Neuropsychological manifestations in children with Sydenham’s chorea after adjunct intravenous immunoglobulin and standard treatment

Abstract

This was an exploratory study comparing neuropsychological manifestations of Sydenham's chorea (SC), 6 months after initiation of treatment, in children who had received intravenous immunoglobulins as an adjunct to standard treatment, with those who had received standard treatment. We included a non-SC control group for comparison. We hypothesized that compared to controls, children with SC who had received prior intravenous immunoglobulins would demonstrate less pronounced impairments compared to those who had received standard care. We conducted a cross-sectional analysis of 17 children with -SC who had received treatment 6 months previously (9 treated with standard of care and 8 augmented with intravenous immunoglobulins) and 17 non-SC, medically well controls. The standard treatment group (n = 9) exhibited significant behavioral difficulties, including significantly poorer co-operation (p = 0.009) compared with the other augmented immunoglobulins and non-SC control groups, and increased impulsivity (p = 0.016) compared with non-SC controls. The standard treatment group scored significantly lower than the other two groups on a measure of executive functioning (p = 0.03). Children with SC may be more at risk for neuropsychological difficulties than non-SC, medically well children. Intravenous immunoglobulins may mitigate some of these impairments.

Treatment of Sydenham’s Chorea: A Review of the Current Evidence

“…Concerns for this study include lack of placebo control arm, use of a non-validated rating scale, and failure of the blinded observer to perform the initial evaluation at the beginning of the protocol. In a follow-up of these patients, it has been suggested that there might be a difference in executive function at 1, 3, and 6 months between those subjects treated with IVIG + haloperidol compared with haloperidol alone 65. Statistical analyses included a comparison to a “healthy” control group, rather than a simple comparison of the original cohorts.…”

Psychiatric Treatment and Management of Psychiatric Comorbidities of Movement Disorders

“…Six months after treatment, the IVIG group showed fewer behavior difficulties, less impulsivity, and better cooperation and executive functioning compared to the standard treatment group. 122 Studies of IVIG treatment of the streptococcal-related autoimmune disease, PANDAS, have been mixed. One small study reported improvement in neuropsychiatric symptoms including anxiety, depression, obsession, compulsion, impairment, and overall severity after IVIG (n=9) or plasmapheresis (n=10).…”

Group A Streptococcus, Acute Rheumatic Fever and Rheumatic Heart Disease: Epidemiology and Clinical Considerations

“…Choreiform movements are non-rhythmic, involuntary, often asymmetrical, and disappear with sleep. Concurrent muscular weakness and emotional disturbances (crying, restlessness, obsessive-compulsive symptoms, rare psychosis) can occur [70]. Alternate diagnoses should be excluded.…”