Re: Microbes and Mental Illness: Insel PANDAS

[Guest guest]

Fascinating article. I find it interesting that they don't have a corresponding

illness for adults. After all, these children do grow up. I had anxiety my whole

life and OCD like behaviors that interfered with everyday functioning. When

tested by Dr. G a few years ago, my strep titers were almost 2,000.

I hope they commit to this research. A lot of people are depending on it.

All the best,

Robyn

 

________________________________

From: <thecolemans4@...>

< >

Sent: Wed, August 18, 2010 8:04:02 PM

Subject: Microbes and Mental Illness: Insel PANDAS

Microbes and Mental Illness

Posted by  Insel

August 13, 2010

http://www.nimh.nih.gov/about/director/2010/microbes-and-mental-illness.shtml

Hints that some mental illness may be linked to infectious agents and/or

autoimmune processes date back to at least the early 20th Century. In the 21st

Century, the field of microbiomics, which is mapping the microbial environment

of the human organism, may transform the way we think about human physical and

mental development.1 It is already clear that 90% of “our DNA†is

microbial, not

human. “We†are, in fact, “super-organisms†made up of thousands of

species,

many of which are being identified for the first time. And there are persistent

individual differences in our microbial ecology established early in life.

Insights from microbiomics have proven important for understanding obesity2 and

Type 1 diabetes,3 but microbiomics has not yet been a focus for research on

mental illness. Yet, there are many clues linking microbiology and mental

disorders, such as epidemiologic evidence of increased risk

for schizophrenia associated with prenatal exposure to influenza. Probably

the

most compelling case for such involvement is children who develop obsessive

compulsive disorder (OCD) and/or tic disorders “overnight,†following a

strep

infection. Despite continuing debate over its parameters, evidence is mounting

in support of Pediatric Autoimmune Neuropsychiatric Disorders Associated with

Streptococcal Infections (PANDAS) — or at least a syndrome modeled on it.

Last month, the NIMH Pediatric Developmental Neuroscience Branch convened

dozens

of experts from the field — including prominent PANDAS critics — to update

the

science and attempt to achieve consensus on criteria defining the syndrome. The

mere fact that the conference took place signals a change in the scientific

climate. Until now, whether a child presenting with sudden onset of OCD and/or

tic symptoms gets checked for possible involvement of strep has varied—often

depending on which medical journals a practitioner happens to read. I am hopeful

that will begin to change in light of the new evidence.

Interest in PANDAS has also been spurred by an increasingly vocal network of

affected families and the clinicians who are treating their often

severely-impaired children. Conference participants heard reports from the front

lines by some of these clinicians, who largely corroborated key features of the

syndrome, originally identified by NIMH’s Dr. Swedo in the mid-l990s.

These include sudden onset of mood swings, impulsivity, anxiety, impaired

attention and poor handwriting in addition to obsessions, compulsions and tics.

Dr. Swedo’s studies have identified brain mechanisms through which

strep antibodies act. They have also demonstrated that cleansing the blood of

the antibodies, via plasma exchange or intravenous immunoglobulin,

significantly

diminishes the symptoms.

Impetus for the July conference came, in part, from publication of two

independent studies within the past year that lend new credence to the PANDAS

concept.

In the first, Columbia University researchers demonstrated, for the first time,

that strep-triggered antibodies alone are necessary and sufficient to trigger a

PANDAS-like syndrome in mice.4 In an autoimmune-disease susceptible strain of

mice, exposure to strep triggered OCD-like repetitive behaviors and antibodies

that attacked specific molecules in the brain. PANDAS-like behaviors also

emerged in naïve mice after they received antibodies from such PANDAS mice.

These included impaired learning and memory and social interaction. As in humans

with PANDAS, these impairments were more common in males than females.

In the second study, a Yale University research team reported that OCD

and Tourette Syndrome (tic) symptoms worsened slightly following a strep

infection in some affected children. Moreover, the strep infection triggered the

worsened symptoms by increasing the impact of psycho-social stress.5 The

findings suggest that a subset of children with these disorders may be at

increased risk of strep infection, which could interact with stress to

exacerbate the course, as is seen in other infectious and autoimmune diseases.

Granted, these new findings are still preliminary and need to be replicated.

However, the data relating to PANDAS is compelling enough to warrant following

up such leads. NIMH is preparing to launch a new trial of intravenous

immunoglobulin (IVIG) treatment for PANDAS this Fall, with support from a NIH

Clinical Center “Bench to Bedsideâ€Â award. The intramural NIMH will provide

the

clinical care, while data analysis will be carried out by independent teams of

investigators at Yale University and the Oklahoma University Health Sciences

Center. Dr. Swedo and her team are hoping to recruit 50 children with clear-cut

PANDAS. They are predicting that IVIG treatment will produce striking benefits

for OCD and other neuropsychiatric symptoms, and will be most effective for

those children who start out with the highest levels of strep-triggered

antibodies that go astray and attack parts of the brain.

Moreover, monoclonal antibodies derived from these patients will be used to

develop animal models of OCD that could lead to improved treatments.

Do infectious agents influence the development of autism, anxiety, or mood

disorders? This remains a frontier area for NIMH research. The increasing

evidence linking strep infection to OCD in children suggests that microbiomics

may prove an important research area for understanding and treating mental

disorders.

References

1Bacterial community variation in human body habitats across space and time.

Costello EK, Lauber CL, Hamady M, Fierer N, Gordon JI, Knight R.

Science. 2009 Dec 18;326(5960):1694-7. Epub 2009 Nov 5.PMID: 19892944

2A core gut microbiome in obese and lean twins.

Turnbaugh PJ, Hamady M, Yatsunenko T, Cantarel BL, Duncan A, Ley RE, Sogin ML,

WJ, Roe BA, Affourtit JP, Egholm M, Henrissat B, Heath AC, Knight R,

Gordon JI.

Nature. 2009 Jan 22;457(7228):480-4. Epub 2008 Nov 30.PMID: 19043404

3Innate immunity and intestinal microbiota in the development of Type 1

diabetes.

Wen L, Ley RE, Volchkov PY, Stranges PB, Avanesyan L, Stonebraker AC, Hu C, Wong

FS, Szot GL, Bluestone JA, Gordon JI, Chervonsky AV.

Nature. 2008 Oct 23;455(7216):1109-13. Epub 2008 Sep 21.PMID: 18806780

4Passive transfer of streptococcus-induced antibodies reproduces behavioral

disturbances in a mouse model of pediatric autoimmune neuropsychiatric disorders

associated with streptococcal infection.

Yaddanapudi K, Hornig M, Serge R, De Miranda J, Baghban A, Villar G, Lipkin WI.

Mol Psychiatry. 2010 Jul;15(7):712-26. Epub 2009 Aug 11.PMID: 19668249.

5Streptococcal upper respiratory tract infections and psychosocial stress

predict future tic and obsessive-compulsive symptom severity in children and

adolescents with Tourette syndrome and obsessive-compulsive disorder.

Lin H, KA, Katsovich L, Findley DB, Grantz H, Lombroso PJ, King RA,

Bessen DE, D, Kaplan EL, Landeros-Weisenberger A, Zhang H, Leckman JF.

Biol Psychiatry. 2010 Apr 1;67(7):684-91. Epub 2009 Oct 14.PMID: 19833320.

[Guest guest]

This is some very interesting information!

Is anyone having their child treated for PANDAS by Dr Goldberg or Dr ? I

am curious to know if they treat it the same way, with IVIG or plasma exchange?

And, their success rate!

Thanks.

-

Sent on the Sprint® Now Network from my BlackBerry®

Microbes and Mental Illness: Insel PANDAS

Microbes and Mental Illness

Posted by  Insel

August 13, 2010

http://www.nimh.nih.gov/about/director/2010/microbes-and-mental-illness.shtml

Hints that some mental illness may be linked to infectious agents and/or

autoimmune processes date back to at least the early 20th Century. In the 21st

Century, the field of microbiomics, which is mapping the microbial environment

of the human organism, may transform the way we think about human physical and

mental development.1 It is already clear that 90% of “our DNA†is

microbial, not

human. “We†are, in fact, “super-organisms†made up of thousands of

species,

many of which are being identified for the first time. And there are persistent

individual differences in our microbial ecology established early in life.

Insights from microbiomics have proven important for understanding obesity2 and

Type 1 diabetes,3 but microbiomics has not yet been a focus for research on

mental illness. Yet, there are many clues linking microbiology and mental

disorders, such as epidemiologic evidence of increased risk

for schizophrenia associated with prenatal exposure to influenza. Probably

the

most compelling case for such involvement is children who develop obsessive

compulsive disorder (OCD) and/or tic disorders “overnight,†following a

strep

infection. Despite continuing debate over its parameters, evidence is mounting

in support of Pediatric Autoimmune Neuropsychiatric Disorders Associated with

Streptococcal Infections (PANDAS) — or at least a syndrome modeled on it.

Last month, the NIMH Pediatric Developmental Neuroscience Branch convened

dozens

of experts from the field — including prominent PANDAS critics — to update

the

science and attempt to achieve consensus on criteria defining the syndrome. The

mere fact that the conference took place signals a change in the scientific

climate. Until now, whether a child presenting with sudden onset of OCD and/or

tic symptoms gets checked for possible involvement of strep has varied—often

depending on which medical journals a practitioner happens to read. I am hopeful

that will begin to change in light of the new evidence.

Interest in PANDAS has also been spurred by an increasingly vocal network of

affected families and the clinicians who are treating their often

severely-impaired children. Conference participants heard reports from the front

lines by some of these clinicians, who largely corroborated key features of the

syndrome, originally identified by NIMH’s Dr. Swedo in the mid-l990s.

These include sudden onset of mood swings, impulsivity, anxiety, impaired

attention and poor handwriting in addition to obsessions, compulsions and tics.

Dr. Swedo’s studies have identified brain mechanisms through which

strep antibodies act. They have also demonstrated that cleansing the blood of

the antibodies, via plasma exchange or intravenous immunoglobulin,

significantly

diminishes the symptoms.

Impetus for the July conference came, in part, from publication of two

independent studies within the past year that lend new credence to the PANDAS

concept.

In the first, Columbia University researchers demonstrated, for the first time,

that strep-triggered antibodies alone are necessary and sufficient to trigger a

PANDAS-like syndrome in mice.4 In an autoimmune-disease susceptible strain of

mice, exposure to strep triggered OCD-like repetitive behaviors and antibodies

that attacked specific molecules in the brain. PANDAS-like behaviors also

emerged in naïve mice after they received antibodies from such PANDAS mice.

These included impaired learning and memory and social interaction. As in humans

with PANDAS, these impairments were more common in males than females.

In the second study, a Yale University research team reported that OCD

and Tourette Syndrome (tic) symptoms worsened slightly following a strep

infection in some affected children. Moreover, the strep infection triggered the

worsened symptoms by increasing the impact of psycho-social stress.5 The

findings suggest that a subset of children with these disorders may be at

increased risk of strep infection, which could interact with stress to

exacerbate the course, as is seen in other infectious and autoimmune diseases.

Granted, these new findings are still preliminary and need to be replicated.

However, the data relating to PANDAS is compelling enough to warrant following

up such leads. NIMH is preparing to launch a new trial of intravenous

immunoglobulin (IVIG) treatment for PANDAS this Fall, with support from a NIH

Clinical Center “Bench to Bedsideâ€Â award. The intramural NIMH will provide

the

clinical care, while data analysis will be carried out by independent teams of

investigators at Yale University and the Oklahoma University Health Sciences

Center. Dr. Swedo and her team are hoping to recruit 50 children with clear-cut

PANDAS. They are predicting that IVIG treatment will produce striking benefits

for OCD and other neuropsychiatric symptoms, and will be most effective for

those children who start out with the highest levels of strep-triggered

antibodies that go astray and attack parts of the brain.

Moreover, monoclonal antibodies derived from these patients will be used to

develop animal models of OCD that could lead to improved treatments.

Do infectious agents influence the development of autism, anxiety, or mood

disorders? This remains a frontier area for NIMH research. The increasing

evidence linking strep infection to OCD in children suggests that microbiomics

may prove an important research area for understanding and treating mental

disorders.

References

1Bacterial community variation in human body habitats across space and time.

Costello EK, Lauber CL, Hamady M, Fierer N, Gordon JI, Knight R.

Science. 2009 Dec 18;326(5960):1694-7. Epub 2009 Nov 5.PMID: 19892944

2A core gut microbiome in obese and lean twins.

Turnbaugh PJ, Hamady M, Yatsunenko T, Cantarel BL, Duncan A, Ley RE, Sogin ML,

WJ, Roe BA, Affourtit JP, Egholm M, Henrissat B, Heath AC, Knight R,

Gordon JI.

Nature. 2009 Jan 22;457(7228):480-4. Epub 2008 Nov 30.PMID: 19043404

3Innate immunity and intestinal microbiota in the development of Type 1

diabetes.

Wen L, Ley RE, Volchkov PY, Stranges PB, Avanesyan L, Stonebraker AC, Hu C, Wong

FS, Szot GL, Bluestone JA, Gordon JI, Chervonsky AV.

Nature. 2008 Oct 23;455(7216):1109-13. Epub 2008 Sep 21.PMID: 18806780

4Passive transfer of streptococcus-induced antibodies reproduces behavioral

disturbances in a mouse model of pediatric autoimmune neuropsychiatric disorders

associated with streptococcal infection.

Yaddanapudi K, Hornig M, Serge R, De Miranda J, Baghban A, Villar G, Lipkin WI.

Mol Psychiatry. 2010 Jul;15(7):712-26. Epub 2009 Aug 11.PMID: 19668249.

5Streptococcal upper respiratory tract infections and psychosocial stress

predict future tic and obsessive-compulsive symptom severity in children and

adolescents with Tourette syndrome and obsessive-compulsive disorder.

Lin H, KA, Katsovich L, Findley DB, Grantz H, Lombroso PJ, King RA,

Bessen DE, D, Kaplan EL, Landeros-Weisenberger A, Zhang H, Leckman JF.

Biol Psychiatry. 2010 Apr 1;67(7):684-91. Epub 2009 Oct 14.PMID: 19833320.

[Guest guest]

Dr. G used erythromycin (actually ERY-PED) long term for my son, while

checking and re-checking the antibodies (ASO titer) as they went down.

I have never of him prescribing plasma exchange or IVIG for PANDAS. By the

way, he feels that IMGG is safer than IVIG.

He tried IMGG for my son at one point, but that was not specifically to

target the PANDAS.

HTH,

Caroline G.

From: <erikadyan71@...>

Reply-< >

Date: Thu, 19 Aug 2010 03:51:47 +0000

< >

Subject: Re: Microbes and Mental Illness: Insel PANDAS

This is some very interesting information!

Is anyone having their child treated for PANDAS by Dr Goldberg or Dr

? I am curious to know if they treat it the same way, with IVIG or

plasma exchange? And, their success rate!

Thanks.

-

Sent on the Sprint® Now Network from my BlackBerry®

Microbes and Mental Illness: Insel PANDAS

Microbes and Mental Illness

Posted by  Insel

August 13, 2010

http://www.nimh.nih.gov/about/director/2010/microbes-and-mental-illness.shtm

l

Hints that some mental illness may be linked to infectious agents and/or

autoimmune processes date back to at least the early 20th Century. In the

21st

Century, the field of microbiomics, which is mapping the microbial

environment

of the human organism, may transform the way we think about human physical

and

mental development.1 It is already clear that 90% of ³our DNA² is microbial,

not

human. ³We² are, in fact, ³super-organisms² made up of thousands of species,

many of which are being identified for the first time. And there are

persistent

individual differences in our microbial ecology established early in life.

Insights from microbiomics have proven important for understanding

obesity2 and

Type 1 diabetes,3 but microbiomics has not yet been a focus for research on

mental illness. Yet, there are many clues linking microbiology and mental

disorders, such as epidemiologic evidence of increased risk

for schizophrenia associated with prenatal exposure to influenza. Probably

the

most compelling case for such involvement is children who develop obsessive

compulsive disorder (OCD) and/or tic disorders ³overnight,² following a

strep

infection. Despite continuing debate over its parameters, evidence is

mounting

in support of Pediatric Autoimmune Neuropsychiatric Disorders Associated

with

Streptococcal Infections (PANDAS) ‹ or at least a syndrome modeled on it.

Last month, the NIMH Pediatric Developmental Neuroscience Branch convened

dozens

of experts from the field ‹ including prominent PANDAS critics ‹ to update

the

science and attempt to achieve consensus on criteria defining the syndrome.

The

mere fact that the conference took place signals a change in the scientific

climate. Until now, whether a child presenting with sudden onset of OCD

and/or

tic symptoms gets checked for possible involvement of strep has varied‹often

depending on which medical journals a practitioner happens to read. I am

hopeful

that will begin to change in light of the new evidence.

Interest in PANDAS has also been spurred by an increasingly vocal network of

affected families and the clinicians who are treating their often

severely-impaired children. Conference participants heard reports from the

front

lines by some of these clinicians, who largely corroborated key features of

the

syndrome, originally identified by NIMH¹s Dr. Swedo in the mid-l990s.

These include sudden onset of mood swings, impulsivity, anxiety, impaired

attention and poor handwriting in addition to obsessions, compulsions and

tics.

