Repost of abstracts, ie bacteria & PANDAS, restless leg....

[Guest guest]

A previous comment from Cheryl:

“My son tends to have problems when he's dealing with

a bacterial infection/OCD. It's always possible that

the probiotic could be a problem by itself or in

combination with some other type of immune stimulus.

I definitely wouldn't give this bacteria to any child

with PANDAS.”

Culturelle is manufactured in gelatin capsules

providing 20 billion colony forming units (CFUs) per

capsule of Lactobacillus GG.

J Leukoc Biol. 2003 Sep; 74(3): 395-402.

Lactobacilli and streptococci induce inflammatory

chemokine production in human macrophages that

stimulates Th1 cell chemotaxis.

Veckman V, Miettinen M, Matikainen S, Lande R,

Giacomini E, Coccia EM, Julkunen I.

Department of Microbiology, National Public Health

Institute, Helsinki,

Finland. ville.veckman@...

Macrophages have a central role in innate-immune

responses to bacteria.

In the present work, we show that infection of human

macrophages with

Gram-positive pathogenic Streptococcus pyogenes or

nonpathogenic Lactobacillus rhamnosus GG enhances mRNA

expression of inflammatory chemokine ligands

CCL2/monocyte chemoattractant protein-1 (MCP-1),

CCL3/macrophage-inflammatory protein-1alpha

(MIP-1alpha), CCL5/regulated on activation, normal T

expressed and secreted, CCL7/MCP-3, CCL19/MIP-3beta,

and CCL20/MIP-3alpha and CXC chemokine igands

CXCL8/interleukin (IL)-8, CXCL9/monokine induced by

interferon-gamma (IFN-gamma), and CXCL10/IFN-inducible

protein 10. Bacteria-induced CCL2, CCL7, CXCL9, and

CXCL10 mRNA expression was partially dependent on

ongoing protein synthesis.

The expression of these chemokines and of CCL19 was

dependent on bacteria-induced IFN-alpha/beta

production. CCL19 and CCL20 mRNA expression was

up-regulated by IL-1beta or tumor necrosis factor

alpha

(TNF-alpha), and in addition, IFN-alpha together with

TNF-alpha further enhanced CCL19 gene expression.

Synergy between IFN-alpha and TNF-alpha was also seen

for CXCL9 and CXCL10 mRNA expression.

Bacteria-stimulated macrophage supernatants induced

the migration of T helper cell type 1 (Th1) cells,

suggesting that in human macrophages, these bacteria

can stimulate efficient inflammatory chemokine gene

expression including those that recruit Th1 cells to

the site of inflammation. Furthermore, L.

rhamnosus-induced Th1 chemokine production could in

part explain the proposed antiallergenic properties of

this bacterium.

PMID: 12949243 [PubMed - indexed for MEDLINE]

J Food Prot. 2003 Mar; 66(3): 466-72. Links

Interactions of lactic acid bacteria with human

intestinal epithelial cells: effects on cytokine

production.

Wallace TD, Bradley S, Buckley ND, Green- JM.

Department of Biology, Acadia University, Wolfville,

Nova Scotia,

Canada B0P 1X0.

As a participant in the mucosal immune response, the

intestinal epithelial cell must respond to a variety

of stimuli, including lactic acid bacteria (LAB)

consumed in the diet. The objective of this study was

to compare the abilities of several strains of LAB to

modulate cytokine secretion by human intestinal

epithelial cell (IEC) line HT-29. Certain strains of

Lactobacillus rhamnosus, Lactobacillus delbrueckii,

and Lactobacillus acidophilus suppressed the

production of the chemokine RANTES by stimulated HT-29

IEC, although the magnitude of this suppression varied

depending on the nature of the bacterial growth

medium. Similarly, specific strains showed growth

condition-dependent suppression of HT-29 interleukin-8

(IL-8) production. Strain-dependent effects were also

seen for the suppression of tumor necrosis factor

alpha (TNF-alpha) and transforming growth factor beta

(TGF-beta) production. The binding of several of these

bacterial strains to the HT-29 cell line was also

examined. Different strains were found to have

differing abilities to interact with IEC, with L.

rhamnosus R0011 being the strain that generally had

the most extensive effects on HT-29 cytokine

production and also bound to HT-29 IEC most

effectively. Modulation of IEC cytokine production has

the potential to profoundly affect the mucosal

microenvironment, influencing the immune response to

pathogens and other ingested antigens.

