The PANDAS subgroup of tic disorders and childhood-onset obsessive–compulsive disorder

Martino, Davide; Defazio, Giovanni; Giovannoni, Gavin

doi:10.1016/j.jpsychores.2009.07.004

Cited by 72 publications

(30 citation statements)

References 80 publications

(101 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Thyroid autoimmunity may be a marker of a preexisting subclinical autoimmune condition of the mothers; such an immune process could cause the developmental problems of the offspring, as maternal antibodies pass through the placenta. There is growing evidence for the role of the autoimmune process in neuropsychiatric symptoms in children (18,19). Lastly, external factors such as genetic risk factors and maternal depressive symptoms could explain the relation between maternal TPOAbs and child behavior.…”

Section: Discussionmentioning

confidence: 99%

“…They argued that it is ''autoimmunity rather than thyroid hormone insufficiency'' which affects the child's development. Recent evidence on the role of the autoimmune process in the psychiatric disorders in childhood supports this theory (18,19). In a retrospective study within a general population sample, Li et al found that maternal thyroid hormones and TPOAbs were associated with intelligence and motor scores in young children.…”

mentioning

confidence: 98%

See 1 more Smart Citation

Maternal Thyroid Autoimmunity During Pregnancy and the Risk of Attention Deficit/Hyperactivity Problems in Children: The Generation R Study

Ghassabian

Bongers-Schokking

Rijke

et al. 2012

Thyroid

131

109

View full text Add to dashboard Cite

Background: Maternal thyroid status and autoimmunity during pregnancy have been associated with impaired development of the offspring in animal and human studies. Our objective was to examine whether elevated titers of maternal thyroid peroxidase antibodies (TPOAbs) in early pregnancy increased the risk of cognitive impairment and problem behavior in preschool children. Second, we aimed at exploring to what extent any effect on child behavior was mediated by maternal thyroid parameters during pregnancy. Methods: In the Generation R Study, a population-based cohort of 3139 children and their mothers, we measured maternal thyroid parameters (thyrotropin [TSH], free Thyroxine, and TPOAbs) at 13.5 -1.8 weeks of gestation. Children's verbal and nonverbal cognitive functioning was measured at 2.5 years using the Language Development Survey and the Parent Report of Children Abilities. At 3 years, children's behavior was assessed using the Child Behavior Checklist. Results: Elevated titers of TPOAbs during pregnancy did not predict the verbal and nonverbal cognitive functioning of the children. However, elevated titers of TPOAbs in mothers were associated with externalizing problems in children (odds ratio [OR] = 1.64, 95% confidence interval [CI]: 1.17-2.29, p = 0.004). In particular, children of TPOAb-positive mothers were at a higher risk of attention deficit/hyperactivity problems (OR = 1.77, 95% CI: 1.15-2.72, p = 0.01). To explore whether the effect of maternal TPOAbs on child problem behavior was mediated by maternal thyroid parameters, we added maternal TSH to the model. After correcting for TSH, the effect of TPOAbs on externalizing problems was attenuated slightly but remained significant (OR = 1.56, 95% CI: 1.14, 2.14, p = 0.005). Conclusions: Our findings imply that the elevated titers of TPOAbs during pregnancy impact children's risk of problem behavior, in particular, attention deficit/hyperactivity. The observed effect is only partially explained by maternal TSH levels. These findings may point to a specific mechanism of Attention Deficit/Hyperactivity Disorder in children. Nevertheless, we can only speculate about public health implication of the study, as there is no specific treatment for TPOAb-positive pregnant women with normal thyroid function. Further investigation is needed to explore whether TPOAb-positive pregnant women and their children can benefit from close monitoring and early detection of developmental delay in populations at risk.

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 98%

Maternal Thyroid Autoimmunity During Pregnancy and the Risk of Attention Deficit/Hyperactivity Problems in Children: The Generation R Study

Ghassabian

Bongers-Schokking

Rijke

et al. 2012

Thyroid

131

109

View full text Add to dashboard Cite

show abstract

“…ADHD'' was associated with more extensive changes in the excitability of motor cortex circuits than ''TS only'' (Orth et al 2009;Grados and Mathews 2009). Comorbidity of TD and OCD, perhaps even ADHD, has been controversially discussed in the context of paediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (PANDAS) to possibly represent a distinct clinical entity with an underlying genetic predisposition (Leckman 2003;Snider and Swedo 2004;Martino et al 2009). Despite continued research in the field, the relationship between group-A beta-haemolytic Streptococcus pyogenes (GAS) infections and PANDAS, however, remains elusive.…”