Dr. Swedo¹s studies have identified brain mechanisms through which

strep antibodies act. They have also demonstrated that cleansing the blood

of

the antibodies, via plasma exchange or intravenous immunoglobulin,

significantly

diminishes the symptoms.

Impetus for the July conference came, in part, from publication of two

independent studies within the past year that lend new credence to the

PANDAS

concept.

In the first, Columbia University researchers demonstrated, for the first

time,

that strep-triggered antibodies alone are necessary and sufficient to

trigger a

PANDAS-like syndrome in mice.4 In an autoimmune-disease susceptible strain

of

mice, exposure to strep triggered OCD-like repetitive behaviors and

antibodies

that attacked specific molecules in the brain. PANDAS-like behaviors also

emerged in naïve mice after they received antibodies from such PANDAS mice.

These included impaired learning and memory and social interaction. As in

humans

with PANDAS, these impairments were more common in males than females.

In the second study, a Yale University research team reported that OCD

and Tourette Syndrome (tic) symptoms worsened slightly following a strep

infection in some affected children. Moreover, the strep infection triggered

the

worsened symptoms by increasing the impact of psycho-social stress.5 The

findings suggest that a subset of children with these disorders may be at

increased risk of strep infection, which could interact with stress to

exacerbate the course, as is seen in other infectious and autoimmune

diseases.

Granted, these new findings are still preliminary and need to be replicated.

However, the data relating to PANDAS is compelling enough to warrant

following

up such leads. NIMH is preparing to launch a new trial of intravenous

immunoglobulin (IVIG) treatment for PANDAS this Fall, with support from a

NIH

Clinical Center ³Bench to Bedside² award. The intramural NIMH will provide

the

clinical care, while data analysis will be carried out by independent teams

of

investigators at Yale University and the Oklahoma University Health Sciences

Center. Dr. Swedo and her team are hoping to recruit 50 children with

clear-cut

PANDAS. They are predicting that IVIG treatment will produce striking

benefits

for OCD and other neuropsychiatric symptoms, and will be most effective for

those children who start out with the highest levels of strep-triggered

antibodies that go astray and attack parts of the brain.

Moreover, monoclonal antibodies derived from these patients will be used to

develop animal models of OCD that could lead to improved treatments.

Do infectious agents influence the development of autism, anxiety, or mood

disorders? This remains a frontier area for NIMH research. The increasing

evidence linking strep infection to OCD in children suggests that

microbiomics

may prove an important research area for understanding and treating mental

disorders.

References

1Bacterial community variation in human body habitats across space and time.

Costello EK, Lauber CL, Hamady M, Fierer N, Gordon JI, Knight R.

Science. 2009 Dec 18;326(5960):1694-7. Epub 2009 Nov 5.PMID: 19892944

2A core gut microbiome in obese and lean twins.

Turnbaugh PJ, Hamady M, Yatsunenko T, Cantarel BL, Duncan A, Ley RE, Sogin

ML,

WJ, Roe BA, Affourtit JP, Egholm M, Henrissat B, Heath AC, Knight R,

Gordon JI.

Nature. 2009 Jan 22;457(7228):480-4. Epub 2008 Nov 30.PMID: 19043404

3Innate immunity and intestinal microbiota in the development of Type 1

diabetes.

Wen L, Ley RE, Volchkov PY, Stranges PB, Avanesyan L, Stonebraker AC, Hu C,

Wong

FS, Szot GL, Bluestone JA, Gordon JI, Chervonsky AV.

Nature. 2008 Oct 23;455(7216):1109-13. Epub 2008 Sep 21.PMID: 18806780

4Passive transfer of streptococcus-induced antibodies reproduces behavioral

disturbances in a mouse model of pediatric autoimmune neuropsychiatric

disorders

associated with streptococcal infection.

Yaddanapudi K, Hornig M, Serge R, De Miranda J, Baghban A, Villar G, Lipkin

WI.

Mol Psychiatry. 2010 Jul;15(7):712-26. Epub 2009 Aug 11.PMID: 19668249.

5Streptococcal upper respiratory tract infections and psychosocial stress

predict future tic and obsessive-compulsive symptom severity in children and

adolescents with Tourette syndrome and obsessive-compulsive disorder.

Lin H, KA, Katsovich L, Findley DB, Grantz H, Lombroso PJ, King RA,

Bessen DE, D, Kaplan EL, Landeros-Weisenberger A, Zhang H, Leckman

JF.

Biol Psychiatry. 2010 Apr 1;67(7):684-91. Epub 2009 Oct 14.PMID: 19833320.

[Guest guest]

Hey

I have PANDAS but I'm 41.  I did have my first episode at age 9 though, so I

don't if they continue thru life I assume it's still pediatric onset.  They

don't really have it defined for adults.

Dr is treating me by the protocol.  NOT IVIG, not plasma

exchange. 

There are significant issues possible with both treatments if you look at

as a whole. 

I'll give more info later if needed (time) but I've benefited a lot over the

last year.  Time is a necessary factor, as well as antibiotics AND

antifungals. 

The type of antibiotic matters too.

More later,

________________________________

From: " erikadyan71@... " <erikadyan71@...>

Sent: Wed, August 18, 2010 10:51:47 PM

Subject: Re: Microbes and Mental Illness: Insel PANDAS

 

This is some very interesting information!

Is anyone having their child treated for PANDAS by Dr Goldberg or Dr ? I

am curious to know if they treat it the same way, with IVIG or plasma exchange?

And, their success rate!

Thanks.

-

Sent on the Sprint® Now Network from my BlackBerry®

Microbes and Mental Illness: Insel PANDAS

Microbes and Mental Illness

Posted by  Insel

August 13, 2010

http://www.nimh.nih.gov/about/director/2010/microbes-and-mental-illness.shtml

Hints that some mental illness may be linked to infectious agents and/or

autoimmune processes date back to at least the early 20th Century. In the 21st

Century, the field of microbiomics, which is mapping the microbial environment

of the human organism, may transform the way we think about human physical and

mental development.1 It is already clear that 90% of “our DNA†is

microbial, not

human. “We†are, in fact, “super-organisms†made up of thousands of

species,

many of which are being identified for the first time. And there are persistent

individual differences in our microbial ecology established early in life.

Insights from microbiomics have proven important for understanding obesity2 and

Type 1 diabetes,3 but microbiomics has not yet been a focus for research on

mental illness. Yet, there are many clues linking microbiology and mental

disorders, such as epidemiologic evidence of increased risk

for schizophrenia associated with prenatal exposure to influenza. Probably

the

most compelling case for such involvement is children who develop obsessive

compulsive disorder (OCD) and/or tic disorders “overnight,†following a

strep

infection. Despite continuing debate over its parameters, evidence is mounting

in support of Pediatric Autoimmune Neuropsychiatric Disorders Associated with

Streptococcal Infections (PANDAS) — or at least a syndrome modeled on it.

Last month, the NIMH Pediatric Developmental Neuroscience Branch convened

dozens

of experts from the field — including prominent PANDAS critics — to update

the

science and attempt to achieve consensus on criteria defining the syndrome. The

mere fact that the conference took place signals a change in the scientific

climate. Until now, whether a child presenting with sudden onset of OCD and/or

tic symptoms gets checked for possible involvement of strep has varied—often

depending on which medical journals a practitioner happens to read. I am hopeful

that will begin to change in light of the new evidence.

Interest in PANDAS has also been spurred by an increasingly vocal network of

affected families and the clinicians who are treating their often

severely-impaired children. Conference participants heard reports from the front

lines by some of these clinicians, who largely corroborated key features of the

syndrome, originally identified by NIMH’s Dr. Swedo in the mid-l990s.

These include sudden onset of mood swings, impulsivity, anxiety, impaired

attention and poor handwriting in addition to obsessions, compulsions and tics.

Dr. Swedo’s studies have identified brain mechanisms through which

strep antibodies act. They have also demonstrated that cleansing the blood of

the antibodies, via plasma exchange or intravenous immunoglobulin,

significantly

diminishes the symptoms.

Impetus for the July conference came, in part, from publication of two

independent studies within the past year that lend new credence to the PANDAS

concept.

In the first, Columbia University researchers demonstrated, for the first time,

that strep-triggered antibodies alone are necessary and sufficient to trigger a

PANDAS-like syndrome in mice.4 In an autoimmune-disease susceptible strain of

mice, exposure to strep triggered OCD-like repetitive behaviors and antibodies

that attacked specific molecules in the brain. PANDAS-like behaviors also

emerged in naïve mice after they received antibodies from such PANDAS mice.

These included impaired learning and memory and social interaction. As in humans

with PANDAS, these impairments were more common in males than females.

In the second study, a Yale University research team reported that OCD

and Tourette Syndrome (tic) symptoms worsened slightly following a strep

infection in some affected children. Moreover, the strep infection triggered the

worsened symptoms by increasing the impact of psycho-social stress.5 The

findings suggest that a subset of children with these disorders may be at

increased risk of strep infection, which could interact with stress to

exacerbate the course, as is seen in other infectious and autoimmune diseases.

Granted, these new findings are still preliminary and need to be replicated.

However, the data relating to PANDAS is compelling enough to warrant following

up such leads. NIMH is preparing to launch a new trial of intravenous

immunoglobulin (IVIG) treatment for PANDAS this Fall, with support from a NIH

Clinical Center “Bench to Bedsideâ€Â award. The intramural NIMH will provide

the

clinical care, while data analysis will be carried out by independent teams of

investigators at Yale University and the Oklahoma University Health Sciences

Center. Dr. Swedo and her team are hoping to recruit 50 children with clear-cut

PANDAS. They are predicting that IVIG treatment will produce striking benefits

for OCD and other neuropsychiatric symptoms, and will be most effective for

those children who start out with the highest levels of strep-triggered

antibodies that go astray and attack parts of the brain.

Moreover, monoclonal antibodies derived from these patients will be used to

develop animal models of OCD that could lead to improved treatments.

Do infectious agents influence the development of autism, anxiety, or mood

disorders? This remains a frontier area for NIMH research. The increasing

evidence linking strep infection to OCD in children suggests that microbiomics

may prove an important research area for understanding and treating mental

disorders.

References

1Bacterial community variation in human body habitats across space and time.

Costello EK, Lauber CL, Hamady M, Fierer N, Gordon JI, Knight R.

Science. 2009 Dec 18;326(5960):1694-7. Epub 2009 Nov 5.PMID: 19892944

2A core gut microbiome in obese and lean twins.

Turnbaugh PJ, Hamady M, Yatsunenko T, Cantarel BL, Duncan A, Ley RE, Sogin ML,

WJ, Roe BA, Affourtit JP, Egholm M, Henrissat B, Heath AC, Knight R,

Gordon JI.

Nature. 2009 Jan 22;457(7228):480-4. Epub 2008 Nov 30.PMID: 19043404

3Innate immunity and intestinal microbiota in the development of Type 1

diabetes.

Wen L, Ley RE, Volchkov PY, Stranges PB, Avanesyan L, Stonebraker AC, Hu C, Wong

FS, Szot GL, Bluestone JA, Gordon JI, Chervonsky AV.

Nature. 2008 Oct 23;455(7216):1109-13. Epub 2008 Sep 21.PMID: 18806780

4Passive transfer of streptococcus-induced antibodies reproduces behavioral

disturbances in a mouse model of pediatric autoimmune neuropsychiatric disorders

associated with streptococcal infection.

Yaddanapudi K, Hornig M, Serge R, De Miranda J, Baghban A, Villar G, Lipkin WI.

Mol Psychiatry. 2010 Jul;15(7):712-26. Epub 2009 Aug 11.PMID: 19668249.

5Streptococcal upper respiratory tract infections and psychosocial stress

predict future tic and obsessive-compulsive symptom severity in children and

adolescents with Tourette syndrome and obsessive-compulsive disorder.

Lin H, KA, Katsovich L, Findley DB, Grantz H, Lombroso PJ, King RA,

Bessen DE, D, Kaplan EL, Landeros-Weisenberger A, Zhang H, Leckman JF.

Biol Psychiatry. 2010 Apr 1;67(7):684-91. Epub 2009 Oct 14.PMID: 19833320.

[Guest guest]

My son is now on 500 mg of zithromycin/week as our dr is treating him for

PANDAS. Is this antibiotic helpful for PANDAS? What does Dr. G and Dr.

recommend? Thank you.

From: [mailto: ] On Behalf Of

Sent: August-19-10 9:49 AM

Subject: Re: Microbes and Mental Illness: Insel PANDAS

Hey

I have PANDAS but I'm 41. I did have my first episode at age 9 though, so I

don't if they continue thru life I assume it's still pediatric onset. They

don't really have it defined for adults.

Dr is treating me by the protocol. NOT IVIG, not plasma exchange.

There are significant issues possible with both treatments if you look at

as a whole.

I'll give more info later if needed (time) but I've benefited a lot over the

last year. Time is a necessary factor, as well as antibiotics AND antifungals.

The type of antibiotic matters too.

More later,

________________________________

From: " erikadyan71@... <mailto:erikadyan71%40> "

<erikadyan71@... <mailto:erikadyan71%40> >

<mailto:%40>

Sent: Wed, August 18, 2010 10:51:47 PM

Subject: Re: Microbes and Mental Illness: Insel PANDAS

This is some very interesting information!

Is anyone having their child treated for PANDAS by Dr Goldberg or Dr ? I

am curious to know if they treat it the same way, with IVIG or plasma exchange?

And, their success rate!

Thanks.

-

Sent on the Sprint® Now Network from my BlackBerry®

Microbes and Mental Illness: Insel PANDAS

Microbes and Mental Illness

Posted by Insel

August 13, 2010

http://www.nimh.nih.gov/about/director/2010/microbes-and-mental-illness.shtml

Hints that some mental illness may be linked to infectious agents and/or

autoimmune processes date back to at least the early 20th Century. In the 21st

Century, the field of microbiomics, which is mapping the microbial environment

of the human organism, may transform the way we think about human physical and

mental development.1 It is already clear that 90% of “our DNA†is microbial,

not

human. “We†are, in fact, “super-organisms†made up of thousands of

species,

many of which are being identified for the first time. And there are persistent

individual differences in our microbial ecology established early in life.

Insights from microbiomics have proven important for understanding obesity2 and

Type 1 diabetes,3 but microbiomics has not yet been a focus for research on

mental illness. Yet, there are many clues linking microbiology and mental

disorders, such as epidemiologic evidence of increased risk

for schizophrenia associated with prenatal exposure to influenza. Probably the

most compelling case for such involvement is children who develop obsessive

compulsive disorder (OCD) and/or tic disorders “overnight,†following a

strep

infection. Despite continuing debate over its parameters, evidence is mounting

in support of Pediatric Autoimmune Neuropsychiatric Disorders Associated with

Streptococcal Infections (PANDAS) — or at least a syndrome modeled on it.

Last month, the NIMH Pediatric Developmental Neuroscience Branch convened dozens

of experts from the field — including prominent PANDAS critics — to update

the

science and attempt to achieve consensus on criteria defining the syndrome. The

mere fact that the conference took place signals a change in the scientific

climate. Until now, whether a child presenting with sudden onset of OCD and/or

tic symptoms gets checked for possible involvement of strep has varied—often

depending on which medical journals a practitioner happens to read. I am hopeful

that will begin to change in light of the new evidence.

Interest in PANDAS has also been spurred by an increasingly vocal network of

affected families and the clinicians who are treating their often

severely-impaired children. Conference participants heard reports from the front

lines by some of these clinicians, who largely corroborated key features of the

syndrome, originally identified by NIMH’s Dr. Swedo in the mid-l990s.

These include sudden onset of mood swings, impulsivity, anxiety, impaired

attention and poor handwriting in addition to obsessions, compulsions and tics.

Dr. Swedo’s studies have identified brain mechanisms through which

strep antibodies act. They have also demonstrated that cleansing the blood of

the antibodies, via plasma exchange or intravenous immunoglobulin, significantly

diminishes the symptoms.

Impetus for the July conference came, in part, from publication of two

independent studies within the past year that lend new credence to the PANDAS

concept.

In the first, Columbia University researchers demonstrated, for the first time,

that strep-triggered antibodies alone are necessary and sufficient to trigger a

PANDAS-like syndrome in mice.4 In an autoimmune-disease susceptible strain of

mice, exposure to strep triggered OCD-like repetitive behaviors and antibodies

that attacked specific molecules in the brain. PANDAS-like behaviors also

emerged in naïve mice after they received antibodies from such PANDAS mice.

These included impaired learning and memory and social interaction. As in humans

with PANDAS, these impairments were more common in males than females.

In the second study, a Yale University research team reported that OCD

and Tourette Syndrome (tic) symptoms worsened slightly following a strep

infection in some affected children. Moreover, the strep infection triggered the

worsened symptoms by increasing the impact of psycho-social stress.5 The

findings suggest that a subset of children with these disorders may be at

increased risk of strep infection, which could interact with stress to

exacerbate the course, as is seen in other infectious and autoimmune diseases.

Granted, these new findings are still preliminary and need to be replicated.

However, the data relating to PANDAS is compelling enough to warrant following

up such leads. NIMH is preparing to launch a new trial of intravenous

immunoglobulin (IVIG) treatment for PANDAS this Fall, with support from a NIH

Clinical Center “Bench to Bedside†award. The intramural NIMH will provide

the

clinical care, while data analysis will be carried out by independent teams of

investigators at Yale University and the Oklahoma University Health Sciences

Center. Dr. Swedo and her team are hoping to recruit 50 children with clear-cut

PANDAS. They are predicting that IVIG treatment will produce striking benefits

for OCD and other neuropsychiatric symptoms, and will be most effective for

those children who start out with the highest levels of strep-triggered

antibodies that go astray and attack parts of the brain.