PMID: 12636302 [PubMed - indexed for MEDLINE]

: Salminen MK, Rautelin H, Tynkkynen S, Poussa T,

Saxelin M, Valtonen

V,

Jarvinen A.

Lactobacillus bacteremia, clinical significance, and

patient outcome, with special focus on probiotic L.

rhamnosus GG.

Clin Infect Dis. 2004 Jan 1; 38(1): 62-9. Epub 2003

Dec 04.

PMID: 14679449 [PubMed - in process]

Scand J Infect Dis. 2003; 35(6-7): 404-8.

Six cases of Lactobacillus bacteraemia: identification

of organisms and antibiotic susceptibility and

therapy.

Arpi M, Vancanneyt M, Swings J, Leisner JJ.

Arhus University Hospital, Skejby, Arhus, Denmark.

Six cases of bacteraemia in hospitalized patients, 5

with a depressed immune status, were caused by

lactobacilli. Sodium dodecyl

sulfate-polyacrylamide gel electrophoresis of

whole-cell proteins and API 50 CH carbohydrate

patterns assigned the causative agents to the species

Lactobacillus rhamnosus, Lactobacillus curvatus,

Lactobacillus delbrueckii subsp. lactis and

Lactobacillus paracasei subsp. paracasei.

Publication Types:

Case Reports

PMID: 12953954 [PubMed - indexed for MEDLINE] Notario

R, Leardini N, Borda N, Gambande T, Cerutti H. Related

Articles, Links

[Hepatic abscess and bacteremia due to Lactobacillus

rhamnosus]

Rev Argent Microbiol. 2003 Apr-Jun; 35(2): 100-1.

Review. Spanish.

PMID: 12920992 [PubMed - indexed for MEDLINE]

**************************

1-Myelin oligodendrocyte glycoprotein (MOG) gene is

associated with

obsessive-compulsive disorder.

2-PANDAS: current status and directions for research.

3-Dyskinesias and associated psychiatric disorders

following streptococcal

infections

4-Antibasal ganglia antibodies and their relevance to

movement disorders.

5-Restless legs syndrome; Association with

streptococcal or mycoplasma

infection.

-----------------------------------------------------------------

Am J Med Genet. 2004 Aug 15;129B(1):64-8.

Myelin oligodendrocyte glycoprotein (MOG) gene is

associated with

obsessive-compulsive disorder.

Zai G, Bezchlibnyk YB, Richter MA, Arnold P, Burroughs

E, Barr CL, Kennedy

JL.

Neurogenetics Section, Centre for Addiction and Mental

Health, Department of

Psychiatry, University of Toronto, Toronto, ON,

Canada.

Obsessive-compulsive disorder (OCD) is a severe

neuropsychiatric disorder

with a strong genetic component, and may involve

autoimmune processes.

Support for this latter hypothesis comes from the

identification of a

subgroup of children, described by the term pediatric

autoimmune

neuropsychiatric disorder associated with

streptococcal infections (PANDAS),

with onset of OCD symptoms following streptococcal

infections.

Genes involved in immune response therefore represent

possible candidate

genes for OCD, including the myelin oligodendrocyte

glycoprotein (MOG) gene,

which plays an important role in mediating the

complement cascade in the

immune system. Four polymorphisms in the MOG gene, a

dinucleotide CA repeat

(MOG2), a tetranucleotide TAAA repeat (MOG4), and 2

intronic single

nucleotide polymorphisms, C1334T and C10991T, were

investigated for the

possibility of association with OCD using 160 nuclear

families with an OCD

proband.

We examined the transmission of alleles of these four

polymorphisms with the

transmission disequilibrium test (TDT). A biased

transmission of the 459-bp

allele (allele 2: chi2 = 5.255, P = 0.022) of MOG4 was

detected, while MOG2,

C1334T, and C10991T showed no statistically

significant bias in the

transmission of alleles. The transmission of the

C1334T.MOG2.C10991T.MOG4

haplotype 1.13.2.2 (chi2 = 6.426, P = 0.011) was also

significant.

