He has received royalties from Elsevier, and has served as an editor for the journal em Neurolograd /em . and/or recent significant rise in streptococcal antibodies. Laboratory personnel were blinded to case or control status, clinical (exacerbation or not) condition, and clinical evaluators were blinded to the laboratory results. Results No group differences were observed in either the number of clinical exacerbations or BF-168 the number of newly diagnosed GABHS infections. On only six occasions out of a total of 51 (12%) a newly diagnosed GABHS contamination was followed, within two months, by an exacerbation of tic and/or OC symptoms. In every instance, this association occurred in the non-PANDAS group. Conclusions This study provides no evidence for a temporal association between GABHS infections and tic/OC symptom exacerbations in children who meet the published PANDAS diagnostic criteria. GABHS infections and the onset or exacerbations of tic and obsessive-compulsive (OC) symptoms.5C8 To determine whether there is such a specific relationship we conducted an intensive, blinded clinical and laboratory prospective cohort study that included PANDAS as well as non-PANDAS comparison subjects. We hypothesized that, if PANDAS is usually a unique clinical entity, then PANDAS cases would have more clinical exacerbations temporally linked to antecedent GABHS infections than non-PANDAS comparison subjects. The non-PANDAS subjects were diagnosed with either TS or pediatric-onset OCD Rabbit Polyclonal to Cyclin L1 and had no existing evidence of a prior association between GABHS infections and symptom onset or exacerbations as stated in the published criteria.3 Method Subjects All of the subjects were sequentially enrolled at one of six clinical settings (Yale University, Cincinnati Childrens Hospital Medical Center, the New York University Child Study Center, Johns Hopkins University School of Medicine, the University of Alabama at Birmingham, and the University of Rochester School of Medicine) during a four and a half year period from July 2002 to December 2006. Approval by the Institutional Review Boards was obtained at all sites. Case subjects met all five of the published diagnostic criteria for PANDAS described by Swedo et al.3: (1) the presence of OCD and/or a chronic tic disorder (Tourette disorder, chronic motor or vocal tic disorder), defined as meeting lifetime (DSM-IV), diagnostic criteria;38 (2) age at onset between 3 years and the beginning of puberty; (3) clinical course BF-168 characterized by the abrupt onset of symptoms or by a pattern of dramatic recurrent symptom exacerbations and remissions; (4) temporal relationship between GABHS contamination and the clinical course of illness (onset and/or exacerbations) as reported by the subject or parent; and (5) at least one of the following symptoms appeared or became noticeably worse: motoric hyperactivity, choreiform movements, jerks of the hands, arms or legs, clumsiness, slurred speech, impaired dexterity or more difficulty drawing. For criterion 4 above, we used a more exacting criterion. Specifically, we required documentation in the patients medical record that there was a temporal relationship between an antecedent GABHS contamination and the onset of the disorder as well as at least one exacerbation or that there was a temporal relationship between an antecedent GABHS contamination and at least two exacerbations. We used time windows of 9 months for onset and 4 weeks for exacerbations. In addition, all PANDAS cases were required to be 16 years of age. Informed consent had to be provided by a parent or guardian and assent provided by the subject. Exclusion criteria for PANDAS cases included the following: (1) Sydenhams chorea or a history of rheumatic fever; (2) presence of severe intellectual disability IQ 75, autism, or a secondary tic disorder BF-168 other than PANDAS (e.g., drug induced or neuroacanthocytosis); (3) a psychiatric illness other than OCD or a tic disorder or ADHD that is the primary focus of treatment; (4) a major neurological disease (other than a tic disorder); (5) a CNS autoimmune disorder (e.g., multiple sclerosis, systemic lupus erythematosus, Behcets) or a documented infection associated with neuropsychiatric symptoms (Lyme disease); (6) patient treated with corticosteroids, IVIG or plasma exchange during the prior 3 months; and/or (7) patient treated with antibiotics in the past 1 month. Inclusion criteria for non-PANDAS comparison subjects were: (1) the presence of OCD and/or a chronic tic disorder by DSM-IV criteria; (2) age at onset between 3 and 14 years; (3) currently 16 years of age; (4) following a review of the.
He has received royalties from Elsevier, and has served as an editor for the journal em Neurolograd /em