Moreover, monoclonal antibodies derived from these patients will be used to

develop animal models of OCD that could lead to improved treatments.

Do infectious agents influence the development of autism, anxiety, or mood

disorders? This remains a frontier area for NIMH research. The increasing

evidence linking strep infection to OCD in children suggests that microbiomics

may prove an important research area for understanding and treating mental

disorders.

References

1Bacterial community variation in human body habitats across space and time.

Costello EK, Lauber CL, Hamady M, Fierer N, Gordon JI, Knight R.

Science. 2009 Dec 18;326(5960):1694-7. Epub 2009 Nov 5.PMID: 19892944

2A core gut microbiome in obese and lean twins.

Turnbaugh PJ, Hamady M, Yatsunenko T, Cantarel BL, Duncan A, Ley RE, Sogin ML,

WJ, Roe BA, Affourtit JP, Egholm M, Henrissat B, Heath AC, Knight R,

Gordon JI.

Nature. 2009 Jan 22;457(7228):480-4. Epub 2008 Nov 30.PMID: 19043404

3Innate immunity and intestinal microbiota in the development of Type 1

diabetes.

Wen L, Ley RE, Volchkov PY, Stranges PB, Avanesyan L, Stonebraker AC, Hu C, Wong

FS, Szot GL, Bluestone JA, Gordon JI, Chervonsky AV.

Nature. 2008 Oct 23;455(7216):1109-13. Epub 2008 Sep 21.PMID: 18806780

4Passive transfer of streptococcus-induced antibodies reproduces behavioral

disturbances in a mouse model of pediatric autoimmune neuropsychiatric disorders

associated with streptococcal infection.

Yaddanapudi K, Hornig M, Serge R, De Miranda J, Baghban A, Villar G, Lipkin WI.

Mol Psychiatry. 2010 Jul;15(7):712-26. Epub 2009 Aug 11.PMID: 19668249.

5Streptococcal upper respiratory tract infections and psychosocial stress

predict future tic and obsessive-compulsive symptom severity in children and

adolescents with Tourette syndrome and obsessive-compulsive disorder.

Lin H, KA, Katsovich L, Findley DB, Grantz H, Lombroso PJ, King RA,

Bessen DE, D, Kaplan EL, Landeros-Weisenberger A, Zhang H, Leckman JF.

Biol Psychiatry. 2010 Apr 1;67(7):684-91. Epub 2009 Oct 14.PMID: 19833320.

[Guest guest]

It is called mental ILLNESS, right? Why wouldn't mental illness be caused by

microbes? Suddenly people develop mental illness, why can't the brain get

infected and effect its functions? Just like our kids? My child was not born

autistic. That is not genes.

I would bet that almost every mental illness (bipolar, OCD, schizophrenia, even

antisocial behavior) is due to some microbe, probably viral.

>

> Fascinating article. I find it interesting that they don't have a

corresponding

> illness for adults. After all, these children do grow up. I had anxiety my

whole

> life and OCD like behaviors that interfered with everyday functioning. When

> tested by Dr. G a few years ago, my strep titers were almost 2,000.

>

> I hope they commit to this research. A lot of people are depending on it.

>

> All the best,

>

> Robyn

>  

>

> ________________________________

>

> From: <thecolemans4@...>

> < >

> Sent: Wed, August 18, 2010 8:04:02 PM

> Subject: Microbes and Mental Illness: Insel PANDAS

>

>

>

> Microbes and Mental Illness

> Posted by  Insel

>

> August 13, 2010

> http://www.nimh.nih.gov/about/director/2010/microbes-and-mental-illness.shtml

>

> Hints that some mental illness may be linked to infectious agents and/or

> autoimmune processes date back to at least the early 20th Century. In the 21st

> Century, the field of microbiomics, which is mapping the microbial environment

> of the human organism, may transform the way we think about human physical and

> mental development.1 It is already clear that 90% of “our DNA†is

microbial, not

>

> human. “We†are, in fact, “super-organisms†made up of thousands of

species,

> many of which are being identified for the first time. And there are

persistent

> individual differences in our microbial ecology established early in life.

> Insights from microbiomics have proven important for understanding

obesity2 and

> Type 1 diabetes,3 but microbiomics has not yet been a focus for research on

> mental illness. Yet, there are many clues linking microbiology and mental

> disorders, such as epidemiologic evidence of increased risk

> for schizophrenia associated with prenatal exposure to influenza. Probably

the

> most compelling case for such involvement is children who develop obsessive

> compulsive disorder (OCD) and/or tic disorders “overnight,†following a

strep

> infection. Despite continuing debate over its parameters, evidence is mounting

> in support of Pediatric Autoimmune Neuropsychiatric Disorders Associated with

> Streptococcal Infections (PANDAS) †" or at least a syndrome modeled on it.

> Last month, the NIMH Pediatric Developmental Neuroscience Branch convened

dozens

>

> of experts from the field †" including prominent PANDAS critics †" to update

the

> science and attempt to achieve consensus on criteria defining the syndrome.

The

> mere fact that the conference took place signals a change in the scientific

> climate. Until now, whether a child presenting with sudden onset of OCD and/or

> tic symptoms gets checked for possible involvement of strep has varied†" often

> depending on which medical journals a practitioner happens to read. I am

hopeful

>

> that will begin to change in light of the new evidence.

> Interest in PANDAS has also been spurred by an increasingly vocal network of

> affected families and the clinicians who are treating their often

> severely-impaired children. Conference participants heard reports from the

front

>

> lines by some of these clinicians, who largely corroborated key features of

the

> syndrome, originally identified by NIMH’s Dr. Swedo in the mid-l990s.

> These include sudden onset of mood swings, impulsivity, anxiety, impaired

> attention and poor handwriting in addition to obsessions, compulsions and

tics.

> Dr. Swedo’s studies have identified brain mechanisms through which

> strep antibodies act. They have also demonstrated that cleansing the blood

of

> the antibodies, via plasma exchange or intravenous immunoglobulin,

significantly

>

> diminishes the symptoms.

> Impetus for the July conference came, in part, from publication of two

> independent studies within the past year that lend new credence to the PANDAS

> concept.

> In the first, Columbia University researchers demonstrated, for the first

time,

> that strep-triggered antibodies alone are necessary and sufficient to trigger

a

> PANDAS-like syndrome in mice.4 In an autoimmune-disease susceptible strain of

> mice, exposure to strep triggered OCD-like repetitive behaviors and antibodies

> that attacked specific molecules in the brain. PANDAS-like behaviors also

> emerged in naïve mice after they received antibodies from such PANDAS mice.

> These included impaired learning and memory and social interaction. As in

humans

>

> with PANDAS, these impairments were more common in males than females.

> In the second study, a Yale University research team reported that OCD

> and Tourette Syndrome (tic) symptoms worsened slightly following a strep

> infection in some affected children. Moreover, the strep infection triggered

the

>

> worsened symptoms by increasing the impact of psycho-social stress.5 The

> findings suggest that a subset of children with these disorders may be at

> increased risk of strep infection, which could interact with stress to

> exacerbate the course, as is seen in other infectious and autoimmune diseases.

> Granted, these new findings are still preliminary and need to be replicated.

> However, the data relating to PANDAS is compelling enough to warrant following

> up such leads. NIMH is preparing to launch a new trial of intravenous

> immunoglobulin (IVIG) treatment for PANDAS this Fall, with support from a NIH

> Clinical Center “Bench to Bedsideâ€Â award. The intramural NIMH will

provide the

> clinical care, while data analysis will be carried out by independent teams of

> investigators at Yale University and the Oklahoma University Health Sciences

> Center. Dr. Swedo and her team are hoping to recruit 50 children with

clear-cut

> PANDAS. They are predicting that IVIG treatment will produce striking benefits

> for OCD and other neuropsychiatric symptoms, and will be most effective for

> those children who start out with the highest levels of strep-triggered

> antibodies that go astray and attack parts of the brain.

> Moreover, monoclonal antibodies derived from these patients will be used to

> develop animal models of OCD that could lead to improved treatments.

> Do infectious agents influence the development of autism, anxiety, or mood

> disorders? This remains a frontier area for NIMH research. The increasing

> evidence linking strep infection to OCD in children suggests that microbiomics

> may prove an important research area for understanding and treating mental

> disorders.

> References

> 1Bacterial community variation in human body habitats across space and time.

> Costello EK, Lauber CL, Hamady M, Fierer N, Gordon JI, Knight R.

> Science. 2009 Dec 18;326(5960):1694-7. Epub 2009 Nov 5.PMID: 19892944

> 2A core gut microbiome in obese and lean twins.

> Turnbaugh PJ, Hamady M, Yatsunenko T, Cantarel BL, Duncan A, Ley RE, Sogin ML,

> WJ, Roe BA, Affourtit JP, Egholm M, Henrissat B, Heath AC, Knight R,

> Gordon JI.

> Nature. 2009 Jan 22;457(7228):480-4. Epub 2008 Nov 30.PMID: 19043404

> 3Innate immunity and intestinal microbiota in the development of Type 1

> diabetes.

> Wen L, Ley RE, Volchkov PY, Stranges PB, Avanesyan L, Stonebraker AC, Hu C,

Wong

>

> FS, Szot GL, Bluestone JA, Gordon JI, Chervonsky AV.

> Nature. 2008 Oct 23;455(7216):1109-13. Epub 2008 Sep 21.PMID: 18806780

> 4Passive transfer of streptococcus-induced antibodies reproduces behavioral

> disturbances in a mouse model of pediatric autoimmune neuropsychiatric

disorders

>

> associated with streptococcal infection.

> Yaddanapudi K, Hornig M, Serge R, De Miranda J, Baghban A, Villar G, Lipkin

WI.

> Mol Psychiatry. 2010 Jul;15(7):712-26. Epub 2009 Aug 11.PMID: 19668249.

> 5Streptococcal upper respiratory tract infections and psychosocial stress

> predict future tic and obsessive-compulsive symptom severity in children and

> adolescents with Tourette syndrome and obsessive-compulsive disorder.

> Lin H, KA, Katsovich L, Findley DB, Grantz H, Lombroso PJ, King RA,

> Bessen DE, D, Kaplan EL, Landeros-Weisenberger A, Zhang H, Leckman JF.

> Biol Psychiatry. 2010 Apr 1;67(7):684-91. Epub 2009 Oct 14.PMID: 19833320.

>

>

[Guest guest]

Bipolar has been connected to HSV1, and many psychiatrists know their patients

break out into cold sores when they go into the hospital due to depressive or

manic attacks.  They blame it on stress, instead of realizing that something is

going on with the virus days before the cold sore actually breaks out ... why

would they not connect that to triggering the hospitalizing event?

So many schizophrenics were released from institutions after penicillin was

found and they were treated for bacterial infections.  Theirs is also

exacerbated by HSV1.

No kidding.

________________________________

From: <jlhank80@...>

Sent: Thu, August 19, 2010 9:21:56 AM

Subject: Re: Microbes and Mental Illness: Insel PANDAS

 

It is called mental ILLNESS, right? Why wouldn't mental illness be caused by

microbes? Suddenly people develop mental illness, why can't the brain get

infected and effect its functions? Just like our kids? My child was not born

autistic. That is not genes.

I would bet that almost every mental illness (bipolar, OCD, schizophrenia, even

antisocial behavior) is due to some microbe, probably viral.

>

> Fascinating article. I find it interesting that they don't have a

corresponding

>

> illness for adults. After all, these children do grow up. I had anxiety my

>whole

>

> life and OCD like behaviors that interfered with everyday functioning. When

> tested by Dr. G a few years ago, my strep titers were almost 2,000.

>

> I hope they commit to this research. A lot of people are depending on it.

>

> All the best,

>

> Robyn

>  

>

> ________________________________

>

> From: <thecolemans4@...>

> < >

> Sent: Wed, August 18, 2010 8:04:02 PM

> Subject: Microbes and Mental Illness: Insel PANDAS

>

>

>

> Microbes and Mental Illness

> Posted by  Insel

>

> August 13, 2010

> http://www.nimh.nih.gov/about/director/2010/microbes-and-mental-illness.shtml

>

> Hints that some mental illness may be linked to infectious agents and/or

> autoimmune processes date back to at least the early 20th Century. In the 21st

> Century, the field of microbiomics, which is mapping the microbial environment

> of the human organism, may transform the way we think about human physical and

> mental development.1 It is already clear that 90% of “our DNA�

is

>microbial, not

>

>

> human. “We� are, in fact, “super-organisms� made up

of thousands of

>species,

>

> many of which are being identified for the first time. And there are

persistent

>

> individual differences in our microbial ecology established early in life.

> Insights from microbiomics have proven important for understanding

>obesity2 and

>

> Type 1 diabetes,3 but microbiomics has not yet been a focus for research on

> mental illness. Yet, there are many clues linking microbiology and mental

> disorders, such as epidemiologic evidence of increased risk

> for schizophrenia associated with prenatal exposure to influenza.

Probably

>the

>

> most compelling case for such involvement is children who develop obsessive

> compulsive disorder (OCD) and/or tic disorders “overnight,�

following a

>strep

>

> infection. Despite continuing debate over its parameters, evidence is mounting

> in support of Pediatric Autoimmune Neuropsychiatric Disorders Associated

with

> Streptococcal Infections (PANDAS) †" or at least a syndrome modeled on

it.

> Last month, the NIMH Pediatric Developmental Neuroscience

Branch convened

>dozens

>

>

> of experts from the field †" including prominent PANDAS critics †" to

update

>the

>

> science and attempt to achieve consensus on criteria defining the syndrome.

The

>

> mere fact that the conference took place signals a change in the scientific

> climate. Until now, whether a child presenting with sudden onset of OCD and/or

> tic symptoms gets checked for possible involvement of strep has

varied†" often

> depending on which medical journals a practitioner happens to read. I am

>hopeful

>

>

> that will begin to change in light of the new evidence.

> Interest in PANDAS has also been spurred by an increasingly vocal network of

> affected families and the clinicians who are treating their often

> severely-impaired children. Conference participants heard reports from the

>front

>

>

> lines by some of these clinicians, who largely corroborated key features of

the

>

> syndrome, originally identified by NIMH’s Dr. Swedo in the

mid-l990s.

> These include sudden onset of mood swings, impulsivity, anxiety, impaired

> attention and poor handwriting in addition to obsessions, compulsions and

tics.

>

> Dr. Swedo’s studies have identified brain mechanisms through

which

> strep antibodies act. They have also demonstrated that cleansing the

blood of

>

> the antibodies, via plasma exchange or intravenous immunoglobulin,

>significantly

>

>

> diminishes the symptoms.

> Impetus for the July conference came, in part, from publication of two

> independent studies within the past year that lend new credence to the PANDAS

> concept.

> In the first, Columbia University researchers demonstrated, for the first

time,

>

> that strep-triggered antibodies alone are necessary and sufficient to trigger

a

>

> PANDAS-like syndrome in mice.4 In an autoimmune-disease susceptible strain

of

> mice, exposure to strep triggered OCD-like repetitive behaviors and antibodies

> that attacked specific molecules in the brain. PANDAS-like behaviors also

> emerged in naïve mice after they received antibodies from such PANDAS mice.

> These included impaired learning and memory and social interaction. As in

>humans

>

>

> with PANDAS, these impairments were more common in males than females.

> In the second study, a Yale University research team reported that OCD

> and Tourette Syndrome (tic) symptoms worsened slightly following a strep

> infection in some affected children. Moreover, the strep infection triggered

>the

>

>

> worsened symptoms by increasing the impact of psycho-social stress.5 The

> findings suggest that a subset of children with these disorders may be at

> increased risk of strep infection, which could interact with stress to

> exacerbate the course, as is seen in other infectious and autoimmune diseases.

> Granted, these new findings are still preliminary and need to be replicated.

> However, the data relating to PANDAS is compelling enough to warrant following

> up such leads. NIMH is preparing to launch a new trial of intravenous

> immunoglobulin (IVIG) treatment for PANDAS this Fall, with support from a NIH

> Clinical Center “Bench to Bedside� award. The intramural

NIMH will

>provide the

>

> clinical care, while data analysis will be carried out by independent teams of

> investigators at Yale University and the Oklahoma University Health Sciences

> Center. Dr. Swedo and her team are hoping to recruit 50 children with

clear-cut

>

> PANDAS. They are predicting that IVIG treatment will produce striking benefits

> for OCD and other neuropsychiatric symptoms, and will be most effective for

> those children who start out with the highest levels of strep-triggered

> antibodies that go astray and attack parts of the brain.

> Moreover, monoclonal antibodies derived from these patients will be used

to

> develop animal models of OCD that could lead to improved treatments.

> Do infectious agents influence the development of autism, anxiety, or mood

> disorders? This remains a frontier area for NIMH research. The increasing

> evidence linking strep infection to OCD in children suggests that microbiomics

> may prove an important research area for understanding and treating mental

> disorders.

> References

> 1Bacterial community variation in human body habitats across space and time.

> Costello EK, Lauber CL, Hamady M, Fierer N, Gordon JI, Knight R.