Quantitative analysis using the family-based

association test (FBAT) was

significant for MOG4 in total Yale-Brown

Obsessive-Compulsive Scale severity

score (allele 2: z = 2.334, P = 0.020). Further

investigations combining

genetic, pathological, and pharmacological strategies,

are warranted.

Copyright 2004 Wiley-Liss, Inc.

PMID: 15274043 [PubMed - in process]

--------------------------------------------------------------------------------

Mol Psychiatry. 2004 Jul 6 [Epub ahead of print]

PANDAS: current status and directions for research.

Snider LA, Swedo SE.

1Pediatrics & Developmental Neuropsychiatry Branch,

Department of Health and

Human Services, National Institute of Mental Health,

Bethesda, MD, USA.

The recognition of the five criteria for PANDAS

(pediatric autoimmune

neuropsychiatric disorders associated with

streptococcal infections) by

Swedo et al established a homogenous subgroup of

children with childhood

onset obsessive-compulsive disorder (OCD) and/or tic

disorders.

The five clinical characteristics that define the

PANDAS subgroup are the

presence of OCD and/or tic disorder, prepubertal age

of onset, abrupt onset

and relapsing-remitting symptom course, association

with neurological

abnormalities during exacerbations (adventitious

movements or motoric

hyperactivity), and a temporal association between

symptom exacerbations and

a Group-A beta-hemolytic streptococcal (GAS)

infection.

These five criteria have been used for the purpose of

systematic research on

the phenomenology and unique therapies for the PANDAS

subgroup as well as

studies of the pathophysiology of post-streptococcal

OCD and tic disorders.

The etiology of OCD and tics in the PANDAS subgroup is

unknown, but is

theorized to occur as a result of post-streptococcal

autoimmunity in a

manner similar to that of Sydenham's chorea.

The working hypothesis for the pathophysiology begins

with a GAS infection

in a susceptible host that incites the production of

antibodies to GAS that

crossreact with the cellular components of the basal

ganglia, particularly

in the caudate nucleus and putamen.

The obsessions, compulsions, tics, and other

neuropsychiatric symptoms seen

in these children are postulated to arise from an

interaction of these

antibodies with neurons of the basal ganglia.Molecular

Psychiatry advance

online publication, 6 July 2004;

doi:10.1038/sj.mp.4001542

PMID: 15241433 [PubMed - as supplied by publisher]

--------------------------------------------------------------------------

Arch Dis Child. 2004 Jul;89(7):604-10.

Dyskinesias and associated psychiatric disorders

following streptococcal

infections.

Dale RC, Heyman I, Surtees RA, Church AJ, Giovannoni

G, Goodman R, Neville

BG.

Neurosciences Unit, Institute of Child Health and

Great Ormond Street

Hospital for Children NHS Trust, London, UK.

R.Dale@...

BACKGROUND: The classical extrapyramidal movement

disorder following beta

haemolytic streptococcus (BHS) infection is Sydenham's

chorea (SC).

Recently, other post-streptococcal movement disorders

have been described,

including motor tics and dystonia. Associated

emotional and behavioural

alteration is characteristic.

AIMS: To describe experience of post-streptococcal

dyskinesias and

associated co-morbid psychiatric features presenting

to a tertiary referral

centre 1999-2002. METHODS: In all patients, dyskinetic

movement disorders

followed BHS pharyngeal infection. BHS infection was

defined by pharyngeal

culture of the organism, or paired streptococcal

serology. Movement

disorders were classified according to international

criteria, and validated

by experienced child neurologists. Psychiatric

complications were defined

using ICD-10 criteria using a validated psychiatric

interview.

RESULTS: In the 40 patients, the following dyskinetic

movement disorders

were present: chorea (n = 20), motor tics (n = 16),

dystonia (n = 5), tremor

(n = 3), stereotypies (n = 2), opsoclonus (n = 2), and

myoclonus (n = 1).

Sixty five per cent of the chorea patients were

female, whereas 69% of the

tic patients were male. ICD-10 psychiatric diagnoses

were made in 62.5%.

Using the same psychiatric instrument, only 8.9% of UK

children would be

expected to have an ICD-10 psychiatric diagnosis.

Emotional disorders occurred in 47.5%, including

obsessive-compulsive

disorder (27.5%), generalised anxiety (25%), and

depressive episode (17.5%).

