Research

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. 19 Jul 2021. Jnl of Neuropsychiatry & Clinical Neurosciences. DOI: 10.1176/appi.neuropsych.20110277

“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.”

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

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.

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

Raposo-Lima, C., Pereira, I.M., Marques, F. et al. Elevated levels of neutrophil gelatinase-associated lipocalin among OCD patients: an exploratory study. BMC Psychiatry 21, 272 (2021). DOI: 10.1186/s12888-021-03289-w

“Although PANDAS might be of relevance for only a minor proportion of OCD cases, this immune/inflammation hypothesis may be significant given the prevalence of OCS among patients with autoimmune diseases [9]…. In conclusion, we herein report differences in NGAL levels among OCD patients compared to healthy controls. We offer additional evidence to the immune dysregulation hypothesis of OCD by reporting elevated levels of NGAL among OCD patients versus healthy controls, with higher differences being found among women”

F Murgia, A Gagliana, MG Tanca, N Or-Geva, A Hendren, S Carucci, M Pintor, F Cera, F Cossu, S Sotgiu, L Atzori, A Zuddas. Metabolomic Characterization of Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS). Frontiers in Neuroscience. Vol 15. 2021. DOI: 10.3389/fnins.2021.645267  

• Found unique plasma metabolic profile in PANS patients that is significantly different from healthy children
• Suggests involvement of specific patterns of neurotransmission (tryptophan, glycine, histamine/histidine)
• Suggests a general state of neuroinflammation and oxidative stress (glutamine, 2-Hydroxybutyrate, and tryptophan-kynurenine pathway) in the disorder.
• Offers new insights into biological mechanisms underpinning the disorder and supports research of other potential biomarkers implicated in PANS.

Ali A, Anugwom G O, Rehman U, et al. (May 12, 2021) Sydenham Chorea Managed With Immunoglobulin in Acute Rheumatic Fever. Cureus 13(5): e14990. doi:10.7759/cureus.14990

Conclusions:  SC is a rare presentation of ARF. Without adequate treatment and supportive care, SC can cause severe functional impairment. ARF should be considered as a differential diagnosis in school-aged children presenting with choreiform movements. Chorea can be managed with antiepileptics and antipsychotics; however, evidence on IVIG use for chorea has also been reported. There is no international consensus on the standard choice of treatment; therefore, IVIG should be used in severe functional impairment when unresponsive to other therapies.

Elisabeth Fernell, Mikael Sundin, Anders Fasth, Lisa Dinkler, Martyna Galazka, Christopher Gillberg, Mats Johnson Acta Paediatr. DOI: 10.1111/apa.15805

Conclusion
No HLA allele association such as seen in children with narcolepsy after H1N1 immunisation could be confirmed in this group of children with PANS. However, more than half the group had a first‐degree relative with a diagnosed autoimmune disease.

Full Article

Piero Pavone, Manuela Ceccarelli, Silvia Marino, Daniela Caruso, Raffaele Falsaperla, Massimiliano Berretta, et al. Lancet Child Adolesc Health. 2021 . May 04, 2021 DOI:10.1016/S2352-4642(21)00135-8

“Post-infectious, autoimmune, and neuro-inflammatory events are the main mechanisms of Paediatric Acute-onset Neuropsychiatric Syndrome (PANS).4 PANS presents with a sudden onset of obsessive-compulsive disorder (OCD) or a severely restricted food intake, and concurrent neuropsychiatric symptoms and motor dysfunction.4 The estimated prevalence of OCD in childhood and adolescence is 0·25–4·00%, with those aged between 16–18 years (1%) having the highest prevalence.5, 6, 7 Here, we report on two unrelated children with PANS that started 2 weeks after a positive COVID-19 nasopharyngeal swab.”

• Two young adolescents Diagnosed with COVID-19 by a nasal swab
• PANS started 2 weeks after COVID-19 diagnosis
• Had acute new OCD, neuropsychiatric, and motor dysfunction symptoms
• SARS-CoV-2 needs to be acknowledged in the differential diagnosis of PANS

Full Study

Alsheikh A M, Alsheikh M M (May 01, 2021) Obsessive-Compulsive Disorder With Rheumatological and Inflammatory Diseases: A Systematic Review. Cureus 13(5): e14791. doi:10.7759/cureus.14791

“Conclusions: Based on our findings, there is a strong correlation between OCD and different inflammatory as well as rheumatological biomarkers. Such correlations have been demonstrated in both adult and pediatric populations. Future studies should examine the safety and efficacy of anti-inflammatory medications, especially NSAIDs, for the management and control of OCD symptoms in both adults and children, particularly in the early stages of the disease.”