> Science. 2009 Dec 18;326(5960):1694-7. Epub 2009 Nov 5.PMID: 19892944

> 2A core gut microbiome in obese and lean twins.

> Turnbaugh PJ, Hamady M, Yatsunenko T, Cantarel BL, Duncan A, Ley RE, Sogin ML,

> WJ, Roe BA, Affourtit JP, Egholm M, Henrissat B, Heath AC, Knight R,

> Gordon JI.

> Nature. 2009 Jan 22;457(7228):480-4. Epub 2008 Nov 30.PMID: 19043404

> 3Innate immunity and intestinal microbiota in the development of Type 1

> diabetes.

> Wen L, Ley RE, Volchkov PY, Stranges PB, Avanesyan L, Stonebraker AC, Hu C,

>Wong

>

>

> FS, Szot GL, Bluestone JA, Gordon JI, Chervonsky AV.

> Nature. 2008 Oct 23;455(7216):1109-13. Epub 2008 Sep 21.PMID: 18806780

> 4Passive transfer of streptococcus-induced antibodies reproduces behavioral

> disturbances in a mouse model of pediatric autoimmune neuropsychiatric

>disorders

>

>

> associated with streptococcal infection.

> Yaddanapudi K, Hornig M, Serge R, De Miranda J, Baghban A, Villar G, Lipkin

WI.

> Mol Psychiatry. 2010 Jul;15(7):712-26. Epub 2009 Aug 11.PMID: 19668249.

> 5Streptococcal upper respiratory tract infections and psychosocial stress

> predict future tic and obsessive-compulsive symptom severity in children and

> adolescents with Tourette syndrome and obsessive-compulsive disorder.

> Lin H, KA, Katsovich L, Findley DB, Grantz H, Lombroso PJ, King RA,

> Bessen DE, D, Kaplan EL, Landeros-Weisenberger A, Zhang H, Leckman JF.

> Biol Psychiatry. 2010 Apr 1;67(7):684-91. Epub 2009 Oct 14.PMID: 19833320.

>

>

[Guest guest]

Hi, Caroline. Ery-Ped three times per day for two years now...that's how Dr. G

is treating me for the strep titers, and it really works. For the first time in

my life, I am virtually anxiety free. It's great!

Robyn

________________________________

From: Caroline Glover <sfglover@...>

Sent: Wed, August 18, 2010 9:35:21 PM

Subject: Re: Microbes and Mental Illness: Insel PANDAS

 

Dr. G used erythromycin (actually ERY-PED) long term for my son, while

checking and re-checking the antibodies (ASO titer) as they went down.

I have never of him prescribing plasma exchange or IVIG for PANDAS. By the

way, he feels that IMGG is safer than IVIG.

He tried IMGG for my son at one point, but that was not specifically to

target the PANDAS.

HTH,

Caroline G.

From: <erikadyan71@...>

Reply-< >

Date: Thu, 19 Aug 2010 03:51:47 +0000

< >

Subject: Re: Microbes and Mental Illness: Insel PANDAS

This is some very interesting information!

Is anyone having their child treated for PANDAS by Dr Goldberg or Dr

? I am curious to know if they treat it the same way, with IVIG or

plasma exchange? And, their success rate!

Thanks.

-

Sent on the Sprint® Now Network from my BlackBerry®

Microbes and Mental Illness: Insel PANDAS

Microbes and Mental Illness

Posted by  Insel

August 13, 2010

http://www.nimh.nih.gov/about/director/2010/microbes-and-mental-illness.shtm

l

Hints that some mental illness may be linked to infectious agents and/or

autoimmune processes date back to at least the early 20th Century. In the

21st

Century, the field of microbiomics, which is mapping the microbial

environment

of the human organism, may transform the way we think about human physical

and

mental development.1 It is already clear that 90% of ³our DNA² is microbial,

not

human. ³We² are, in fact, ³super-organisms² made up of thousands of species,

many of which are being identified for the first time. And there are

persistent

individual differences in our microbial ecology established early in life.

Insights from microbiomics have proven important for understanding

obesity2 and

Type 1 diabetes,3 but microbiomics has not yet been a focus for research on

mental illness. Yet, there are many clues linking microbiology and mental

disorders, such as epidemiologic evidence of increased risk

for schizophrenia associated with prenatal exposure to influenza. Probably

the

most compelling case for such involvement is children who develop obsessive

compulsive disorder (OCD) and/or tic disorders ³overnight,² following a

strep

infection. Despite continuing debate over its parameters, evidence is

mounting

in support of Pediatric Autoimmune Neuropsychiatric Disorders Associated

with

Streptococcal Infections (PANDAS) ‹ or at least a syndrome modeled on it.

Last month, the NIMH Pediatric Developmental Neuroscience Branch convened

dozens

of experts from the field ‹ including prominent PANDAS critics ‹ to update

the

science and attempt to achieve consensus on criteria defining the syndrome.

The

mere fact that the conference took place signals a change in the scientific

climate. Until now, whether a child presenting with sudden onset of OCD

and/or

tic symptoms gets checked for possible involvement of strep has varied‹often

depending on which medical journals a practitioner happens to read. I am

hopeful

that will begin to change in light of the new evidence.

Interest in PANDAS has also been spurred by an increasingly vocal network of

affected families and the clinicians who are treating their often

severely-impaired children. Conference participants heard reports from the

front

lines by some of these clinicians, who largely corroborated key features of

the

syndrome, originally identified by NIMH¹s Dr. Swedo in the mid-l990s.

These include sudden onset of mood swings, impulsivity, anxiety, impaired

attention and poor handwriting in addition to obsessions, compulsions and

tics.

Dr. Swedo¹s studies have identified brain mechanisms through which

strep antibodies act. They have also demonstrated that cleansing the blood

of

the antibodies, via plasma exchange or intravenous immunoglobulin,

significantly

diminishes the symptoms.

Impetus for the July conference came, in part, from publication of two

independent studies within the past year that lend new credence to the

PANDAS

concept.

In the first, Columbia University researchers demonstrated, for the first

time,

that strep-triggered antibodies alone are necessary and sufficient to

trigger a

PANDAS-like syndrome in mice.4 In an autoimmune-disease susceptible strain

of

mice, exposure to strep triggered OCD-like repetitive behaviors and

antibodies

that attacked specific molecules in the brain. PANDAS-like behaviors also

emerged in naïve mice after they received antibodies from such PANDAS mice.

These included impaired learning and memory and social interaction. As in

humans

with PANDAS, these impairments were more common in males than females.

In the second study, a Yale University research team reported that OCD

and Tourette Syndrome (tic) symptoms worsened slightly following a strep

infection in some affected children. Moreover, the strep infection triggered

the

worsened symptoms by increasing the impact of psycho-social stress.5 The

findings suggest that a subset of children with these disorders may be at

increased risk of strep infection, which could interact with stress to

exacerbate the course, as is seen in other infectious and autoimmune

diseases.

Granted, these new findings are still preliminary and need to be replicated.

However, the data relating to PANDAS is compelling enough to warrant

following

up such leads. NIMH is preparing to launch a new trial of intravenous

immunoglobulin (IVIG) treatment for PANDAS this Fall, with support from a

NIH

Clinical Center ³Bench to Bedside² award. The intramural NIMH will provide

the

clinical care, while data analysis will be carried out by independent teams

of

investigators at Yale University and the Oklahoma University Health Sciences

Center. Dr. Swedo and her team are hoping to recruit 50 children with

clear-cut

PANDAS. They are predicting that IVIG treatment will produce striking

benefits

for OCD and other neuropsychiatric symptoms, and will be most effective for

those children who start out with the highest levels of strep-triggered

antibodies that go astray and attack parts of the brain.

Moreover, monoclonal antibodies derived from these patients will be used to

develop animal models of OCD that could lead to improved treatments.

Do infectious agents influence the development of autism, anxiety, or mood

disorders? This remains a frontier area for NIMH research. The increasing

evidence linking strep infection to OCD in children suggests that

microbiomics

may prove an important research area for understanding and treating mental

disorders.

References

1Bacterial community variation in human body habitats across space and time.

Costello EK, Lauber CL, Hamady M, Fierer N, Gordon JI, Knight R.

Science. 2009 Dec 18;326(5960):1694-7. Epub 2009 Nov 5.PMID: 19892944

2A core gut microbiome in obese and lean twins.

Turnbaugh PJ, Hamady M, Yatsunenko T, Cantarel BL, Duncan A, Ley RE, Sogin

ML,

WJ, Roe BA, Affourtit JP, Egholm M, Henrissat B, Heath AC, Knight R,

Gordon JI.

Nature. 2009 Jan 22;457(7228):480-4. Epub 2008 Nov 30.PMID: 19043404

3Innate immunity and intestinal microbiota in the development of Type 1

diabetes.

Wen L, Ley RE, Volchkov PY, Stranges PB, Avanesyan L, Stonebraker AC, Hu C,

Wong

FS, Szot GL, Bluestone JA, Gordon JI, Chervonsky AV.

Nature. 2008 Oct 23;455(7216):1109-13. Epub 2008 Sep 21.PMID: 18806780

4Passive transfer of streptococcus-induced antibodies reproduces behavioral

disturbances in a mouse model of pediatric autoimmune neuropsychiatric

disorders

associated with streptococcal infection.

Yaddanapudi K, Hornig M, Serge R, De Miranda J, Baghban A, Villar G, Lipkin

WI.

Mol Psychiatry. 2010 Jul;15(7):712-26. Epub 2009 Aug 11.PMID: 19668249.

5Streptococcal upper respiratory tract infections and psychosocial stress

predict future tic and obsessive-compulsive symptom severity in children and

adolescents with Tourette syndrome and obsessive-compulsive disorder.

Lin H, KA, Katsovich L, Findley DB, Grantz H, Lombroso PJ, King RA,

Bessen DE, D, Kaplan EL, Landeros-Weisenberger A, Zhang H, Leckman

JF.

Biol Psychiatry. 2010 Apr 1;67(7):684-91. Epub 2009 Oct 14.PMID: 19833320.

[Guest guest]

Hi Robyn,

Does Ery-Ped upset your stomach?

Argie

On Aug 19, 2010, at 8:50 AM, Robyn & Greg Coggins wrote:

> Hi, Caroline. Ery-Ped three times per day for two years now...that's

> how Dr. G

> is treating me for the strep titers, and it really works. For the

> first time in

> my life, I am virtually anxiety free. It's great!

>

> Robyn

>

> ________________________________

> From: Caroline Glover <sfglover@...>

>

> Sent: Wed, August 18, 2010 9:35:21 PM

> Subject: Re: Microbes and Mental Illness: Insel PANDAS

>

>

>

> Dr. G used erythromycin (actually ERY-PED) long term for my son, while

> checking and re-checking the antibodies (ASO titer) as they went down.

>

> I have never of him prescribing plasma exchange or IVIG for PANDAS.

> By the

> way, he feels that IMGG is safer than IVIG.

>

> He tried IMGG for my son at one point, but that was not specifically

> to

> target the PANDAS.

>

> HTH,

> Caroline G.

>

> From: <erikadyan71@...>

> Reply-< >

> Date: Thu, 19 Aug 2010 03:51:47 +0000

> < >

> Subject: Re: Microbes and Mental Illness: Insel PANDAS

>

> This is some very interesting information!

> Is anyone having their child treated for PANDAS by Dr Goldberg or Dr

> ? I am curious to know if they treat it the same way, with

> IVIG or

> plasma exchange? And, their success rate!

> Thanks.

>

> -

> Sent on the Sprint® Now Network from my BlackBerry®

>

> Microbes and Mental Illness: Insel PANDAS

>

> Microbes and Mental Illness

> Posted by Insel

>

> August 13, 2010

> http://www.nimh.nih.gov/about/director/2010/microbes-and-mental-illness.shtm

> l

>

> Hints that some mental illness may be linked to infectious agents

> and/or

> autoimmune processes date back to at least the early 20th Century.

> In the

> 21st

> Century, the field of microbiomics, which is mapping the microbial

> environment

> of the human organism, may transform the way we think about human

> physical

> and

> mental development.1 It is already clear that 90% of ³our DNA² is

> microbial,

> not

> human. ³We² are, in fact, ³super-organisms² made up of thousands of

> species,

> many of which are being identified for the first time. And there are

> persistent

> individual differences in our microbial ecology established early in

> life.

> Insights from microbiomics have proven important for understanding

> obesity2 and

> Type 1 diabetes,3 but microbiomics has not yet been a focus for

> research on

> mental illness. Yet, there are many clues linking microbiology and

> mental

> disorders, such as epidemiologic evidence of increased risk

> for schizophrenia associated with prenatal exposure to influenza.

> Probably

> the

> most compelling case for such involvement is children who develop

> obsessive

> compulsive disorder (OCD) and/or tic disorders ³overnight,²

> following a

> strep

> infection. Despite continuing debate over its parameters, evidence is

> mounting

> in support of Pediatric Autoimmune Neuropsychiatric Disorders

> Associated

> with

> Streptococcal Infections (PANDAS) ‹ or at least a syndrome modeled

> on it.

> Last month, the NIMH Pediatric Developmental Neuroscience Branch

> convened

> dozens

> of experts from the field ‹ including prominent PANDAS critics ‹ to

> update

> the

> science and attempt to achieve consensus on criteria defining the

> syndrome.

> The

> mere fact that the conference took place signals a change in the

> scientific

> climate. Until now, whether a child presenting with sudden onset of

> OCD

> and/or

> tic symptoms gets checked for possible involvement of strep has

> varied‹often

> depending on which medical journals a practitioner happens to read.

> I am

> hopeful

> that will begin to change in light of the new evidence.

> Interest in PANDAS has also been spurred by an increasingly vocal

> network of

> affected families and the clinicians who are treating their often

> severely-impaired children. Conference participants heard reports

> from the

> front

> lines by some of these clinicians, who largely corroborated key

> features of

> the

> syndrome, originally identified by NIMH¹s Dr. Swedo in the mid-

> l990s.

> These include sudden onset of mood swings, impulsivity, anxiety,

> impaired

> attention and poor handwriting in addition to obsessions,

> compulsions and

> tics.

> Dr. Swedo¹s studies have identified brain mechanisms through which

> strep antibodies act. They have also demonstrated that cleansing the

> blood

> of

> the antibodies, via plasma exchange or intravenous immunoglobulin,

> significantly

> diminishes the symptoms.

> Impetus for the July conference came, in part, from publication of two

> independent studies within the past year that lend new credence to the

> PANDAS

> concept.

> In the first, Columbia University researchers demonstrated, for the

> first

> time,

> that strep-triggered antibodies alone are necessary and sufficient to

> trigger a

> PANDAS-like syndrome in mice.4 In an autoimmune-disease susceptible

> strain

> of

> mice, exposure to strep triggered OCD-like repetitive behaviors and

> antibodies

> that attacked specific molecules in the brain. PANDAS-like behaviors

> also

> emerged in naïve mice after they received antibodies from such

> PANDAS mice.

> These included impaired learning and memory and social interaction.

> As in

> humans

> with PANDAS, these impairments were more common in males than females.

> In the second study, a Yale University research team reported that OCD

> and Tourette Syndrome (tic) symptoms worsened slightly following a

> strep

> infection in some affected children. Moreover, the strep infection

> triggered

> the

> worsened symptoms by increasing the impact of psycho-social stress.5

> The

> findings suggest that a subset of children with these disorders may

> be at

> increased risk of strep infection, which could interact with stress to

> exacerbate the course, as is seen in other infectious and autoimmune

> diseases.

> Granted, these new findings are still preliminary and need to be

> replicated.

> However, the data relating to PANDAS is compelling enough to warrant

> following

> up such leads. NIMH is preparing to launch a new trial of intravenous

> immunoglobulin (IVIG) treatment for PANDAS this Fall, with support

> from a

> NIH

> Clinical Center ³Bench to Bedside² award. The intramural NIMH will

> provide

> the

> clinical care, while data analysis will be carried out by

> independent teams

> of

> investigators at Yale University and the Oklahoma University Health

> Sciences

> Center. Dr. Swedo and her team are hoping to recruit 50 children with

> clear-cut

> PANDAS. They are predicting that IVIG treatment will produce striking

> benefits

> for OCD and other neuropsychiatric symptoms, and will be most

> effective for

> those children who start out with the highest levels of strep-

> triggered

> antibodies that go astray and attack parts of the brain.

> Moreover, monoclonal antibodies derived from these patients will be

> used to

> develop animal models of OCD that could lead to improved treatments.

> Do infectious agents influence the development of autism, anxiety,

> or mood

> disorders? This remains a frontier area for NIMH research. The

> increasing

> evidence linking strep infection to OCD in children suggests that

> microbiomics

> may prove an important research area for understanding and treating

> mental

> disorders.

> References

> 1Bacterial community variation in human body habitats across space

> and time.

> Costello EK, Lauber CL, Hamady M, Fierer N, Gordon JI, Knight R.

> Science. 2009 Dec 18;326(5960):1694-7. Epub 2009 Nov 5.PMID: 19892944

> 2A core gut microbiome in obese and lean twins.

> Turnbaugh PJ, Hamady M, Yatsunenko T, Cantarel BL, Duncan A, Ley RE,

> Sogin

> ML,

> WJ, Roe BA, Affourtit JP, Egholm M, Henrissat B, Heath AC,

> Knight R,

> Gordon JI.