Additional psychiatric morbidity included conduct

disorders (27.5%) and

hyperkinetic disorders (15%). Psychiatric, movement,

and post-streptococcal

autoimmune disorders were commonly observed in family

members. At a mean

follow up of 2.7 years, 72.5% had continuing movement

and psychiatric

disorders.

CONCLUSION: Post-streptococcal dyskinesias occur with

significant and

disabling psychiatric co-morbidity and are potential

autoimmune models of

common " idiopathic " movement and psychiatric disorders

in children.

Multiple factors may be involved in disease

_expression including genetic

predisposition, developmental status, and the

patient's sex.

PMID: 15210487 [PubMed - in process]

--------------------------------------------------------------------------------\

------

Curr Opin Neurol. 2004 Aug;17(4):425-432.

Antibasal ganglia antibodies and their relevance to

movement disorders.

o D, Giovannoni G.

Institute of Neurology, University College London, UK

and University of

Bari, Italy.

PURPOSE OF REVIEW: Recently, autoaggressive

immunological responses were

included among the causative agents of basal ganglia

dysfunction.

Autoaggressive immune-mediated illnesses secondary to

group A

beta-haemolytic streptococcal infections present with

motor and psychiatric

symptoms, due to basal ganglia involvement. These

disorders have been

associated with serum antineuronal antibodies,

relatively specific to human

basal ganglia tissue. This review summarizes the most

recent studies

concerning antibasal ganglia antibodies, focusing on

the associated

phenotypes and the hypotheses concerning their

pathogenicity.

RECENT FINDINGS: The spectrum of post-streptococcal

neuropsychiatric

disorders associated with antibasal ganglia antibodies

seems broader than

previously recognized.

Other than chorea, tics and obsessive-compulsive

disorder, which constituted

the bulk of previously described disorders associated

with antibasal ganglia

antibodies, post-streptococcal neuropsychiatric

disturbances include a wider

range of motor and behavioural abnormalities, in

keeping with the

multifunctional role of the basal ganglia.

An encephalitis lethargica-like illness following

streptococcal infection

was reported, and unusual adult-onset movement

disorders associated with

antibasal ganglia antibodies were documented.

Moreover, investigators

provided preliminary evidence for a pathogenic role of

autoantibodies in

Sydenham's chorea, the prototypic post-streptococcal

neuropsychiatric

disorder.

SUMMARY: Antibasal ganglia antibodies are relatively

specific in identifying

post-streptococcal neuropsychiatric disorders, which

constitute a wider

spectrum of movement disorders than previously

recognized. Although their

sensitivity in diagnosing Sydenham's chorea seems

excellent, it is not yet

possible to extrapolate this sensitivity to all the

recently identified

post-streptococcal neuropsychiatric disorders.

The antigens targeted by these autoantibodies and

their pathogenic

importance are currently under investigation.

Preliminary evidence suggests

that antibasal ganglia antibodies may be pathogenic.

PMID: 15247537 [PubMed - as supplied by publisher]

-------------------------------------------

Pediatr Neurol. 2004 Aug;31(2):119-21.

Restless legs syndrome; Association with streptococcal

or mycoplasma

infection.

Matsuo M, Tsuchiya K, Hamasaki Y, Singer HS.

Department of Pediatrics, Faculty of Medicine, Saga

University, Saga, Japan.

Group A beta-hemolytic streptococcal infections have

been reported to cause

neuropsychiatric symptoms, such as chorea, tics, and

obsessive-compulsive

disorder, presumably through autoimmune damage to

basal ganglia. Mycoplasma

pneumoniae infections have also been reported to cause

damage to the basal

ganglia.

Restless legs syndrome is a movement disorder with

focal restlessness, an

irresistible desire to move, and exacerbation by long

periods of sitting or

lying.

We present three children with transient restless legs

syndrome-like

symptoms possibly associated with group A

beta-hemolytic streptococcal

infection or Mycoplasma pneumoniae infection.

One of three patients had persistently elevated

enzyme-linked immunosorbent

optical density values against human caudate and

putamen.

