National Institute of Mental Health (NIMH) researchers report that some children whose symptoms of obsessive-compulsive disorder (OCD) and tic disorders were worsened by a common strep infection have been successfully treated with plasma exchange (PEX) and intravenous immunoglobulin (IVIG). Dr. Susan Swedo and colleagues at the National Institutes of Health reported their findings in the October 2 issue of Lancet.
In previous studies, Dr. Swedo and others observed that in a small number of children suffering from the obsessional thoughts and compulsive behaviors typical of OCD and tic disorders, symptoms suddenly became worse following infection with Group A beta hemolytic streptococci. Evidence pointed to an autoimmune response to the infection, in which antibodies attack healthy as well as infected cells, leading to inflammation in the brain's basal ganglia, an area involving movement and motor control. The syndrome, known as PANDAS, or Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections, typically occurs in young children and is noted for its dramatic, sudden onset or exacerbation of symptoms and episodic course, in which periods of symptom worsening follow strep infections.
"The investigation shows that plasma exchange and IVIG relieve neuropsychiatric
symptoms in this subgroup of children with tics and obsessive-compulsive
disorder. A few children were even able to discontinue all psychotropic
medications after treatment," Dr. Swedo said. "The study does not, however,
support using PEX and IVIG for all cases of tics or OCD. Nor does it suggest
that all children with untreated strep infections will get OCD, tics, or
Tourette syndrome. In fact, strep infections are very common and strep-triggered
neuropsychiatric disorders are quite rare, so the vast majority of children with strep infections are
not going to develop these disorders, particularly with prompt attention and
treatment," according to Dr.
Contact: Constance Burr
NIH/National Institute of Mental Health