> Nature. 2009 Jan 22;457(7228):480-4. Epub 2008 Nov 30.PMID: 19043404

> 3Innate immunity and intestinal microbiota in the development of

> Type 1

> diabetes.

> Wen L, Ley RE, Volchkov PY, Stranges PB, Avanesyan L, Stonebraker

> AC, Hu C,

> Wong

> FS, Szot GL, Bluestone JA, Gordon JI, Chervonsky AV.

> Nature. 2008 Oct 23;455(7216):1109-13. Epub 2008 Sep 21.PMID: 18806780

> 4Passive transfer of streptococcus-induced antibodies reproduces

> behavioral

> disturbances in a mouse model of pediatric autoimmune neuropsychiatric

> disorders

> associated with streptococcal infection.

> Yaddanapudi K, Hornig M, Serge R, De Miranda J, Baghban A, Villar G,

> Lipkin

> WI.

> Mol Psychiatry. 2010 Jul;15(7):712-26. Epub 2009 Aug 11.PMID:

> 19668249.

> 5Streptococcal upper respiratory tract infections and psychosocial

> stress

> predict future tic and obsessive-compulsive symptom severity in

> children and

> adolescents with Tourette syndrome and obsessive-compulsive disorder.

> Lin H, KA, Katsovich L, Findley DB, Grantz H, Lombroso PJ,

> King RA,

> Bessen DE, D, Kaplan EL, Landeros-Weisenberger A, Zhang H,

> Leckman

> JF.

> Biol Psychiatry. 2010 Apr 1;67(7):684-91. Epub 2009 Oct 14.PMID:

> 19833320.

>

>

[Guest guest]

No, it doesn't. Biaxin gives me more problems than Ery-Ped

HTH,

Robyn

________________________________

From: Argie Olivo <golivo@...>

Sent: Thu, August 19, 2010 11:50:54 AM

Subject: Re: Microbes and Mental Illness: Insel PANDAS

Hi Robyn,

Does Ery-Ped upset your stomach?

Argie

On Aug 19, 2010, at 8:50 AM, Robyn & Greg Coggins wrote:

> Hi, Caroline. Ery-Ped three times per day for two years now...that's 

> how Dr. G

> is treating me for the strep titers, and it really works. For the 

> first time in

> my life, I am virtually anxiety free. It's great!

>

> Robyn

>

> ________________________________

> From: Caroline Glover <sfglover@...>

>

> Sent: Wed, August 18, 2010 9:35:21 PM

> Subject: Re: Microbes and Mental Illness: Insel PANDAS

>

>

>

> Dr. G used erythromycin (actually ERY-PED) long term for my son, while

> checking and re-checking the antibodies (ASO titer) as they went down.

>

> I have never of him prescribing plasma exchange or IVIG for PANDAS. 

> By the

> way, he feels that IMGG is safer than IVIG.

>

> He tried IMGG for my son at one point, but that was not specifically 

> to

> target the PANDAS.

>

> HTH,

> Caroline G.

>

> From: <erikadyan71@...>

> Reply-< >

> Date: Thu, 19 Aug 2010 03:51:47 +0000

> < >

> Subject: Re: Microbes and Mental Illness: Insel PANDAS

>

> This is some very interesting information!

> Is anyone having their child treated for PANDAS by Dr Goldberg or Dr

> ? I am curious to know if they treat it the same way, with 

> IVIG or

> plasma exchange? And, their success rate!

> Thanks.

>

> -

> Sent on the Sprint® Now Network from my BlackBerry®

>

> Microbes and Mental Illness: Insel PANDAS

>

> Microbes and Mental Illness

> Posted by Insel

>

> August 13, 2010

> http://www.nimh.nih.gov/about/director/2010/microbes-and-mental-illness.shtm

> l

>

> Hints that some mental illness may be linked to infectious agents 

> and/or

> autoimmune processes date back to at least the early 20th Century. 

> In the

> 21st

> Century, the field of microbiomics, which is mapping the microbial

> environment

> of the human organism, may transform the way we think about human 

> physical

> and

> mental development.1 It is already clear that 90% of ³our DNA² is 

> microbial,

> not

> human. ³We² are, in fact, ³super-organisms² made up of thousands of 

> species,

> many of which are being identified for the first time. And there are

> persistent

> individual differences in our microbial ecology established early in 

> life.

> Insights from microbiomics have proven important for understanding

> obesity2 and

> Type 1 diabetes,3 but microbiomics has not yet been a focus for 

> research on

> mental illness. Yet, there are many clues linking microbiology and 

> mental

> disorders, such as epidemiologic evidence of increased risk

> for schizophrenia associated with prenatal exposure to influenza. 

> Probably

> the

> most compelling case for such involvement is children who develop 

> obsessive

> compulsive disorder (OCD) and/or tic disorders ³overnight,² 

> following a

> strep

> infection. Despite continuing debate over its parameters, evidence is

> mounting

> in support of Pediatric Autoimmune Neuropsychiatric Disorders 

> Associated

> with

> Streptococcal Infections (PANDAS) ‹ or at least a syndrome modeled 

> on it.

> Last month, the NIMH Pediatric Developmental Neuroscience Branch 

> convened

> dozens

> of experts from the field ‹ including prominent PANDAS critics ‹ to 

> update

> the

> science and attempt to achieve consensus on criteria defining the 

> syndrome.

> The

> mere fact that the conference took place signals a change in the 

> scientific

> climate. Until now, whether a child presenting with sudden onset of 

> OCD

> and/or

> tic symptoms gets checked for possible involvement of strep has 

> varied‹often

> depending on which medical journals a practitioner happens to read. 

> I am

> hopeful

> that will begin to change in light of the new evidence.

> Interest in PANDAS has also been spurred by an increasingly vocal 

> network of

> affected families and the clinicians who are treating their often

> severely-impaired children. Conference participants heard reports 

> from the

> front

> lines by some of these clinicians, who largely corroborated key 

> features of

> the

> syndrome, originally identified by NIMH¹s Dr. Swedo in the mid-

> l990s.

> These include sudden onset of mood swings, impulsivity, anxiety, 

> impaired

> attention and poor handwriting in addition to obsessions, 

> compulsions and

> tics.

> Dr. Swedo¹s studies have identified brain mechanisms through which

> strep antibodies act. They have also demonstrated that cleansing the 

> blood

> of

> the antibodies, via plasma exchange or intravenous immunoglobulin,

> significantly

> diminishes the symptoms.

> Impetus for the July conference came, in part, from publication of two

> independent studies within the past year that lend new credence to the

> PANDAS

> concept.

> In the first, Columbia University researchers demonstrated, for the 

> first

> time,

> that strep-triggered antibodies alone are necessary and sufficient to

> trigger a

> PANDAS-like syndrome in mice.4 In an autoimmune-disease susceptible 

> strain

> of

> mice, exposure to strep triggered OCD-like repetitive behaviors and

> antibodies

> that attacked specific molecules in the brain. PANDAS-like behaviors 

> also

> emerged in naïve mice after they received antibodies from such 

> PANDAS mice.

> These included impaired learning and memory and social interaction. 

> As in

> humans

> with PANDAS, these impairments were more common in males than females.

> In the second study, a Yale University research team reported that OCD

> and Tourette Syndrome (tic) symptoms worsened slightly following a 

> strep

> infection in some affected children. Moreover, the strep infection 

> triggered

> the

> worsened symptoms by increasing the impact of psycho-social stress.5 

> The

> findings suggest that a subset of children with these disorders may 

> be at

> increased risk of strep infection, which could interact with stress to

> exacerbate the course, as is seen in other infectious and autoimmune

> diseases.

> Granted, these new findings are still preliminary and need to be 

> replicated.

> However, the data relating to PANDAS is compelling enough to warrant

> following

> up such leads. NIMH is preparing to launch a new trial of intravenous

> immunoglobulin (IVIG) treatment for PANDAS this Fall, with support 

> from a

> NIH

> Clinical Center ³Bench to Bedside² award. The intramural NIMH will 

> provide

> the

> clinical care, while data analysis will be carried out by 

> independent teams

> of

> investigators at Yale University and the Oklahoma University Health 

> Sciences

> Center. Dr. Swedo and her team are hoping to recruit 50 children with

> clear-cut

> PANDAS. They are predicting that IVIG treatment will produce striking

> benefits

> for OCD and other neuropsychiatric symptoms, and will be most 

> effective for

> those children who start out with the highest levels of strep-

> triggered

> antibodies that go astray and attack parts of the brain.

> Moreover, monoclonal antibodies derived from these patients will be 

> used to

> develop animal models of OCD that could lead to improved treatments.

> Do infectious agents influence the development of autism, anxiety, 

> or mood

> disorders? This remains a frontier area for NIMH research. The 

> increasing

> evidence linking strep infection to OCD in children suggests that

> microbiomics

> may prove an important research area for understanding and treating 

> mental

> disorders.

> References

> 1Bacterial community variation in human body habitats across space 

> and time.

> Costello EK, Lauber CL, Hamady M, Fierer N, Gordon JI, Knight R.

> Science. 2009 Dec 18;326(5960):1694-7. Epub 2009 Nov 5.PMID: 19892944

> 2A core gut microbiome in obese and lean twins.

> Turnbaugh PJ, Hamady M, Yatsunenko T, Cantarel BL, Duncan A, Ley RE, 

> Sogin

> ML,

> WJ, Roe BA, Affourtit JP, Egholm M, Henrissat B, Heath AC, 

> Knight R,

> Gordon JI.

> Nature. 2009 Jan 22;457(7228):480-4. Epub 2008 Nov 30.PMID: 19043404

> 3Innate immunity and intestinal microbiota in the development of 

> Type 1

> diabetes.

> Wen L, Ley RE, Volchkov PY, Stranges PB, Avanesyan L, Stonebraker 

> AC, Hu C,

> Wong

> FS, Szot GL, Bluestone JA, Gordon JI, Chervonsky AV.

> Nature. 2008 Oct 23;455(7216):1109-13. Epub 2008 Sep 21.PMID: 18806780

> 4Passive transfer of streptococcus-induced antibodies reproduces 

> behavioral

> disturbances in a mouse model of pediatric autoimmune neuropsychiatric

> disorders

> associated with streptococcal infection.

> Yaddanapudi K, Hornig M, Serge R, De Miranda J, Baghban A, Villar G, 

> Lipkin

> WI.

> Mol Psychiatry. 2010 Jul;15(7):712-26. Epub 2009 Aug 11.PMID: 

> 19668249.

> 5Streptococcal upper respiratory tract infections and psychosocial 

> stress

> predict future tic and obsessive-compulsive symptom severity in 

> children and

> adolescents with Tourette syndrome and obsessive-compulsive disorder.

> Lin H, KA, Katsovich L, Findley DB, Grantz H, Lombroso PJ, 

> King RA,

> Bessen DE, D, Kaplan EL, Landeros-Weisenberger A, Zhang H, 

> Leckman

> JF.

> Biol Psychiatry. 2010 Apr 1;67(7):684-91. Epub 2009 Oct 14.PMID: 

> 19833320.

>

>

[Guest guest]

I took my 11 yo son (he was diagnosed with Pandas at 3 1/2) to Dr.

starting in July and he's got him on regime of 500 mg of Keflex per day and we

just started the antivirals this week. All the symptoms I've ever seen with the

PANDAS have been coming out since about a week after he started the

antibiotics...particularly the urination and fear issues. I take SCIg for my

PID and I'm fairly sure I'm the reason why he's having all these issues but I'm

hoping that finally finding a regimen that addresses the neurological and

immunological will bring some improvements.

Robin

>

> This is some very interesting information!

> Is anyone having their child treated for PANDAS by Dr Goldberg or Dr ?

I am curious to know if they treat it the same way, with IVIG or plasma

exchange? And, their success rate!

> Thanks.

>

> -

> Sent on the Sprint® Now Network from my BlackBerry®

>

> Microbes and Mental Illness: Insel PANDAS

>

>

>

> Microbes and Mental Illness

> Posted by  Insel

>

> August 13, 2010

> http://www.nimh.nih.gov/about/director/2010/microbes-and-mental-illness.shtml

>

>

> Hints that some mental illness may be linked to infectious agents and/or

> autoimmune processes date back to at least the early 20th Century. In the 21st

> Century, the field of microbiomics, which is mapping the microbial environment

> of the human organism, may transform the way we think about human physical and

> mental development.1 It is already clear that 90% of “our DNA†is

microbial, not

> human. “We†are, in fact, “super-organisms†made up of thousands of

species,

> many of which are being identified for the first time. And there are

persistent

> individual differences in our microbial ecology established early in life.

> Insights from microbiomics have proven important for understanding

obesity2 and

> Type 1 diabetes,3 but microbiomics has not yet been a focus for research on

> mental illness. Yet, there are many clues linking microbiology and mental

> disorders, such as epidemiologic evidence of increased risk

> for schizophrenia associated with prenatal exposure to influenza. Probably

the

> most compelling case for such involvement is children who develop obsessive

> compulsive disorder (OCD) and/or tic disorders “overnight,†following a

strep

> infection. Despite continuing debate over its parameters, evidence is mounting

> in support of Pediatric Autoimmune Neuropsychiatric Disorders Associated with

> Streptococcal Infections (PANDAS) †" or at least a syndrome modeled on it.

> Last month, the NIMH Pediatric Developmental Neuroscience Branch convened

dozens

> of experts from the field †" including prominent PANDAS critics †" to update

the

> science and attempt to achieve consensus on criteria defining the syndrome.

The

> mere fact that the conference took place signals a change in the scientific

> climate. Until now, whether a child presenting with sudden onset of OCD and/or

> tic symptoms gets checked for possible involvement of strep has varied†" often

> depending on which medical journals a practitioner happens to read. I am

hopeful

> that will begin to change in light of the new evidence.

> Interest in PANDAS has also been spurred by an increasingly vocal network of

> affected families and the clinicians who are treating their often

> severely-impaired children. Conference participants heard reports from the

front

> lines by some of these clinicians, who largely corroborated key features of

the

> syndrome, originally identified by NIMH’s Dr. Swedo in the mid-l990s.

> These include sudden onset of mood swings, impulsivity, anxiety, impaired

> attention and poor handwriting in addition to obsessions, compulsions and

tics.

> Dr. Swedo’s studies have identified brain mechanisms through which

> strep antibodies act. They have also demonstrated that cleansing the blood

of

> the antibodies, via plasma exchange or intravenous immunoglobulin,

significantly

> diminishes the symptoms.

> Impetus for the July conference came, in part, from publication of two

> independent studies within the past year that lend new credence to the PANDAS

> concept.

> In the first, Columbia University researchers demonstrated, for the first

time,

> that strep-triggered antibodies alone are necessary and sufficient to trigger

a

> PANDAS-like syndrome in mice.4 In an autoimmune-disease susceptible strain of

> mice, exposure to strep triggered OCD-like repetitive behaviors and antibodies

> that attacked specific molecules in the brain. PANDAS-like behaviors also

> emerged in naïve mice after they received antibodies from such PANDAS mice.

> These included impaired learning and memory and social interaction. As in

humans

> with PANDAS, these impairments were more common in males than females.

> In the second study, a Yale University research team reported that OCD

> and Tourette Syndrome (tic) symptoms worsened slightly following a strep

> infection in some affected children. Moreover, the strep infection triggered

the

> worsened symptoms by increasing the impact of psycho-social stress.5 The

> findings suggest that a subset of children with these disorders may be at

> increased risk of strep infection, which could interact with stress to

> exacerbate the course, as is seen in other infectious and autoimmune diseases.

> Granted, these new findings are still preliminary and need to be replicated.

> However, the data relating to PANDAS is compelling enough to warrant following

> up such leads. NIMH is preparing to launch a new trial of intravenous

> immunoglobulin (IVIG) treatment for PANDAS this Fall, with support from a NIH

> Clinical Center “Bench to Bedsideâ€Â award. The intramural NIMH will

provide the

> clinical care, while data analysis will be carried out by independent teams of

> investigators at Yale University and the Oklahoma University Health Sciences

> Center. Dr. Swedo and her team are hoping to recruit 50 children with

clear-cut

> PANDAS. They are predicting that IVIG treatment will produce striking benefits

> for OCD and other neuropsychiatric symptoms, and will be most effective for

> those children who start out with the highest levels of strep-triggered

> antibodies that go astray and attack parts of the brain.

> Moreover, monoclonal antibodies derived from these patients will be used to

> develop animal models of OCD that could lead to improved treatments.

> Do infectious agents influence the development of autism, anxiety, or mood

> disorders? This remains a frontier area for NIMH research. The increasing

> evidence linking strep infection to OCD in children suggests that microbiomics

> may prove an important research area for understanding and treating mental

> disorders.

> References

> 1Bacterial community variation in human body habitats across space and time.

> Costello EK, Lauber CL, Hamady M, Fierer N, Gordon JI, Knight R.

> Science. 2009 Dec 18;326(5960):1694-7. Epub 2009 Nov 5.PMID: 19892944

> 2A core gut microbiome in obese and lean twins.

> Turnbaugh PJ, Hamady M, Yatsunenko T, Cantarel BL, Duncan A, Ley RE, Sogin ML,

> WJ, Roe BA, Affourtit JP, Egholm M, Henrissat B, Heath AC, Knight R,

> Gordon JI.