PMID: 15301831 [PubMed - in process]

__________________________________________________

[Guest guest]

I was hoping someone would post this, as it has been suggested in the past. I

was aware there were some strains to stay away from (streptococci), but I have

never heard of caution with all of the below strains. I have doubts as

probiotic-rich foods were the mainstay of the human diet for thousands of years

until recent centuries when living foods have all but gone away. Maybe that's

part of the problem -- probiotics should really comes from foods, not pills.

-

<thecolemans4@...> wrote:

A previous comment from Cheryl:

“My son tends to have problems when he's dealing with

a bacterial infection/OCD. It's always possible that

the probiotic could be a problem by itself or in

combination with some other type of immune stimulus.

I definitely wouldn't give this bacteria to any child

with PANDAS.”

Culturelle is manufactured in gelatin capsules

providing 20 billion colony forming units (CFUs) per

capsule of Lactobacillus GG.

J Leukoc Biol. 2003 Sep; 74(3): 395-402.

Lactobacilli and streptococci induce inflammatory

chemokine production in human macrophages that

stimulates Th1 cell chemotaxis.

Veckman V, Miettinen M, Matikainen S, Lande R,

Giacomini E, Coccia EM, Julkunen I.

Department of Microbiology, National Public Health

Institute, Helsinki,

Finland. ville.veckman@...

Macrophages have a central role in innate-immune

responses to bacteria.

In the present work, we show that infection of human

macrophages with

Gram-positive pathogenic Streptococcus pyogenes or

nonpathogenic Lactobacillus rhamnosus GG enhances mRNA

expression of inflammatory chemokine ligands

CCL2/monocyte chemoattractant protein-1 (MCP-1),

CCL3/macrophage-inflammatory protein-1alpha

(MIP-1alpha), CCL5/regulated on activation, normal T

expressed and secreted, CCL7/MCP-3, CCL19/MIP-3beta,

and CCL20/MIP-3alpha and CXC chemokine igands

CXCL8/interleukin (IL)-8, CXCL9/monokine induced by

interferon-gamma (IFN-gamma), and CXCL10/IFN-inducible

protein 10. Bacteria-induced CCL2, CCL7, CXCL9, and

CXCL10 mRNA expression was partially dependent on

ongoing protein synthesis.

The expression of these chemokines and of CCL19 was

dependent on bacteria-induced IFN-alpha/beta

production. CCL19 and CCL20 mRNA expression was

up-regulated by IL-1beta or tumor necrosis factor

alpha

(TNF-alpha), and in addition, IFN-alpha together with

TNF-alpha further enhanced CCL19 gene expression.

Synergy between IFN-alpha and TNF-alpha was also seen

for CXCL9 and CXCL10 mRNA expression.

Bacteria-stimulated macrophage supernatants induced

the migration of T helper cell type 1 (Th1) cells,

suggesting that in human macrophages, these bacteria

can stimulate efficient inflammatory chemokine gene

expression including those that recruit Th1 cells to

the site of inflammation. Furthermore, L.

rhamnosus-induced Th1 chemokine production could in

part explain the proposed antiallergenic properties of

this bacterium.

PMID: 12949243 [PubMed - indexed for MEDLINE]

J Food Prot. 2003 Mar; 66(3): 466-72. Links

Interactions of lactic acid bacteria with human

intestinal epithelial cells: effects on cytokine

production.

Wallace TD, Bradley S, Buckley ND, Green- JM.

Department of Biology, Acadia University, Wolfville,

Nova Scotia,

Canada B0P 1X0.

As a participant in the mucosal immune response, the

intestinal epithelial cell must respond to a variety

of stimuli, including lactic acid bacteria (LAB)

consumed in the diet. The objective of this study was

to compare the abilities of several strains of LAB to

modulate cytokine secretion by human intestinal

epithelial cell (IEC) line HT-29. Certain strains of

Lactobacillus rhamnosus, Lactobacillus delbrueckii,

and Lactobacillus acidophilus suppressed the

production of the chemokine RANTES by stimulated HT-29

IEC, although the magnitude of this suppression varied

depending on the nature of the bacterial growth

medium. Similarly, specific strains showed growth

condition-dependent suppression of HT-29 interleukin-8

(IL-8) production. Strain-dependent effects were also

seen for the suppression of tumor necrosis factor

alpha (TNF-alpha) and transforming growth factor beta

(TGF-beta) production. The binding of several of these

bacterial strains to the HT-29 cell line was also

examined. Different strains were found to have

differing abilities to interact with IEC, with L.

rhamnosus R0011 being the strain that generally had

the most extensive effects on HT-29 cytokine

production and also bound to HT-29 IEC most

effectively. Modulation of IEC cytokine production has

the potential to profoundly affect the mucosal

microenvironment, influencing the immune response to

pathogens and other ingested antigens.

