their Sequelae

Madeleine W. Cunningham
Microbiology Spectrum-August 2019
Author manuscript – In advance of print

The studies suggest 1) that the antibodies against streptococci and brain in Sydenham chorea and related diseases produce CNS dysfunction through a neuronal signal transduction and subsequent excess dopamine release mechanism and 2) that the molecular targets of the chorea antibodies include lysoganglioside and the dopamine receptors in neuronal cell membranes. The anti-neuronal autoantibodies also target the group A streptococcal carbohydrate epitope N-acetyl beta-D-glucosamine present on the rhamnose backbone of the carbohydrate and present in the cell membrane and wall of the group A streptococci as well as the intracellular brain protein tubulin. The diagram in Figure 15 illustrates proposed events of how antineuronal autoantibodies against lysoganglioside and the dopamine receptors D1 and D2 may function in Sydenham chorea and PANDAS (3).

Obsessive-Compulsive Disorder: Autoimmunity and Neuroinflammation

Mona Gerentes, Antoine Pelissolo, Krishnamoorthy Rajagopal, Ryad Tamouza, Nora Hamdani,
Anxiety Disorders-August 2019

This review highlights that OCD is associated with low-grade inflammation, neural antibodies, and neuro-inflammatory and auto-immune disorders. In some subset of OCD patients, autoimmunity is likely triggered by specific bacterial, viral, or parasitic agents with overlapping surface epitopes in CNS. Hence, subset-profiling in OCD is warranted to benefit from distinct immune-targeted treatment modalities.

The role of infections in autoimmune encephalitides

B. Joubert, J.Dalmau
International meeting of the French society of neurology & SPILF 2019

Abstract: Autoimmune encephalitides are autoimmune neurological disorders characterized by rapidly progressive central nervous system symptoms associated with specific auto-antibodies targeting neuronal cell-surface proteins. The clinical features of encephalitis are frequently preceded by symptoms suggesting an infectious process, and specific pathogens have been detected at the early phase of the disease in some patients, suggesting that it can be triggered by infections. Moreover, recent data have shown an association with specific HLA haplotypes, suggesting a genetic susceptibility to develop at least some subtypes of autoimmune encephalitis. Nonetheless, the immunological mechanisms leading from an adequate response to infection to autoimmunity against neuronal self-antigens remain highly hypothetical. Molecular mimicry, inborn errors of the host immune system, as well as epitope spreading and chronic activation of innate immunity actors, may be involved. Importantly, the frequency of prodromal infectious symptoms and association with HLA haplotypes differ among autoimmune encephalitides, suggesting that depending on the subtype distinct immunopathogenic mechanisms are involved. A direct link between infection and autoimmune encephalitis was recently provided by the demonstration that most of the so-called relapsing neurological symptoms post-herpes simplex virus encephalitis corresponded to viral-induced autoimmune encephalitis with antibodies against NMDA receptors or other, yet unknown, neuronal surface antigens. Although this association has also been demonstrated experimentally in mice, the underlying immunological mechanisms remain unknown. Overall, a body of clinical, epidemiological and experimental data suggests infections are involved in the pathogenesis of autoimmune encephalitides. Further studies, focusing on the interplays between pathogens, genetic determinants of the host immune response, and brain inflammation, are needed to clarify the immunological mechanisms that lead to autoimmune encephalitis after infection.

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

•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.