> Nature. 2009 Jan 22;457(7228):480-4. Epub 2008 Nov 30.PMID: 19043404

> 3Innate immunity and intestinal microbiota in the development of Type 1

> diabetes.

> Wen L, Ley RE, Volchkov PY, Stranges PB, Avanesyan L, Stonebraker AC, Hu C,

Wong

> FS, Szot GL, Bluestone JA, Gordon JI, Chervonsky AV.

> Nature. 2008 Oct 23;455(7216):1109-13. Epub 2008 Sep 21.PMID: 18806780

> 4Passive transfer of streptococcus-induced antibodies reproduces behavioral

> disturbances in a mouse model of pediatric autoimmune neuropsychiatric

disorders

> associated with streptococcal infection.

> Yaddanapudi K, Hornig M, Serge R, De Miranda J, Baghban A, Villar G, Lipkin

WI.

> Mol Psychiatry. 2010 Jul;15(7):712-26. Epub 2009 Aug 11.PMID: 19668249.

> 5Streptococcal upper respiratory tract infections and psychosocial stress

> predict future tic and obsessive-compulsive symptom severity in children and

> adolescents with Tourette syndrome and obsessive-compulsive disorder.

> Lin H, KA, Katsovich L, Findley DB, Grantz H, Lombroso PJ, King RA,

> Bessen DE, D, Kaplan EL, Landeros-Weisenberger A, Zhang H, Leckman JF.

> Biol Psychiatry. 2010 Apr 1;67(7):684-91. Epub 2009 Oct 14.PMID: 19833320.

>

>

>

>

>

>

>

[Guest guest]

Agreed! It is so interesting to me how we (as a society) assume that mental

illness is just a defect of character. Even when we have a much more convincing

scientific argument, most people look at this stuff from an almost Freudian

perspective... Which is ridiculous.

> >

> > Fascinating article. I find it interesting that they don't have a

corresponding

> > illness for adults. After all, these children do grow up. I had anxiety my

whole

> > life and OCD like behaviors that interfered with everyday functioning. When

> > tested by Dr. G a few years ago, my strep titers were almost 2,000.

> >

> > I hope they commit to this research. A lot of people are depending on it.

> >

> > All the best,

> >

> > Robyn

> >  

> >

> > ________________________________

> >

> > From: <thecolemans4@>

> > < >

> > Sent: Wed, August 18, 2010 8:04:02 PM

> > Subject: Microbes and Mental Illness: Insel PANDAS

> >

> >

> >

> > Microbes and Mental Illness

> > Posted by  Insel

> >

> > August 13, 2010

> >

http://www.nimh.nih.gov/about/director/2010/microbes-and-mental-illness.shtml

> >

> > Hints that some mental illness may be linked to infectious agents and/or

> > autoimmune processes date back to at least the early 20th Century. In the

21st

> > Century, the field of microbiomics, which is mapping the microbial

environment

> > of the human organism, may transform the way we think about human physical

and

> > mental development.1 It is already clear that 90% of “our DNA†is

microbial, not

> >

> > human. “We†are, in fact, “super-organisms†made up of thousands of

species,

> > many of which are being identified for the first time. And there are

persistent

> > individual differences in our microbial ecology established early in life.

> > Insights from microbiomics have proven important for understanding

obesity2 and

> > Type 1 diabetes,3 but microbiomics has not yet been a focus for research on

> > mental illness. Yet, there are many clues linking microbiology and mental

> > disorders, such as epidemiologic evidence of increased risk

> > for schizophrenia associated with prenatal exposure to influenza.

Probably the

> > most compelling case for such involvement is children who develop obsessive

> > compulsive disorder (OCD) and/or tic disorders “overnight,†following a

strep

> > infection. Despite continuing debate over its parameters, evidence is

mounting

> > in support of Pediatric Autoimmune Neuropsychiatric Disorders Associated

with

> > Streptococcal Infections (PANDAS) †" or at least a syndrome modeled on it.

> > Last month, the NIMH Pediatric Developmental Neuroscience Branch convened

dozens

> >

> > of experts from the field †" including prominent PANDAS critics †" to

update the

> > science and attempt to achieve consensus on criteria defining the syndrome.

The

> > mere fact that the conference took place signals a change in the scientific

> > climate. Until now, whether a child presenting with sudden onset of OCD

and/or

> > tic symptoms gets checked for possible involvement of strep has

varied†" often

> > depending on which medical journals a practitioner happens to read. I am

hopeful

> >

> > that will begin to change in light of the new evidence.

> > Interest in PANDAS has also been spurred by an increasingly vocal network of

> > affected families and the clinicians who are treating their often

> > severely-impaired children. Conference participants heard reports from the

front

> >

> > lines by some of these clinicians, who largely corroborated key features of

the

> > syndrome, originally identified by NIMH’s Dr. Swedo in the

mid-l990s.

> > These include sudden onset of mood swings, impulsivity, anxiety, impaired

> > attention and poor handwriting in addition to obsessions, compulsions and

tics.

> > Dr. Swedo’s studies have identified brain mechanisms through which

> > strep antibodies act. They have also demonstrated that cleansing the blood

of

> > the antibodies, via plasma exchange or intravenous immunoglobulin,

significantly

> >

> > diminishes the symptoms.

> > Impetus for the July conference came, in part, from publication of two

> > independent studies within the past year that lend new credence to the

PANDAS

> > concept.

> > In the first, Columbia University researchers demonstrated, for the first

time,

> > that strep-triggered antibodies alone are necessary and sufficient to

trigger a

> > PANDAS-like syndrome in mice.4 In an autoimmune-disease susceptible strain

of

> > mice, exposure to strep triggered OCD-like repetitive behaviors and

antibodies

> > that attacked specific molecules in the brain. PANDAS-like behaviors also

> > emerged in naïve mice after they received antibodies from such PANDAS mice.

> > These included impaired learning and memory and social interaction. As in

humans

> >

> > with PANDAS, these impairments were more common in males than females.

> > In the second study, a Yale University research team reported that OCD

> > and Tourette Syndrome (tic) symptoms worsened slightly following a strep

> > infection in some affected children. Moreover, the strep infection triggered

the

> >

> > worsened symptoms by increasing the impact of psycho-social stress.5 The

> > findings suggest that a subset of children with these disorders may be at

> > increased risk of strep infection, which could interact with stress to

> > exacerbate the course, as is seen in other infectious and autoimmune

diseases.

> > Granted, these new findings are still preliminary and need to be replicated.

> > However, the data relating to PANDAS is compelling enough to warrant

following

> > up such leads. NIMH is preparing to launch a new trial of intravenous

> > immunoglobulin (IVIG) treatment for PANDAS this Fall, with support from a

NIH

> > Clinical Center “Bench to Bedsideâ€Â award. The intramural NIMH will

provide the

> > clinical care, while data analysis will be carried out by independent teams

of

> > investigators at Yale University and the Oklahoma University Health Sciences

> > Center. Dr. Swedo and her team are hoping to recruit 50 children with

clear-cut

> > PANDAS. They are predicting that IVIG treatment will produce striking

benefits

> > for OCD and other neuropsychiatric symptoms, and will be most effective for

> > those children who start out with the highest levels of strep-triggered

> > antibodies that go astray and attack parts of the brain.

> > Moreover, monoclonal antibodies derived from these patients will be used

to

> > develop animal models of OCD that could lead to improved treatments.

> > Do infectious agents influence the development of autism, anxiety, or mood

> > disorders? This remains a frontier area for NIMH research. The increasing

> > evidence linking strep infection to OCD in children suggests that

microbiomics

> > may prove an important research area for understanding and treating mental

> > disorders.

> > References

> > 1Bacterial community variation in human body habitats across space and time.

> > Costello EK, Lauber CL, Hamady M, Fierer N, Gordon JI, Knight R.

> > Science. 2009 Dec 18;326(5960):1694-7. Epub 2009 Nov 5.PMID: 19892944

> > 2A core gut microbiome in obese and lean twins.

> > Turnbaugh PJ, Hamady M, Yatsunenko T, Cantarel BL, Duncan A, Ley RE, Sogin

ML,

> > WJ, Roe BA, Affourtit JP, Egholm M, Henrissat B, Heath AC, Knight R,

> > Gordon JI.

> > Nature. 2009 Jan 22;457(7228):480-4. Epub 2008 Nov 30.PMID: 19043404

> > 3Innate immunity and intestinal microbiota in the development of Type 1

> > diabetes.

> > Wen L, Ley RE, Volchkov PY, Stranges PB, Avanesyan L, Stonebraker AC, Hu C,

Wong

> >

> > FS, Szot GL, Bluestone JA, Gordon JI, Chervonsky AV.

> > Nature. 2008 Oct 23;455(7216):1109-13. Epub 2008 Sep 21.PMID: 18806780

> > 4Passive transfer of streptococcus-induced antibodies reproduces behavioral

> > disturbances in a mouse model of pediatric autoimmune neuropsychiatric

disorders

> >

> > associated with streptococcal infection.

> > Yaddanapudi K, Hornig M, Serge R, De Miranda J, Baghban A, Villar G, Lipkin

WI.

> > Mol Psychiatry. 2010 Jul;15(7):712-26. Epub 2009 Aug 11.PMID: 19668249.

> > 5Streptococcal upper respiratory tract infections and psychosocial stress

> > predict future tic and obsessive-compulsive symptom severity in children and

> > adolescents with Tourette syndrome and obsessive-compulsive disorder.

> > Lin H, KA, Katsovich L, Findley DB, Grantz H, Lombroso PJ, King RA,

> > Bessen DE, D, Kaplan EL, Landeros-Weisenberger A, Zhang H, Leckman

JF.

> > Biol Psychiatry. 2010 Apr 1;67(7):684-91. Epub 2009 Oct 14.PMID: 19833320.

> >

> >

[Guest guest]

Yes!

I had my first PANDAS episode in 4th grade in the mid 70s.  They had my mom

convinced that I was being molested.  That was quite traumatic for a 9 year old

w/intense onbsession and anxiety.

________________________________

From: Sloan <Sloan_smith@...>

Sent: Fri, August 20, 2010 12:23:15 AM

Subject: Re: Microbes and Mental Illness: Insel PANDAS

 

Agreed! It is so interesting to me how we (as a society) assume that mental

illness is just a defect of character. Even when we have a much more convincing

scientific argument, most people look at this stuff from an almost Freudian

perspective... Which is ridiculous.

> >

> > Fascinating article. I find it interesting that they don't have a

>corresponding

>

> > illness for adults. After all, these children do grow up. I had anxiety my

>whole

>

> > life and OCD like behaviors that interfered with everyday functioning. When

> > tested by Dr. G a few years ago, my strep titers were almost 2,000.

> >

> > I hope they commit to this research. A lot of people are depending on it.

> >

> > All the best,

> >

> > Robyn

> >  

> >

> > ________________________________

> >

> > From: <thecolemans4@>

> > < >

> > Sent: Wed, August 18, 2010 8:04:02 PM

> > Subject: Microbes and Mental Illness: Insel PANDAS

> >

> >

> >

> > Microbes and Mental Illness

> > Posted by  Insel

> >

> > August 13, 2010

> >

http://www.nimh.nih.gov/about/director/2010/microbes-and-mental-illness.shtml

> >

> > Hints that some mental illness may be linked to infectious agents and/or

> > autoimmune processes date back to at least the early 20th Century. In the

>21st

>

> > Century, the field of microbiomics, which is mapping the microbial

>environment

>

> > of the human organism, may transform the way we think about human physical

>and

>

> > mental development.1 It is already clear that 90% of “our

DNA� is

>microbial, not

>

> >

> > human. “We� are, in fact, “super-organisms� made

up of thousands of

>species,

>

> > many of which are being identified for the first time. And there are

>persistent

>

> > individual differences in our microbial ecology established early in life.

> > Insights from microbiomics have proven important for understanding

>obesity2 and

>

> > Type 1 diabetes,3 but microbiomics has not yet been a focus for research

on

> > mental illness. Yet, there are many clues linking microbiology and mental

> > disorders, such as epidemiologic evidence of increased risk

> > for schizophrenia associated with prenatal exposure to influenza.

Probably

>the

>

> > most compelling case for such involvement is children who

develop obsessive

> > compulsive disorder (OCD) and/or tic disorders “overnight,�

following a

>strep

>

> > infection. Despite continuing debate over its parameters, evidence is

>mounting

>

> > in support of Pediatric Autoimmune Neuropsychiatric Disorders Associated

>with

>

> > Streptococcal Infections (PANDAS) †" or at least a syndrome modeled

on it.

> > Last month, the NIMH Pediatric Developmental Neuroscience

Branch convened

>dozens

>

> >

> > of experts from the field †" including prominent PANDAS critics †"

to

>update the

>

> > science and attempt to achieve consensus on criteria defining the syndrome.

>The

>

> > mere fact that the conference took place signals a change in the scientific

> > climate. Until now, whether a child presenting with sudden onset of OCD

>and/or

>

> > tic symptoms gets checked for possible involvement of strep has

>varied†" often

>

> > depending on which medical journals a practitioner happens to read. I am

>hopeful

>

> >

> > that will begin to change in light of the new evidence.

> > Interest in PANDAS has also been spurred by an increasingly vocal network of

> > affected families and the clinicians who are treating their often

> > severely-impaired children. Conference participants heard reports from the

>front

>

> >

> > lines by some of these clinicians, who largely corroborated key features of

>the

>

> > syndrome, originally identified by NIMH’s Dr. Swedo in the

mid-l990s.

>

> > These include sudden onset of mood swings, impulsivity, anxiety, impaired

> > attention and poor handwriting in addition to obsessions, compulsions and

>tics.

>

> > Dr. Swedo’s studies have identified brain mechanisms through

which

> > strep antibodies act. They have also demonstrated that cleansing the

blood

>of

>

> > the antibodies, via plasma exchange or intravenous immunoglobulin,

>significantly

>

> >

> > diminishes the symptoms.

> > Impetus for the July conference came, in part, from publication of two

> > independent studies within the past year that lend new credence to the

PANDAS

>

> > concept.

> > In the first, Columbia University researchers demonstrated, for the first

>time,

>

> > that strep-triggered antibodies alone are necessary and sufficient to

trigger

>a

>

> > PANDAS-like syndrome in mice.4 In an autoimmune-disease susceptible

strain

>of

>

> > mice, exposure to strep triggered OCD-like repetitive behaviors and

>antibodies

>

> > that attacked specific molecules in the brain. PANDAS-like behaviors also

> > emerged in naïve mice after they received antibodies from such PANDAS

mice.

> > These included impaired learning and memory and social interaction. As in

>humans

>

> >

> > with PANDAS, these impairments were more common in males than females.

> > In the second study, a Yale University research team reported that OCD

> > and Tourette Syndrome (tic) symptoms worsened slightly following a

strep

> > infection in some affected children. Moreover, the strep infection triggered

>the

>

> >

> > worsened symptoms by increasing the impact of psycho-social stress.5 The

> > findings suggest that a subset of children with these disorders may be at

> > increased risk of strep infection, which could interact with stress to

> > exacerbate the course, as is seen in other infectious and autoimmune

>diseases.

> > Granted, these new findings are still preliminary and need to be replicated.

> > However, the data relating to PANDAS is compelling enough to warrant

>following

>

> > up such leads. NIMH is preparing to launch a new trial of intravenous

> > immunoglobulin (IVIG) treatment for PANDAS this Fall, with support from a

NIH

>

> > Clinical Center “Bench to Bedside� award. The intramural

NIMH will

>provide the

>

> > clinical care, while data analysis will be carried out by independent teams

>of

>

> > investigators at Yale University and the Oklahoma University Health Sciences

> > Center. Dr. Swedo and her team are hoping to recruit 50 children with

>clear-cut

>

> > PANDAS. They are predicting that IVIG treatment will produce striking

>benefits

>

> > for OCD and other neuropsychiatric symptoms, and will be most effective for

> > those children who start out with the highest levels of strep-triggered

> > antibodies that go astray and attack parts of the brain.

> > Moreover, monoclonal antibodies derived from these patients will be

used to

>

> > develop animal models of OCD that could lead to improved treatments.

> > Do infectious agents influence the development of autism, anxiety, or mood

> > disorders? This remains a frontier area for NIMH research. The increasing

> > evidence linking strep infection to OCD in children suggests that

>microbiomics

>

> > may prove an important research area for understanding and treating mental

> > disorders.

> > References

> > 1Bacterial community variation in human body habitats across space and time.

> > Costello EK, Lauber CL, Hamady M, Fierer N, Gordon JI, Knight R.

> > Science. 2009 Dec 18;326(5960):1694-7. Epub 2009 Nov 5.PMID: 19892944

> > 2A core gut microbiome in obese and lean twins.

> > Turnbaugh PJ, Hamady M, Yatsunenko T, Cantarel BL, Duncan A, Ley RE, Sogin

>ML,

>

> > WJ, Roe BA, Affourtit JP, Egholm M, Henrissat B, Heath AC, Knight R,

> > Gordon JI.

> > Nature. 2009 Jan 22;457(7228):480-4. Epub 2008 Nov 30.PMID: 19043404

> > 3Innate immunity and intestinal microbiota in the development of Type 1

> > diabetes.