PMID: 12636302 [PubMed - indexed for MEDLINE]

: Salminen MK, Rautelin H, Tynkkynen S, Poussa T,

Saxelin M, Valtonen

V,

Jarvinen A.

Lactobacillus bacteremia, clinical significance, and

patient outcome, with special focus on probiotic L.

rhamnosus GG.

Clin Infect Dis. 2004 Jan 1; 38(1): 62-9. Epub 2003

Dec 04.

PMID: 14679449 [PubMed - in process]

Scand J Infect Dis. 2003; 35(6-7): 404-8.

Six cases of Lactobacillus bacteraemia: identification

of organisms and antibiotic susceptibility and

therapy.

Arpi M, Vancanneyt M, Swings J, Leisner JJ.

Arhus University Hospital, Skejby, Arhus, Denmark.

Six cases of bacteraemia in hospitalized patients, 5

with a depressed immune status, were caused by

lactobacilli. Sodium dodecyl

sulfate-polyacrylamide gel electrophoresis of

whole-cell proteins and API 50 CH carbohydrate

patterns assigned the causative agents to the species

Lactobacillus rhamnosus, Lactobacillus curvatus,

Lactobacillus delbrueckii subsp. lactis and

Lactobacillus paracasei subsp. paracasei.

Publication Types:

Case Reports

PMID: 12953954 [PubMed - indexed for MEDLINE] Notario

R, Leardini N, Borda N, Gambande T, Cerutti H. Related

Articles, Links

[Hepatic abscess and bacteremia due to Lactobacillus

rhamnosus]

Rev Argent Microbiol. 2003 Apr-Jun; 35(2): 100-1.

Review. Spanish.

PMID: 12920992 [PubMed - indexed for MEDLINE]

**************************

1-Myelin oligodendrocyte glycoprotein (MOG) gene is

associated with

obsessive-compulsive disorder.

2-PANDAS: current status and directions for research.

3-Dyskinesias and associated psychiatric disorders

following streptococcal

infections

4-Antibasal ganglia antibodies and their relevance to

movement disorders.

5-Restless legs syndrome; Association with

streptococcal or mycoplasma

infection.

----------------------------------------------------------

Am J Med Genet. 2004 Aug 15;129B(1):64-8.

Myelin oligodendrocyte glycoprotein (MOG) gene is

associated with

obsessive-compulsive disorder.

Zai G, Bezchlibnyk YB, Richter MA, Arnold P, Burroughs

E, Barr CL, Kennedy

JL.

Neurogenetics Section, Centre for Addiction and Mental

Health, Department of

Psychiatry, University of Toronto, Toronto, ON,

Canada.

Obsessive-compulsive disorder (OCD) is a severe

neuropsychiatric disorder

with a strong genetic component, and may involve

autoimmune processes.

Support for this latter hypothesis comes from the

identification of a

subgroup of children, described by the term pediatric

autoimmune

neuropsychiatric disorder associated with

streptococcal infections (PANDAS),

with onset of OCD symptoms following streptococcal

infections.

Genes involved in immune response therefore represent

possible candidate

genes for OCD, including the myelin oligodendrocyte

glycoprotein (MOG) gene,

which plays an important role in mediating the

complement cascade in the

immune system. Four polymorphisms in the MOG gene, a

dinucleotide CA repeat

(MOG2), a tetranucleotide TAAA repeat (MOG4), and 2

intronic single

nucleotide polymorphisms, C1334T and C10991T, were

investigated for the

possibility of association with OCD using 160 nuclear

families with an OCD

proband.

We examined the transmission of alleles of these four

polymorphisms with the

transmission disequilibrium test (TDT). A biased

transmission of the 459-bp

allele (allele 2: chi2 = 5.255, P = 0.022) of MOG4 was

detected, while MOG2,

C1334T, and C10991T showed no statistically

significant bias in the

transmission of alleles. The transmission of the

C1334T.MOG2.C10991T.MOG4

haplotype 1.13.2.2 (chi2 = 6.426, P = 0.011) was also

significant.