Section: Discussionmentioning

confidence: 99%

Developmental comorbidity in attention-deficit/hyperactivity disorder

Taurines

Schmitt

Renner

et al. 2010

ADHD Atten Def Hyp Disord

164

116

View full text Add to dashboard Cite

With the present review, we intend to highlight the importance of considering the age- and development-dependent occurrence of comorbidity in ADHD and to outline distinct trajectories of symptom progression with possible impact on course and outcome of ADHD. The review will focus on introducing the concepts of "developmental epidemiology" and "developmental comorbidity". Psychiatric and non-psychiatric age-dependent comorbidity can be seen in the majority of children, adolescents and adults with ADHD, resulting in a severe impairment of everyday life with considerable functional and psychosocial problems. Concerning the temporal order of occurrence, psychiatric conditions may be present before the appearance of first definite ADHD symptoms ("pre-comorbidity", such as temperament factors, sleep disturbance, autism spectrum disorders and atopic eczema). They may coincide with the time when ADHD symptoms reach a clinically significant level ("simultaneous comorbidity": enuresis, encopresis, developmental dyslexia). The majority of comorbidity, however, appears after the onset of ADHD in the course of disease ("post-comorbidity": tic disorder, depression and suicidality, anxiety disorders, obsessive compulsive disorder, bipolar disorder, conduct and substance use disorders, obesity and personality disorders). The aetio-pathophysiology of ADHD and its comorbid disorders and also the nature of comorbidity itself being highly heterogeneous, we additionally discuss possible models of comorbidity. In the future, longitudinal data on distinct patterns of symptom and comorbidity progression would help to refine disease classification systems, strengthen the power of future genetic studies and finally allow for more specific treatment strategies.

show abstract

“…However, increases in antibodies to aldolase C, enolase, and pyruvate kinase were not detected in serial serum specimens obtained during one of the prospective longitudinal studies described above (Kurlan et al 2008;Singer et al 2008). Methodological differences in the laboratory procedures and patient selection may account for some of the inconsistencies across studies (Martino et al 2009).…”

Section: Serologic and Prospective Studiesmentioning

confidence: 99%

The Immunobiology of Tourette's Disorder, Pediatric Autoimmune Neuropsychiatric Disorders Associated withStreptococcus, and Related Disorders: A Way Forward

Murphy

Kurlan

Leckman

2010

Journal of Child and Adolescent Psychopharmacology

144

View full text Add to dashboard Cite

Obsessive-compulsive disorder (OCD) and related conditions including Tourette's disorder (TD) are chronic, relapsing disorders of unknown etiology associated with marked impairment and disability. Associated immune dysfunction has been reported and debated in the literature since the late 80s. The immunologic culprit receiving the most interest has been Group A Streptococcus (GAS), which began to receive attention as a potential cause of neuropsychiatric symptoms, following the investigation of the symptoms reported in Sydenham's chorea (SC) and rheumatic fever, such as motor tics, vocal tics, and both obsessive-compulsive and attention deficit/hyperactivity symptoms. Young children have been described as having a sudden onset of these neuropsychiatric symptoms temporally associated with GAS, but without supporting evidence of rheumatic fever. This presentation of OCD and tics has been termed pediatric autoimmune neuropsychiatric disorders associated with Streptococcus (PANDAS). Of note, SC, OCD, and TD often begin in early childhood and share common anatomic areas-the basal ganglia of the brain and the related cortical and thalamic sites-adding support to the possibility that these disorders might share a common immunologic and/or genetic vulnerability. Relevant manuscripts were identified through searches of the PsycINFO and MedLine databases using the following keywords: OCD, immune, PANDAS, Sydenham chorea, Tourette's disorder Group A Streptococcus. Articles were also identified through reference lists from research articles and other materials on childhood OCD, PANDAS, and TD between 1966 and December 2010. Considering the overlap of clinical and neuroanatomic findings among these disorders, this review explores evidence regarding the immunobiology as well as the relevant clinical and therapeutic aspects of TD, OCD, and PANDAS.

show abstract

The PANDAS subgroup of tic disorders and childhood-onset obsessive–compulsive disorder

Cited by 72 publications

References 80 publications

Maternal Thyroid Autoimmunity During Pregnancy and the Risk of Attention Deficit/Hyperactivity Problems in Children: The Generation R Study

Maternal Thyroid Autoimmunity During Pregnancy and the Risk of Attention Deficit/Hyperactivity Problems in Children: The Generation R Study

Developmental comorbidity in attention-deficit/hyperactivity disorder

The Immunobiology of Tourette's Disorder, Pediatric Autoimmune Neuropsychiatric Disorders Associated withStreptococcus, and Related Disorders: A Way Forward

Contact Info

Product

Resources

About