> > Wen L, Ley RE, Volchkov PY, Stranges PB, Avanesyan L, Stonebraker AC, Hu C,

>Wong

>

> >

> > FS, Szot GL, Bluestone JA, Gordon JI, Chervonsky AV.

> > Nature. 2008 Oct 23;455(7216):1109-13. Epub 2008 Sep 21.PMID: 18806780

> > 4Passive transfer of streptococcus-induced antibodies reproduces behavioral

> > disturbances in a mouse model of pediatric autoimmune neuropsychiatric

>disorders

>

> >

> > associated with streptococcal infection.

> > Yaddanapudi K, Hornig M, Serge R, De Miranda J, Baghban A, Villar G, Lipkin

>WI.

> > Mol Psychiatry. 2010 Jul;15(7):712-26. Epub 2009 Aug 11.PMID: 19668249.

> > 5Streptococcal upper respiratory tract infections and psychosocial stress

> > predict future tic and obsessive-compulsive symptom severity in children and

> > adolescents with Tourette syndrome and obsessive-compulsive disorder.

> > Lin H, KA, Katsovich L, Findley DB, Grantz H, Lombroso PJ, King RA,

> > Bessen DE, D, Kaplan EL, Landeros-Weisenberger A, Zhang H, Leckman

>JF.

> > Biol Psychiatry. 2010 Apr 1;67(7):684-91. Epub 2009 Oct 14.PMID: 19833320.

> >

> >

[Guest guest]

My son is currently on zithromax (500mg, 1 per week) for PANDAS and is taking a

low-dose ssri. Is it alright to take ssri with zithromax for PANDAS?

From: [mailto: ] On Behalf Of

Sent: August-20-10 9:44 AM

Subject: Re: Re: Microbes and Mental Illness: Insel PANDAS

Yes!

I had my first PANDAS episode in 4th grade in the mid 70s. They had my mom

convinced that I was being molested. That was quite traumatic for a 9 year old

w/intense onbsession and anxiety.

________________________________

From: Sloan <Sloan_smith@... <mailto:Sloan_smith%40> >

<mailto:%40>

Sent: Fri, August 20, 2010 12:23:15 AM

Subject: Re: Microbes and Mental Illness: Insel PANDAS

Agreed! It is so interesting to me how we (as a society) assume that mental

illness is just a defect of character. Even when we have a much more convincing

scientific argument, most people look at this stuff from an almost Freudian

perspective... Which is ridiculous.

> >

> > Fascinating article. I find it interesting that they don't have a

>corresponding

>

> > illness for adults. After all, these children do grow up. I had anxiety my

>whole

>

> > life and OCD like behaviors that interfered with everyday functioning. When

> > tested by Dr. G a few years ago, my strep titers were almost 2,000.

> >

> > I hope they commit to this research. A lot of people are depending on it.

> >

> > All the best,

> >

> > Robyn

> > Â

> >

> > ________________________________

> >

> > From: <thecolemans4@>

> > < <mailto:%40> >

> > Sent: Wed, August 18, 2010 8:04:02 PM

> > Subject: Microbes and Mental Illness: Insel PANDAS

> >

> >

> >

> > Microbes and Mental Illness

> > Posted by Insel

> >

> > August 13, 2010

> >

http://www.nimh.nih.gov/about/director/2010/microbes-and-mental-illness.shtml

> >

> > Hints that some mental illness may be linked to infectious agents and/or

> > autoimmune processes date back to at least the early 20th Century. In the

>21st

>

> > Century, the field of microbiomics, which is mapping the microbial

>environment

>

> > of the human organism, may transform the way we think about human physical

>and

>

> > mental development.1 It is already clear that 90% of “our

DNA� is

>microbial, not

>

> >

> > human. “We� are, in fact, “super-organisms� made

up of thousands of

>species,

>

> > many of which are being identified for the first time. And there are

>persistent

>

> > individual differences in our microbial ecology established early in life.

> > Insights from microbiomics have proven important for understanding

>obesity2Â and

>

> > Type 1 diabetes,3Â but microbiomics has not yet been a focus for research

on

> > mental illness. Yet, there are many clues linking microbiology and mental

> > disorders, such as epidemiologic evidence of increased risk

> > for schizophrenia associated with prenatal exposure to influenza.

Probably

>the

>

> > most compelling case for such involvement is children who developÂ

obsessive

> > compulsive disorder (OCD) and/or tic disorders “overnight,�

following a

>strep

>

> > infection. Despite continuing debate over its parameters, evidence is

>mounting

>

> > in support of Pediatric Autoimmune Neuropsychiatric Disorders Associated

>with

>

> > Streptococcal Infections (PANDAS) †" or at least a syndrome modeled on

it.

> > Last month, the NIMH Pediatric Developmental Neuroscience BranchÂ

convened

>dozens

>

> >

> > of experts from the field †" including prominent PANDAS critics †"

to

>update the

>

> > science and attempt to achieve consensus on criteria defining the syndrome.

>The

>

> > mere fact that the conference took place signals a change in the scientific

> > climate. Until now, whether a child presenting with sudden onset of OCD

>and/or

>

> > tic symptoms gets checked for possible involvement of strep has

>varied†" often

>

> > depending on which medical journals a practitioner happens to read. I am

>hopeful

>

> >

> > that will begin to change in light of the new evidence.

> > Interest in PANDAS has also been spurred by an increasingly vocal network of

> > affected families and the clinicians who are treating their often

> > severely-impaired children. Conference participants heard reports from the

>front

>

> >

> > lines by some of these clinicians, who largely corroborated key features of

>the

>

> > syndrome, originally identified by NIMH’s Dr. Swedo in the

mid-l990s.

>

> > These include sudden onset of mood swings, impulsivity, anxiety, impaired

> > attention and poor handwriting in addition to obsessions, compulsions and

>tics.

>

> > Dr. Swedo’s studies have identified brain mechanisms through

which

> > strep antibodies act. They have also demonstrated that cleansing the

blood

>of

>

> > the antibodies, via plasma exchange or intravenous immunoglobulin,

>significantly

>

> >

> > diminishes the symptoms.

> > Impetus for the July conference came, in part, from publication of two

> > independent studies within the past year that lend new credence to the

PANDAS

>

> > concept.

> > In the first, Columbia University researchers demonstrated, for the first

>time,

>

> > that strep-triggered antibodies alone are necessary and sufficient to

trigger

>a

>

> > PANDAS-like syndrome in mice.4Â In an autoimmune-disease susceptible strain

>of

>

> > mice, exposure to strep triggered OCD-like repetitive behaviors and

>antibodies

>

> > that attacked specific molecules in the brain. PANDAS-like behaviors also

> > emerged in naïve mice after they received antibodies from such PANDAS

mice.

> > These included impaired learning and memory and social interaction. As in

>humans

>

> >

> > with PANDAS, these impairments were more common in males than females.

> > In the second study, a Yale University research team reported that OCD

> > and Tourette Syndrome (tic) symptoms worsened slightly following a strep

> > infection in some affected children. Moreover, the strep infection triggered

>the

>

> >

> > worsened symptoms by increasing the impact of psycho-social stress.5Â The

> > findings suggest that a subset of children with these disorders may be at

> > increased risk of strep infection, which could interact with stress to

> > exacerbate the course, as is seen in other infectious and autoimmune

>diseases.

> > Granted, these new findings are still preliminary and need to be replicated.

> > However, the data relating to PANDAS is compelling enough to warrant

>following

>

> > up such leads. NIMH is preparing to launch a new trial of intravenous

> > immunoglobulin (IVIG) treatment for PANDAS this Fall, with support from a

NIH

>

> > Clinical Center “Bench to Bedside� award. The intramural

NIMH will

>provide the

>

> > clinical care, while data analysis will be carried out by independent teams

>of

>

> > investigators at Yale University and the Oklahoma University Health Sciences

> > Center. Dr. Swedo and her team are hoping to recruit 50 children with

>clear-cut

>

> > PANDAS. They are predicting that IVIG treatment will produce striking

>benefits

>

> > for OCD and other neuropsychiatric symptoms, and will be most effective for

> > those children who start out with the highest levels of strep-triggered

> > antibodies that go astray and attack parts of the brain.

> > Moreover, monoclonal antibodies derived from these patients will be used

to

>

> > develop animal models of OCD that could lead to improved treatments.

> > Do infectious agents influence the development of autism, anxiety, or mood

> > disorders? This remains a frontier area for NIMH research. The increasing

> > evidence linking strep infection to OCD in children suggests that

>microbiomics

>

> > may prove an important research area for understanding and treating mental

> > disorders.

> > References

> > 1Bacterial community variation in human body habitats across space and time.

> > Costello EK, Lauber CL, Hamady M, Fierer N, Gordon JI, Knight R.

> > Science. 2009 Dec 18;326(5960):1694-7. Epub 2009 Nov 5.PMID: 19892944

> > 2A core gut microbiome in obese and lean twins.

> > Turnbaugh PJ, Hamady M, Yatsunenko T, Cantarel BL, Duncan A, Ley RE, Sogin

>ML,

>

> > WJ, Roe BA, Affourtit JP, Egholm M, Henrissat B, Heath AC, Knight R,

> > Gordon JI.

> > Nature. 2009 Jan 22;457(7228):480-4. Epub 2008 Nov 30.PMID: 19043404

> > 3Innate immunity and intestinal microbiota in the development of Type 1

> > diabetes.

> > Wen L, Ley RE, Volchkov PY, Stranges PB, Avanesyan L, Stonebraker AC, Hu C,

>Wong

>

> >

> > FS, Szot GL, Bluestone JA, Gordon JI, Chervonsky AV.

> > Nature. 2008 Oct 23;455(7216):1109-13. Epub 2008 Sep 21.PMID: 18806780

> > 4Passive transfer of streptococcus-induced antibodies reproduces behavioral

> > disturbances in a mouse model of pediatric autoimmune neuropsychiatric

>disorders

>

> >

> > associated with streptococcal infection.

> > Yaddanapudi K, Hornig M, Serge R, De Miranda J, Baghban A, Villar G, Lipkin

>WI.

> > Mol Psychiatry. 2010 Jul;15(7):712-26. Epub 2009 Aug 11.PMID: 19668249.

> > 5Streptococcal upper respiratory tract infections and psychosocial stress

> > predict future tic and obsessive-compulsive symptom severity in children and

> > adolescents with Tourette syndrome and obsessive-compulsive disorder.

> > Lin H, KA, Katsovich L, Findley DB, Grantz H, Lombroso PJ, King RA,

> > Bessen DE, D, Kaplan EL, Landeros-Weisenberger A, Zhang H, Leckman

>JF.

> > Biol Psychiatry. 2010 Apr 1;67(7):684-91. Epub 2009 Oct 14.PMID: 19833320.

> >

> >

[Guest guest]

,

I can't answer your question, but I use www.drugs.com  when my son has to take

more than 1 medication.

There's a tab called " Interactions Checker " and of course it's only a guideline,

not a Dr.  But

you are able to type in several medications and you get a list of any known

interactions and a list of other meds it may

interact with.  There's a quick guide and a detail.

HTH,

Velma

  

________________________________

From: and Freeman <freemanbk@...>

Sent: Fri, August 20, 2010 5:46:28 PM

Subject: RE: Re: Microbes and Mental Illness: Insel PANDAS

 

My son is currently on zithromax (500mg, 1 per week) for PANDAS and is taking a

low-dose ssri. Is it alright to take ssri with zithromax for PANDAS?

From: [mailto: ] On Behalf Of

Sent: August-20-10 9:44 AM

Subject: Re: Re: Microbes and Mental Illness: Insel PANDAS

Yes!

I had my first PANDAS episode in 4th grade in the mid 70s. They had my mom

convinced that I was being molested. That was quite traumatic for a 9 year old

w/intense onbsession and anxiety.

________________________________

From: Sloan <Sloan_smith@... <mailto:Sloan_smith%40> >

<mailto:%40>

Sent: Fri, August 20, 2010 12:23:15 AM

Subject: Re: Microbes and Mental Illness: Insel PANDAS

Agreed! It is so interesting to me how we (as a society) assume that mental

illness is just a defect of character. Even when we have a much more convincing

scientific argument, most people look at this stuff from an almost Freudian

perspective... Which is ridiculous.

> >

> > Fascinating article. I find it interesting that they don't have a

>corresponding

>

> > illness for adults. After all, these children do grow up. I had anxiety my

>whole

>

> > life and OCD like behaviors that interfered with everyday functioning. When

> > tested by Dr. G a few years ago, my strep titers were almost 2,000.

> >

> > I hope they commit to this research. A lot of people are depending on it.

> >

> > All the best,

> >

> > Robyn

> > Â

> >

> > ________________________________

> >

> > From: <thecolemans4@>

> > < <mailto:%40> >

> > Sent: Wed, August 18, 2010 8:04:02 PM

> > Subject: Microbes and Mental Illness: Insel PANDAS

> >

> >

> >

> > Microbes and Mental Illness

> > Posted by Insel

> >

> > August 13, 2010

> >

http://www.nimh.nih.gov/about/director/2010/microbes-and-mental-illness.shtml

> >

> > Hints that some mental illness may be linked to infectious agents and/or

> > autoimmune processes date back to at least the early 20th Century. In the

>21st

>

> > Century, the field of microbiomics, which is mapping the microbial

>environment

>

> > of the human organism, may transform the way we think about human physical

>and

>

> > mental development.1 It is already clear that 90% of “our

DNA� is

>microbial, not

>

> >

> > human. “We� are, in fact, “super-organisms� made

up of thousands of

>species,

>

> > many of which are being identified for the first time. And there are

>persistent

>

> > individual differences in our microbial ecology established early in life.

> > Insights from microbiomics have proven important for understanding

>obesity2Â and

>

> > Type 1 diabetes,3Â but microbiomics has not yet been a focus for research

on

> > mental illness. Yet, there are many clues linking microbiology and mental

> > disorders, such as epidemiologic evidence of increased risk

> > for schizophrenia associated with prenatal exposure to influenza.

Probably

>

>the

>

> > most compelling case for such involvement is children who developÂ

obsessive

> > compulsive disorder (OCD) and/or tic disorders “overnight,�

following a

>strep

>

> > infection. Despite continuing debate over its parameters, evidence is

>mounting

>

> > in support of Pediatric Autoimmune Neuropsychiatric Disorders Associated

>with

>

> > Streptococcal Infections (PANDAS) †" or at least a syndrome modeled on

it.

> > Last month, the NIMH Pediatric Developmental Neuroscience BranchÂ

convened

>dozens

>

> >

> > of experts from the field †" including prominent PANDAS critics †"

to

>update the

>

> > science and attempt to achieve consensus on criteria defining the syndrome.

>The

>

> > mere fact that the conference took place signals a change in the scientific

> > climate. Until now, whether a child presenting with sudden onset of OCD

>and/or

>

> > tic symptoms gets checked for possible involvement of strep has

>varied†" often

>

> > depending on which medical journals a practitioner happens to read. I am

>hopeful

>

> >

> > that will begin to change in light of the new evidence.

> > Interest in PANDAS has also been spurred by an increasingly vocal network of

> > affected families and the clinicians who are treating their often

> > severely-impaired children. Conference participants heard reports from the

>front

>

> >

> > lines by some of these clinicians, who largely corroborated key features of

>the

>

> > syndrome, originally identified by NIMH’s Dr. Swedo in the

mid-l990s.

>

>

> > These include sudden onset of mood swings, impulsivity, anxiety, impaired

> > attention and poor handwriting in addition to obsessions, compulsions and

>tics.

>

> > Dr. Swedo’s studies have identified brain mechanisms through

which

> > strep antibodies act. They have also demonstrated that cleansing the

blood

>of

>

> > the antibodies, via plasma exchange or intravenous immunoglobulin,

>significantly

>

> >

> > diminishes the symptoms.

> > Impetus for the July conference came, in part, from publication of two

> > independent studies within the past year that lend new credence to the

PANDAS

>

>

> > concept.

> > In the first, Columbia University researchers demonstrated, for the first

>time,

>

> > that strep-triggered antibodies alone are necessary and sufficient to

trigger

>

>a

>

> > PANDAS-like syndrome in mice.4Â In an autoimmune-disease susceptible strain

>of

>

> > mice, exposure to strep triggered OCD-like repetitive behaviors and

>antibodies

>

> > that attacked specific molecules in the brain. PANDAS-like behaviors also

> > emerged in naïve mice after they received antibodies from such PANDAS

mice.

> > These included impaired learning and memory and social interaction. As in

>humans

>

> >

> > with PANDAS, these impairments were more common in males than females.

> > In the second study, a Yale University research team reported that OCD

> > and Tourette Syndrome (tic) symptoms worsened slightly following a strep

> > infection in some affected children. Moreover, the strep infection triggered

>the

>

> >

> > worsened symptoms by increasing the impact of psycho-social stress.5Â The

> > findings suggest that a subset of children with these disorders may be at

> > increased risk of strep infection, which could interact with stress to

> > exacerbate the course, as is seen in other infectious and autoimmune

>diseases.

> > Granted, these new findings are still preliminary and need to be replicated.

