Antibodies against human putamen in children with Tourette syndrome

Singer, Harvey S.; Giuliano, Joseph; Hansen, Bendt H; Hallett, J. J.; Laurino, Joseph P.; Benson, Margaret; Kiessling, Louise S.

doi:10.1212/wnl.50.6.1618

Cited by 191 publications

(139 citation statements)

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“…In contrast to several previous reports [39][40][41][42] and in agreement with others, [43][44][45] we did not find that our patients had higher titers of antistreptococcal antibodies. The reason for these discrepancies is unclear but is possibly related to regional and seasonal differences and the composition of the patient sample.…”

Section: Subjectssupporting

confidence: 88%

“…Third, because it has been postulated that GABHS infection must be the initial autoimmune response-inciting event but subsequent symptom exacerbations can be triggered by viruses, other bacteria, or noninfectious immunologic responses, 14 future studies will need to monitor patients systematically for other potential triggers. Much remains to be investigated in this area, including the potential roles of antineuronal antibodies, 41,43,44 bacterial superantigens, 59 host factors, and other regulators of immune responses, such as cytokines, chemokines, and specific subsets of T cells that have been implicated in autoimmune diseases. Additional prospective longitudinal studies are needed to clarify these mechanisms.…”

Section: Limitationsmentioning

confidence: 99%

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Prospective Longitudinal Study of Children With Tic Disorders and/or Obsessive-Compulsive Disorder: Relationship of Symptom Exacerbations to Newly Acquired Streptococcal Infections

Luo¹,

et al. 2004

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ABSTRACT. Background. It has been proposed that infection by group A ␤-hemolytic streptococci (GABHS) can trigger acute symptom exacerbations among patients with Tourette's syndrome (TS) or obsessive-compulsive disorder (OCD), via autoimmune mechanisms.Objective. To examine the temporal relationship between newly acquired GABHS infections (and other immunologic indices) and acute exacerbations of tics and obsessive-compulsive symptoms.Methods. Pediatric patients (7-17 years of age) with TS and/or OCD (N ‫؍‬ 47) and healthy control subjects (N ‫؍‬ 19) were prospectively monitored for newly acquired GABHS infections, nonspecific markers of acute inflammatory responses, and D8/17-reactive cells (a marker of rheumatic fever). Objective monthly ratings of tic and obsessive-compulsive symptom severity were used to determine the timing of symptom exacerbations.Results. The overall rate of acute exacerbations of neuropsychiatric symptoms was 0.56 exacerbations per patient per year. The average rate of new GABHS infections, using a stringent definition, was 0.42 infections per subject per year among patients, compared with 0.28 infections per subject per year for control subjects. The association between symptom exacerbations and new GABHS infections among patients was no greater than that expected on the basis of chance. At baseline, patients demonstrated significantly higher levels of D8/17-reactive cells and neopterin, compared with control subjects, but there was no consistent pattern of change when exacerbation time points were compared with baseline or follow-up time points.Conclusions. The results suggest no clear relationship between new GABHS infections and symptom exacerbations in an unselected group of patients with TS and/or OCD. Pediatrics 2004;113:e578 -e585. URL: http://www. pediatrics.org/cgi/content/full/113/6/e578; Tourette's syndrome, obsessive-compulsive disorder, PANDAS, group A ␤-hemolytic streptococci, D8/17, neopterin, C-reactive protein.ABBREVIATIONS. ADHD, attention-deficit/hyperactivity disorder; ASO, anti-streptolysin O; BRR, B repeat region; CRP, C-reactive protein; CRR, C repeat region; Y-BOCS, Yale-Brown Obsessive-Compulsive Scale; GABHS, group A ␤-hemolytic streptococci; OCD, obsessive-compulsive disorder; OC, obsessive compulsive; PANDAS, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections; RF, rheumatic fever; TS, Tourette's syndrome; YGTSS, Yale Global Tic Severity Scale; IgG, immunoglobulin G.T ic disorders, obsessive-compulsive disorder (OCD), and related conditions affect as many as 3% of children and adolescents. [1][2][3][4][5][6] The factors that contribute to the pathogenesis of these disorders are poorly defined. The hypothesis that infections can modulate the clinical appearance of tic disorders dates from the 1800s. 7 The past decade has seen the reemergence of the hypothesis that postinfectious immune mechanisms account for at least some cases of Tourette's syndrome (TS) and OCD.It is well known that group A ␤-hemolytic streptococci (GABHS...

