Research

U Prosell, H Norman, A Sand, A McAllister, Infection and speech: Disfluency and other speech symptoms in Pediatric Acute-onset Neuropsychiatric Syndrome, Journal of Communication Disorders, 2022, 106250, https://doi.org/10.1016/j.jcomdis.2022.106250.

Hajjari, P., Oldmark, M.H., Fernell, E. et al. Paediatric Acute-onset Neuropsychiatric Syndrome (PANS) and intravenous immunoglobulin (IVIG): comprehensive open-label trial in ten children. BMC Psychiatry 22, 535 (2022). https://doi.org/10.1186/s12888-022-04181-x

Conclusion: Considerable and pervasive improvements in symptoms and clinical impairments were seen in these ten children after three monthly IVIG treatments. Moderate to severe transient side effects occurred in three cases.

• Considerable improvements of PANS global symptoms and impairment were seen on the PANS Scale, CGI-S, CGI-I, and improved OCD symptoms on the CY-BOCS scale, lasting at least one month after the third IVIG treatment (at Visit 3).
• All children had improved at Visit 1 (one month after the first IVIG treatment).
• At Visit 3 – 8 of 10 children had lasting improvements, but 2 showed symptom rebounds
  • 1 patient had good but transient responses lasting only 2–3 weeks after each IVIG, followed by deteriorations
  • One had a concurrent viral infection at Visit 3.
• At baseline the severe symptoms had considerable impact on the children’s school attendance
  • Marked improvements in attendance were seen post-treatment
  • School absence during 3 months before baseline was 47% of the school days/month, compared to 13% after the third IVIG treatment.
• The main side effects were of a previously well-known type, i.e. transient headache, neck pain, nausea/vomiting (mild to severe), stomach pain, mild transient anemia, and brief allergic reaction.

Hutanu A, Reddy L N, Mathew J, et al. (August 06, 2022) Pediatric Autoimmune Neuropsychiatric Disorders Associated With Group A Streptococci: Etiopathology and Diagnostic Challenges. Cureus 14(8): e27729. doi:10.7759/cureus.27729

O’Dor, S.L., Zagaroli, J., Belisle, R. et al. The COVID-19 pandemic and children with PANS/PANDAS: an evaluation of symptom severity, telehealth, and vaccination hesitancy. Child Psychiatry Hum Dev (2022). https://doi.org/10.1007/s10578-022-01401-z

• Assessed the impact of the COVID-19 pandemic on children with PANS/PANDAS
• A majority of respondents endorsed a negative impact on their child’s friendships, relationships with extended family, hobbies, and academic skills due to the pandemic
• Children with suspected or diagnosed COVID-19 experienced new or worsened psychiatric symptoms, particularly mood lability, OCD, and anxiety
• Telehealth care was the preferred treatment modality if the child had mild symptoms of PANS/PANDAS
• Caregivers experienced a high level of burn-out both before and during the pandemic, and thus this should continue to be an area of inquiry and appropriate intervention by providers
• Data suggest an overall negative impact of the COVID-19 pandemic on children with PANS/PANDAS and their caregivers.

Konstantinou GN, Konstantinou GN, Koulias C, Petalas K, Makris M. Further Understanding of Neuro-Immune Interactions in Allergy: Implications in Pathophysiology and Role in Disease Progression. J Asthma Allergy. 2022;15:1273-1291. https://doi.org/10.2147/JAA.S282039

“We have systematically reviewed and discussed the evidence regarding the role of the neuro-immune interactions in common allergic clinical modalities like allergic rhinitis, chronic rhinosinusitis, allergic asthma, food allergy, atopic dermatitis, and urticaria. It is essential to understand unknown – to most of the immunology and allergy experts – neurological networks that not only physiologically cooperate with the immune system to regulate homeostasis but also pathogenetically interact with more or less known immunological pathways, contribute to what is known as neuroimmunological inflammation, and shift homeostasis to instability and disease clinical expression.”