Quantitative analysis using the family-based

association test (FBAT) was

significant for MOG4 in total Yale-Brown

Obsessive-Compulsive Scale severity

score (allele 2: z = 2.334, P = 0.020). Further

investigations combining

genetic, pathological, and pharmacological strategies,

are warranted.

Copyright 2004 Wiley-Liss, Inc.

PMID: 15274043 [PubMed - in process]

----------------------------------------------------------

Mol Psychiatry. 2004 Jul 6 [Epub ahead of print]

PANDAS: current status and directions for research.

Snider LA, Swedo SE.

1Pediatrics & Developmental Neuropsychiatry Branch,

Department of Health and

Human Services, National Institute of Mental Health,

Bethesda, MD, USA.

The recognition of the five criteria for PANDAS

(pediatric autoimmune

neuropsychiatric disorders associated with

streptococcal infections) by

Swedo et al established a homogenous subgroup of

children with childhood

onset obsessive-compulsive disorder (OCD) and/or tic

disorders.

The five clinical characteristics that define the

PANDAS subgroup are the

presence of OCD and/or tic disorder, prepubertal age

of onset, abrupt onset

and relapsing-remitting symptom course, association

with neurological

abnormalities during exacerbations (adventitious

movements or motoric

hyperactivity), and a temporal association between

symptom exacerbations and

a Group-A beta-hemolytic streptococcal (GAS)

infection.

These five criteria have been used for the purpose of

systematic research on

the phenomenology and unique therapies for the PANDAS

subgroup as well as

studies of the pathophysiology of post-streptococcal

OCD and tic disorders.

The etiology of OCD and tics in the PANDAS subgroup is

unknown, but is

theorized to occur as a result of post-streptococcal

autoimmunity in a

manner similar to that of Sydenham's chorea.

The working hypothesis for the pathophysiology begins

with a GAS infection

in a susceptible host that incites the production of

antibodies to GAS that

crossreact with the cellular components of the basal

ganglia, particularly

in the caudate nucleus and putamen.

The obsessions, compulsions, tics, and other

neuropsychiatric symptoms seen

in these children are postulated to arise from an

interaction of these

antibodies with neurons of the basal ganglia.Molecular

Psychiatry advance

online publication, 6 July 2004;

doi:10.1038/sj.mp.4001542

PMID: 15241433 [PubMed - as supplied by publisher]

----------------------------------------------------------

Arch Dis Child. 2004 Jul;89(7):604-10.

Dyskinesias and associated psychiatric disorders

following streptococcal

infections.

Dale RC, Heyman I, Surtees RA, Church AJ, Giovannoni

G, Goodman R, Neville

BG.

Neurosciences Unit, Institute of Child Health and

Great Ormond Street

Hospital for Children NHS Trust, London, UK.

R.Dale@...

BACKGROUND: The classical extrapyramidal movement

disorder following beta

haemolytic streptococcus (BHS) infection is Sydenham's

chorea (SC).

Recently, other post-streptococcal movement disorders

have been described,

including motor tics and dystonia. Associated

emotional and behavioural

alteration is characteristic.

AIMS: To describe experience of post-streptococcal

dyskinesias and

associated co-morbid psychiatric features presenting

to a tertiary referral

centre 1999-2002. METHODS: In all patients, dyskinetic

movement disorders

followed BHS pharyngeal infection. BHS infection was

defined by pharyngeal

culture of the organism, or paired streptococcal

serology. Movement

disorders were classified according to international

criteria, and validated

by experienced child neurologists. Psychiatric

complications were defined

using ICD-10 criteria using a validated psychiatric

interview.

RESULTS: In the 40 patients, the following dyskinetic

movement disorders

were present: chorea (n = 20), motor tics (n = 16),

dystonia (n = 5), tremor

(n = 3), stereotypies (n = 2), opsoclonus (n = 2), and

myoclonus (n = 1).

Sixty five per cent of the chorea patients were

female, whereas 69% of the

tic patients were male. ICD-10 psychiatric diagnoses

were made in 62.5%.

Using the same psychiatric instrument, only 8.9% of UK

children would be

expected to have an ICD-10 psychiatric diagnosis.