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Section: Subjectssupporting

confidence: 88%

Section: Limitationsmentioning

confidence: 99%

Prospective Longitudinal Study of Children With Tic Disorders and/or Obsessive-Compulsive Disorder: Relationship of Symptom Exacerbations to Newly Acquired Streptococcal Infections

Luo¹,

et al. 2004

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“…It is yet to be decided whether this type of OCD should be considered a specific subtype, a special pattern of comorbidity or a new disorder. However, it is clear that pediatric autoimmune neuropsychiatric disorder associated with streptococcal (PAN-DAS) should be screened when there is a suspicion of streptococcal infection (Swedo et al, 1998;Singer et al, 1998;Peterson et al, 2000) and may be important in evaluating the adequacy and response to treatments such as plasma exchange (Nicolson et al, 2000).…”

Section: Subtypesmentioning

confidence: 99%

Treatment-refractory obsessive-compulsive disorder: Methodological issues, operational definitions and therapeutic lines

Pallanti

Quercioli

2006

Progress in Neuro-Psychopharmacology and Biological Psychiatry

337

190

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While controlled trials with SRIs have demonstrated a selective efficacy in obsessive-compulsive disorder (OCD), up to 40 -60% of patients do not have a satisfactory outcome. Non-response to treatment in OCD is associated with serious social disability. There are a large number of nonresponsive patients, and they are difficult to cluster due to ambiguities in diagnostic criteria, possibility of subtypes and a high rate of comorbidity. Moreover, the findings of current studies of ''so-called'' non-responsive cases are currently non-generalizable because of the lack of an operational definition of non-response. The result has been that a cumulative body of data on a reasonably homogeneous sample of non-responders has not been developed. The aims of the research in this area are to clarify some of the obstacles in defining stages of response and levels of non-response and, through a comprehensive analysis, to propose a systematic nosology for this rather common condition. Better characterization of which patients respond and do not respond to various treatments will enable more accurate clustering of patients, and help facilitate multisite data collection for future research trials. The authors reviewed also the more recent therapeutic pharmacological and psychological lines for the treatment of refractoriness in OCD. D

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“…Previous studies have proposed that antineural antibodies in patients with tic disorders and related conditions, such as obsessive-compulsive disorder [1][2][3][4][5][6][7]. Swedo and colleagues proposed the existence of a group of patients with pediatric antoimmune neuropsychiatric disorders associated with streptococcal infection, or ''PANDAS'' [8].…”

Section: Introductionmentioning

confidence: 99%

Antineural antibody in patients with Tourette’s syndrome and their family members

Yeh

Wu²,

Tsung³

et al. 2005

J Biomed Sci

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SummaryIt has been proposed that antineural antibodies were present in patients with Tourette's syndrome (TS) and other neuropsychiatric disorders. The purpose of our study was to investigate the presence of antineural antibodies in the individuals with Tourette's syndrome and the family members of TS patients. The sera of four TS patients with no current streptococcal infection, their tic-free family members including father, mother and sibling, and a age-matched control group who were tic free were assayed for antineural antibodies directed against rat tissue and neurons in primary cell culture. There were prominent antineural antibodies present in TS patients and their first-degree family members, but not in the control group. Western blotting showed proteins of about 120 kDa in their sera that were not present in the sera of controls. The preliminary results of our study suggest the importance of genetic vulnerability in the immunological pathophysiology of tic disorders. Future studies should investigate the interactions of genetics, environment, infectious agents, and immunity on symptom expression in families with tic disorders.

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Antibodies against human putamen in children with Tourette syndrome

Abstract: Children and adolescents with TS had significantly higher serum levels of antineuronal antibodies against putamen than did controls, but their relation to clinical characteristics and markers for streptococcal infection remains equivocal.

Cited by 191 publications

References 0 publications

Prospective Longitudinal Study of Children With Tic Disorders and/or Obsessive-Compulsive Disorder: Relationship of Symptom Exacerbations to Newly Acquired Streptococcal Infections

Prospective Longitudinal Study of Children With Tic Disorders and/or Obsessive-Compulsive Disorder: Relationship of Symptom Exacerbations to Newly Acquired Streptococcal Infections

Treatment-refractory obsessive-compulsive disorder: Methodological issues, operational definitions and therapeutic lines

Antineural antibody in patients with Tourette’s syndrome and their family members

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