Oroojzadeh, P., Bostanabad, S.Y. & Lotfi, H. Psychobiotics: the Influence of Gut Microbiota on the Gut-Brain Axis in Neurological Disorders. J Mol Neurosci (2022). https://doi.org/10.1007/s12031-022-02053-3

• Psychobiotics are a probiotic strain capable to affect the gut-brain axis.
• Finding suggests that Psychobiotics can efficiently alleviate the symptoms of several CNS disorders such as autism spectrum disorders, Parkinson’s disease, multiple sclerosis, insomnia, depression, diabetic neuropathy, and anorexia nervosa.
• It can be concluded that functional foods containing psychotropic strains can help to improve mental health.

T Bhikram, P Sandor, Neutrophil-lymphocyte ratios as inflammatory biomarkers in psychiatric patients, Brain, Behavior, and Immunity, Volume 105, 2022, Pages 237-246, https://doi.org/10.1016/j.bbi.2022.07.006.

Pourshahid S, Khademolhosseini S, Giri B, et al. (July 12, 2022) A Case of Steroid-Responsive Severe Pneumonia Following a Recent COVID-19 Infection in a Patient With Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infection. Cureus 14(7): e26785. doi:10.7759/cureus.26785

“Drug-induced pneumonitis was a possibility as well; however, she was only taking rituximab and cetirizine. Rituximab is a potential agent for the treatment of pneumonitis refractory to conventional treatments [25]. Although there are a few reported cases of rituximab-induced pneumonitis [26], the three-month delay after the last injection of rituximab and rapid progression in a few days are not consistent with drug-induced pneumonitis.

It is conceivable that her recent COVID-19 infection may have activated an exaggerated inflammatory response as the immunosuppression related to rituximab was subsiding. The rapidly progressing pulmonary consolidations and worsening respiratory symptoms under these circumstances should prompt the clinician to consider steroid-responsive-pneumonia like post-COVID OP, MISA, and IRIS-like reactions. Rapid institution of high-dose steroids seems to be the key to treatment. Whether her history of PANDAS may have further impacted her immune system, making her more prone to this exaggerated response is unclear.”

Congiu, P., Puligheddu, M., Capodiferro, A. M., Falqui, S. G., Tamburrino, L., Figorilli, M., Plazzi, G., & Gagliano, A. (2024). Narcolepsy and pediatric acute-onset neuropsychiatric syndrome: A case report that suggests a putative link between the two disorders. Sleep Medicine, 121, 370–374. https://doi.org/10.1016/j.sleep.2024.06.02

• Case report of a 13-year-old boy diagnosed with both NT1 and PANS, suggesting a shared neuroimmune mechanism.
• Abrupt onset of vocal tics, OCD symptoms, anxiety, regression, school decline, and sleep disturbance.
• Progressed to daytime sleepiness, spontaneous falls, confusion, and cataplexy-like episodes.
• Elevated ASLO titer indicated prior streptococcal exposure; MRI/EEG normal; sleep study confirmed NT1.
• HLA DQB1*06:02 negative — rare in NT1 but documented.
• No clinical improvement with steroid immunotherapy.
• Significant improvement with narcolepsy and psychiatric medications, including remission of cataplexy.
• Authors propose NT1 and PANS may exist on a post-infectious autoimmune spectrum involving orexin (sleep/cataplexy) and dopamine (tics/OCD/anxiety) dysfunction.

Citation: Bransfield, R.C. Adverse Childhood Events, Post-Traumatic Stress Disorder, Infectious Encephalopathies and Immune-Mediated Disease. Healthcare 2022, 10, 1127. https://doi.org/10.3390/healthcare10061127

“In summary, insight into the underlying pathophysiology of Adverse Childhood Events, Post-Traumatic Stress Disorder, and infectious encephalopathies offers expanded treatment opportunities that include psychotherapeutic treatments that help to differentiate safety vs. danger, therapies to improve empowerment, and psychotropic medications to reduce intrusive symptoms and other symptoms, anti-infective treatments, immune-modulating treatments and education for patients and caregivers.“