Emotional disorders occurred in 47.5%, including

obsessive-compulsive

disorder (27.5%), generalised anxiety (25%), and

depressive episode (17.5%).

Additional psychiatric morbidity included conduct

disorders (27.5%) and

hyperkinetic disorders (15%). Psychiatric, movement,

and post-streptococcal

autoimmune disorders were commonly observed in family

members. At a mean

follow up of 2.7 years, 72.5% had continuing movement

and psychiatric

disorders.

CONCLUSION: Post-streptococcal dyskinesias occur with

significant and

disabling psychiatric co-morbidity and are potential

autoimmune models of

common " idiopathic " movement and psychiatric disorders

in children.

Multiple factors may be involved in disease

_expression including genetic

predisposition, developmental status, and the

patient's sex.

PMID: 15210487 [PubMed - in process]

----------------------------------------------------------

Curr Opin Neurol. 2004 Aug;17(4):425-432.

Antibasal ganglia antibodies and their relevance to

movement disorders.

o D, Giovannoni G.

Institute of Neurology, University College London, UK

and University of

Bari, Italy.

PURPOSE OF REVIEW: Recently, autoaggressive

immunological responses were

included among the causative agents of basal ganglia

dysfunction.

Autoaggressive immune-mediated illnesses secondary to

group A

beta-haemolytic streptococcal infections present with

motor and psychiatric

symptoms, due to basal ganglia involvement. These

disorders have been

associated with serum antineuronal antibodies,

relatively specific to human

basal ganglia tissue. This review summarizes the most

recent studies

concerning antibasal ganglia antibodies, focusing on

the associated

phenotypes and the hypotheses concerning their

pathogenicity.

RECENT FINDINGS: The spectrum of post-streptococcal

neuropsychiatric

disorders associated with antibasal ganglia antibodies

seems broader than

previously recognized.

Other than chorea, tics and obsessive-compulsive

disorder, which constituted

the bulk of previously described disorders associated

with antibasal ganglia

antibodies, post-streptococcal neuropsychiatric

disturbances include a wider

range of motor and behavioural abnormalities, in

keeping with the

multifunctional role of the basal ganglia.

An encephalitis lethargica-like illness following

streptococcal infection

was reported, and unusual adult-onset movement

disorders associated with

antibasal ganglia antibodies were documented.

Moreover, investigators

provided preliminary evidence for a pathogenic role of

autoantibodies in

Sydenham's chorea, the prototypic post-streptococcal

neuropsychiatric

disorder.

SUMMARY: Antibasal ganglia antibodies are relatively

specific in identifying

post-streptococcal neuropsychiatric disorders, which

constitute a wider

spectrum of movement disorders than previously

recognized. Although their

sensitivity in diagnosing Sydenham's chorea seems

excellent, it is not yet

possible to extrapolate this sensitivity to all the

recently identified

post-streptococcal neuropsychiatric disorders.

The antigens targeted by these autoantibodies and

their pathogenic

importance are currently under investigation.

Preliminary evidence suggests

that antibasal ganglia antibodies may be pathogenic.

PMID: 15247537 [PubMed - as supplied by publisher]

-------------------------------------------

Pediatr Neurol. 2004 Aug;31(2):119-21.

Restless legs syndrome; Association with streptococcal

or mycoplasma

infection.

Matsuo M, Tsuchiya K, Hamasaki Y, Singer HS.

Department of Pediatrics, Faculty of Medicine, Saga

University, Saga, Japan.

Group A beta-hemolytic streptococcal infections have

been reported to cause

neuropsychiatric symptoms, such as chorea, tics, and

obsessive-compulsive

disorder, presumably through autoimmune damage to

basal ganglia. Mycoplasma

pneumoniae infections have also been reported to cause

damage to the basal

ganglia.

Restless legs syndrome is a movement disorder with

focal restlessness, an

irresistible desire to move, and exacerbation by long

periods of sitting or

lying.

We present three children with transient restless legs

syndrome-like

symptoms possibly associated with group A

beta-hemolytic streptococcal

infection or Mycoplasma pneumoniae infection.

One of three patients had persistently elevated

enzyme-linked immunosorbent

optical density values against human caudate and

putamen.

PMID: 15301831 [PubMed - in process]

__________________________________________________