Strep infection doesn't worsen childhood tics or OCD symptoms
by Will Boggs, MD
2008-06-16 13:29:56 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Streptococcal infection does not cause exacerbations of childhood tics or obsessive-compulsive symptoms, according to a report in the June issue of Pediatrics.
"This study provides further evidence against the use of chronic antibiotic or immune-suppressing therapy to treat these patients, as has been suggested," Dr. Roger Kurlan from University of Rochester School of Medicine, New York told Reuters Health.
"Patients meeting criteria for PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections) seem to do fine with standard treatments for their symptoms of tics or obsessive-compulsive disorder (OCD)."
Dr. Kurlan and colleagues sought to determine whether there is a bona fide relationship between antecedent group A beta-hemolytic streptococcal (GABHS) infection and exacerbation of symptoms in 40 children who met the published diagnostic criteria for PANDAS, which included a temporal relationship between the course of illness and GABHS infection. These children were matched with 40 controls, who had OCD or a chronic tic.
Sixty-five clinical exacerbations occurred during the study; of these, 40 episodes occurred in 21 PANDAS children and 25 episodes were seen in 14 control children, the authors report, resulting in exacerbation rates of 0.56 per person-year for PANDAS children and 0.28 per person-year for control subjects.
PANDAS children, however, had more than three-times the GABHS infection rate than control children (0.43 versus 0.13 per person-year), the report indicates, and the higher risk of clinical exacerbation of tics or OCD for PANDAS children did not reach statistical significance.
Only 5 of the 64 total clinical exacerbations of tics and/or OCD occurred within 4 weeks of GABHS infection, and all 5 occurred in PANDAS subjects.
Based on a variety of time intervals and infection classifications, 75% to 92.5% of exacerbations in PANDAS children occurred with no observed evidence of a temporal relationship to GABHS infection, the investigators say.
"Our study results must be interpreted with caution," the researchers note, "because the number of clinical exacerbations and the number of GABHS infections observed were smaller than originally anticipated, particularly in control subjects."
"The most surprising result was that for children meeting criteria for PANDAS, so few of their exacerbations were linked to strep infection," Dr. Kurlan said.
"It remains unclear if the PANDAS hypothesis is true as presented," Dr. Kurlan concluded. In another trial the investigators "found no evidence of immune factors in association with clinical exacerbations in PANDAS cases, casting doubt on the autoimmune hypothesis."
Copyright Reuters 2008.
This research is very interesting but doesn't convince me of no link. Obviously there IS a link in my own home and with the myriad of children I read about and see with my own eyes day after day in elementary classrooms. My children also do not meet the exact description of PANDAS as outlined by the Am. Academy of Pediatrics. Funny though, I thought the AAP didn't agree to a diagnostic criteria for PANDAS, referring to it only as a theory. Now in this publishing they refer to a criteria. Makes you wonder what is going on here. Bottom line is there are atypical responses to strep too numerous to ignore. Autoimmune reactions to strep, 5ths disease, Lyme, and many other illnesses is very disturbing and warrant immediate funding and attention. This is the future and it's obviously not going away.
I've written more posts on this topic. Also go to my Labels on the right and click on P.A.N.D.A.S. or strep.