> > However, the data relating to PANDAS is compelling enough to warrant

>following

>

> > up such leads. NIMH is preparing to launch a new trial of intravenous

> > immunoglobulin (IVIG) treatment for PANDAS this Fall, with support from a

NIH

>

>

> > Clinical Center “Bench to Bedside� award. The intramural

NIMH will

>provide the

>

> > clinical care, while data analysis will be carried out by independent teams

>of

>

> > investigators at Yale University and the Oklahoma University Health Sciences

> > Center. Dr. Swedo and her team are hoping to recruit 50 children with

>clear-cut

>

> > PANDAS. They are predicting that IVIG treatment will produce striking

>benefits

>

> > for OCD and other neuropsychiatric symptoms, and will be most effective for

> > those children who start out with the highest levels of strep-triggered

> > antibodies that go astray and attack parts of the brain.

> > Moreover, monoclonal antibodies derived from these patients will be used

to

>

>

> > develop animal models of OCD that could lead to improved treatments.

> > Do infectious agents influence the development of autism, anxiety, or mood

> > disorders? This remains a frontier area for NIMH research. The increasing

> > evidence linking strep infection to OCD in children suggests that

>microbiomics

>

> > may prove an important research area for understanding and treating mental

> > disorders.

> > References

> > 1Bacterial community variation in human body habitats across space and time.

> > Costello EK, Lauber CL, Hamady M, Fierer N, Gordon JI, Knight R.

> > Science. 2009 Dec 18;326(5960):1694-7. Epub 2009 Nov 5.PMID: 19892944

> > 2A core gut microbiome in obese and lean twins.

> > Turnbaugh PJ, Hamady M, Yatsunenko T, Cantarel BL, Duncan A, Ley RE, Sogin

>ML,

>

> > WJ, Roe BA, Affourtit JP, Egholm M, Henrissat B, Heath AC, Knight R,

> > Gordon JI.

> > Nature. 2009 Jan 22;457(7228):480-4. Epub 2008 Nov 30.PMID: 19043404

> > 3Innate immunity and intestinal microbiota in the development of Type 1

> > diabetes.

> > Wen L, Ley RE, Volchkov PY, Stranges PB, Avanesyan L, Stonebraker AC, Hu C,

>Wong

>

> >

> > FS, Szot GL, Bluestone JA, Gordon JI, Chervonsky AV.

> > Nature. 2008 Oct 23;455(7216):1109-13. Epub 2008 Sep 21.PMID: 18806780

> > 4Passive transfer of streptococcus-induced antibodies reproduces behavioral

> > disturbances in a mouse model of pediatric autoimmune neuropsychiatric

>disorders

>

> >

> > associated with streptococcal infection.

> > Yaddanapudi K, Hornig M, Serge R, De Miranda J, Baghban A, Villar G, Lipkin

>WI.

> > Mol Psychiatry. 2010 Jul;15(7):712-26. Epub 2009 Aug 11.PMID: 19668249.

> > 5Streptococcal upper respiratory tract infections and psychosocial stress

> > predict future tic and obsessive-compulsive symptom severity in children and

> > adolescents with Tourette syndrome and obsessive-compulsive disorder.

> > Lin H, KA, Katsovich L, Findley DB, Grantz H, Lombroso PJ, King RA,

> > Bessen DE, D, Kaplan EL, Landeros-Weisenberger A, Zhang H, Leckman

>JF.

> > Biol Psychiatry. 2010 Apr 1;67(7):684-91. Epub 2009 Oct 14.PMID: 19833320.

> >

> >

[Guest guest]

Hi,

Zithromycin can help with PANDAS.  It is not typically the primary antibiotic

of

choice with Dr Goldberg.  I'm not sure which Dr leans toward, but he is

giving me Doxycycline for PANDAS - that one particularly helps me plus my

fatigue.  It makes a bigger difference in my anxiety and my cognitive function

than others do.  I also do not do as well without an antifungal.  The two

together are the most effective.

One thing I didn't like about zithromycin is that it makes me " sparky " - makes

my brain flicker so badly that I can't function.  I've tried it enough times

(before I got settled on doxy) to know that it is the zithro and not a

coincidence.  It also makes my anxiety increase.  I don't know if it does

everyone, but it is something to watch for.  Zithromycin increases one of the

THs (TH1?) as part of it's function, and it's already too high in some. 

Sometimes it can be increasing it, but you see so much so much other improvement

that it goes unnoticed (which is probably fine).  I just don't think it's best,

but if that's what you get from the doctor and what he's comfortable with, and

you're not seeing bad anxiety or flickering mind, then don't worry about it.

Dr G's choices start with erythromycin - one of the safest long-term

antibiotics.  If that doesn't go well, he switches to Ery-Ped - it is a little

easier on the stomach.  I think it contains sulfa (? you'd want to verify) so

if

you're sensitive to that, it's a no.  But it often does a little better than

erythromycin for some - not all, so you start with the first and only move on if

not getting results or not tolerating it.  Others he used for us (there were

sinus problems too and the ery's weren't being tolerated well nor effective for

the sinus) were bactrum - which I can't take at all but both kids seemed to do

well on. 

For older kids, sometimes doxycycline can be very wow.  My son doesn't have

PANDAS (although he does get anxiety and OCD when he has strep but fortunately

it goes away as soon as treated - so far that is), but he was (is?) having a lot

of brain fog and complaining of not being able to think, and it seemed so

similar to what I feel sometimes that Dr decided to try a lower dose of

doxycycline with him too.  It made an immediate improvement - my son came home

(not knowing anything about the antibiotic - he just takes his pills) from

school and said " I had a great day today Mom! My brain actually worked!! "   

But

it also made him very nauseous and he didn't make it past 3 days, and it went

right back to where he had been.  Other antibiotics did not have the same

impact.  I hope we can try it again later but nausea is intolerable to him, and

it afflicts him easily.  Anyway, I don't know of Dr G or Dr R using that one

regularly - maybe because most of the kids are too young for it - you need to be

9 or so and have all your teeth in.  But I'm a big believer in it and if your

kid is old enough, I would suggest asking for it.  But although it says to take

it without food, take it with food!  And don't take it long-term if you don't

have an antifungal to complement it - no way could someone prone to yeast

tolerate it without in my opinion.

No matter what antibiotic you have, as long as you're seeing the ASO titers go

down, you're making progress.  You don't always see an immediate change, but

you

should see some reduction.  It's going to take time for all the symptoms to

diminish.  I've been on and off doxycycline 3+ years, but only a little over a

year the right way w/Dr giving it long-term at the right dose along with

an antifungal.  Only in the past few months have I started to feel like I've

gotten over it (mostly).  So I started backing off to once a day w/doxycycline,

but my ASO went back up to 700.  However, I've usually been able to tell if my

titers were going up or down by my symptoms, and this time I could have sworn

they had gone down below 500 or less, so I was surprised to find that they had

gone up.  But my iron stores did go down - as my ASO goes up, my iron goes

down.

One other thing sometimes overlooked - probiotics can aggrevate probiotics.  L

bacillus is bad for me, and acidophilus will bother it too.  I don't remember

about kyodophilus.  But ABSOLUTELY avoid culturelle at all costs - or any

probiotic w/ l. rhamuses.  It specifically triggers some cytokines (a positive

in some illnesses like Crohn's or Ulcerative colitis) that are bad news in

PANDAS.

HTH  - sorry so long.

________________________________

From: and Freeman <freemanbk@...>

Sent: Thu, August 19, 2010 8:19:15 AM

Subject: RE: Microbes and Mental Illness: Insel PANDAS

 

My son is now on 500 mg of zithromycin/week as our dr is treating him for

PANDAS. Is this antibiotic helpful for PANDAS? What does Dr. G and Dr.

recommend? Thank you.

From: [mailto: ] On Behalf Of

Sent: August-19-10 9:49 AM

Subject: Re: Microbes and Mental Illness: Insel PANDAS

Hey

I have PANDAS but I'm 41. I did have my first episode at age 9 though, so I

don't if they continue thru life I assume it's still pediatric onset. They

don't really have it defined for adults.

Dr is treating me by the protocol. NOT IVIG, not plasma exchange.

There are significant issues possible with both treatments if you look at

as a whole.

I'll give more info later if needed (time) but I've benefited a lot over the

last year. Time is a necessary factor, as well as antibiotics AND antifungals.

The type of antibiotic matters too.

More later,

________________________________

From: " erikadyan71@... <mailto:erikadyan71%40> "

<erikadyan71@... <mailto:erikadyan71%40> >

<mailto:%40>

Sent: Wed, August 18, 2010 10:51:47 PM

Subject: Re: Microbes and Mental Illness: Insel PANDAS

This is some very interesting information!

Is anyone having their child treated for PANDAS by Dr Goldberg or Dr ? I

am curious to know if they treat it the same way, with IVIG or plasma exchange?

And, their success rate!

Thanks.

-

Sent on the Sprint® Now Network from my BlackBerry®

Microbes and Mental Illness: Insel PANDAS

Microbes and Mental Illness

Posted by Insel

August 13, 2010

http://www.nimh.nih.gov/about/director/2010/microbes-and-mental-illness.shtml

Hints that some mental illness may be linked to infectious agents and/or

autoimmune processes date back to at least the early 20th Century. In the 21st

Century, the field of microbiomics, which is mapping the microbial environment

of the human organism, may transform the way we think about human physical and

mental development.1 It is already clear that 90% of “our DNA†is microbial,

not

human. “We†are, in fact, “super-organisms†made up of thousands of

species,

many of which are being identified for the first time. And there are persistent

individual differences in our microbial ecology established early in life.

Insights from microbiomics have proven important for understanding obesity2 and

Type 1 diabetes,3 but microbiomics has not yet been a focus for research on

mental illness. Yet, there are many clues linking microbiology and mental

disorders, such as epidemiologic evidence of increased risk

for schizophrenia associated with prenatal exposure to influenza. Probably the

most compelling case for such involvement is children who develop obsessive

compulsive disorder (OCD) and/or tic disorders “overnight,†following a

strep

infection. Despite continuing debate over its parameters, evidence is mounting

in support of Pediatric Autoimmune Neuropsychiatric Disorders Associated with

Streptococcal Infections (PANDAS) — or at least a syndrome modeled on it.

Last month, the NIMH Pediatric Developmental Neuroscience Branch convened dozens

of experts from the field — including prominent PANDAS critics — to update

the

science and attempt to achieve consensus on criteria defining the syndrome. The

mere fact that the conference took place signals a change in the scientific

climate. Until now, whether a child presenting with sudden onset of OCD and/or

tic symptoms gets checked for possible involvement of strep has varied—often

depending on which medical journals a practitioner happens to read. I am hopeful

that will begin to change in light of the new evidence.

Interest in PANDAS has also been spurred by an increasingly vocal network of

affected families and the clinicians who are treating their often

severely-impaired children. Conference participants heard reports from the front

lines by some of these clinicians, who largely corroborated key features of the

syndrome, originally identified by NIMH’s Dr. Swedo in the mid-l990s.

These include sudden onset of mood swings, impulsivity, anxiety, impaired

attention and poor handwriting in addition to obsessions, compulsions and tics.

Dr. Swedo’s studies have identified brain mechanisms through which

strep antibodies act. They have also demonstrated that cleansing the blood of

the antibodies, via plasma exchange or intravenous immunoglobulin, significantly

diminishes the symptoms.

Impetus for the July conference came, in part, from publication of two

independent studies within the past year that lend new credence to the PANDAS

concept.

In the first, Columbia University researchers demonstrated, for the first time,

that strep-triggered antibodies alone are necessary and sufficient to trigger a

PANDAS-like syndrome in mice.4 In an autoimmune-disease susceptible strain of

mice, exposure to strep triggered OCD-like repetitive behaviors and antibodies

that attacked specific molecules in the brain. PANDAS-like behaviors also

emerged in naïve mice after they received antibodies from such PANDAS mice.

These included impaired learning and memory and social interaction. As in humans

with PANDAS, these impairments were more common in males than females.

In the second study, a Yale University research team reported that OCD

and Tourette Syndrome (tic) symptoms worsened slightly following a strep

infection in some affected children. Moreover, the strep infection triggered the

worsened symptoms by increasing the impact of psycho-social stress.5 The

findings suggest that a subset of children with these disorders may be at

increased risk of strep infection, which could interact with stress to

exacerbate the course, as is seen in other infectious and autoimmune diseases.

Granted, these new findings are still preliminary and need to be replicated.

However, the data relating to PANDAS is compelling enough to warrant following

up such leads. NIMH is preparing to launch a new trial of intravenous

immunoglobulin (IVIG) treatment for PANDAS this Fall, with support from a NIH

Clinical Center “Bench to Bedside†award. The intramural NIMH will provide

the

clinical care, while data analysis will be carried out by independent teams of

investigators at Yale University and the Oklahoma University Health Sciences

Center. Dr. Swedo and her team are hoping to recruit 50 children with clear-cut

PANDAS. They are predicting that IVIG treatment will produce striking benefits

for OCD and other neuropsychiatric symptoms, and will be most effective for

those children who start out with the highest levels of strep-triggered

antibodies that go astray and attack parts of the brain.

Moreover, monoclonal antibodies derived from these patients will be used to

develop animal models of OCD that could lead to improved treatments.

Do infectious agents influence the development of autism, anxiety, or mood

disorders? This remains a frontier area for NIMH research. The increasing

evidence linking strep infection to OCD in children suggests that microbiomics

may prove an important research area for understanding and treating mental

disorders.

References

1Bacterial community variation in human body habitats across space and time.

Costello EK, Lauber CL, Hamady M, Fierer N, Gordon JI, Knight R.

Science. 2009 Dec 18;326(5960):1694-7. Epub 2009 Nov 5.PMID: 19892944

2A core gut microbiome in obese and lean twins.

Turnbaugh PJ, Hamady M, Yatsunenko T, Cantarel BL, Duncan A, Ley RE, Sogin ML,

WJ, Roe BA, Affourtit JP, Egholm M, Henrissat B, Heath AC, Knight R,

Gordon JI.

Nature. 2009 Jan 22;457(7228):480-4. Epub 2008 Nov 30.PMID: 19043404

3Innate immunity and intestinal microbiota in the development of Type 1

diabetes.

Wen L, Ley RE, Volchkov PY, Stranges PB, Avanesyan L, Stonebraker AC, Hu C, Wong

FS, Szot GL, Bluestone JA, Gordon JI, Chervonsky AV.

Nature. 2008 Oct 23;455(7216):1109-13. Epub 2008 Sep 21.PMID: 18806780

4Passive transfer of streptococcus-induced antibodies reproduces behavioral

disturbances in a mouse model of pediatric autoimmune neuropsychiatric disorders

associated with streptococcal infection.

Yaddanapudi K, Hornig M, Serge R, De Miranda J, Baghban A, Villar G, Lipkin WI.

Mol Psychiatry. 2010 Jul;15(7):712-26. Epub 2009 Aug 11.PMID: 19668249.

5Streptococcal upper respiratory tract infections and psychosocial stress

predict future tic and obsessive-compulsive symptom severity in children and

adolescents with Tourette syndrome and obsessive-compulsive disorder.

Lin H, KA, Katsovich L, Findley DB, Grantz H, Lombroso PJ, King RA,

Bessen DE, D, Kaplan EL, Landeros-Weisenberger A, Zhang H, Leckman JF.

Biol Psychiatry. 2010 Apr 1;67(7):684-91. Epub 2009 Oct 14.PMID: 19833320.

[Guest guest]

Help! Can anyone explain why Culturelle would be BAD for PANDAS?(as posted

below)

I have avoided strep strains entirely and cannot see this is a strep strain.

>

> Hi,

> Zithromycin can help with PANDAS.  It is not typically the primary antibiotic

of

> choice with Dr Goldberg.  I'm not sure which Dr leans toward, but he

is

> giving me Doxycycline for PANDAS - that one particularly helps me plus my

> fatigue.  It makes a bigger difference in my anxiety and my cognitive

function

> than others do.  I also do not do as well without an antifungal.  The two

> together are the most effective.

>

> One thing I didn't like about zithromycin is that it makes me " sparky " - makes

> my brain flicker so badly that I can't function.  I've tried it enough times

> (before I got settled on doxy) to know that it is the zithro and not a

> coincidence.  It also makes my anxiety increase.  I don't know if it does

> everyone, but it is something to watch for.  Zithromycin increases one of the

> THs (TH1?) as part of it's function, and it's already too high in some. 

> Sometimes it can be increasing it, but you see so much so much other

improvement

> that it goes unnoticed (which is probably fine).  I just don't think it's

best,

> but if that's what you get from the doctor and what he's comfortable with, and

> you're not seeing bad anxiety or flickering mind, then don't worry about it.

>

> Dr G's choices start with erythromycin - one of the safest long-term

> antibiotics.  If that doesn't go well, he switches to Ery-Ped - it is a

little

> easier on the stomach.  I think it contains sulfa (? you'd want to verify) so

if

> you're sensitive to that, it's a no.  But it often does a little better than

> erythromycin for some - not all, so you start with the first and only move on

if

> not getting results or not tolerating it.  Others he used for us (there were

> sinus problems too and the ery's weren't being tolerated well nor effective

for

> the sinus) were bactrum - which I can't take at all but both kids seemed to do

> well on. 

>

>

> For older kids, sometimes doxycycline can be very wow.  My son doesn't have

> PANDAS (although he does get anxiety and OCD when he has strep but fortunately

> it goes away as soon as treated - so far that is), but he was (is?) having a

lot

> of brain fog and complaining of not being able to think, and it seemed so

> similar to what I feel sometimes that Dr decided to try a lower dose

of

> doxycycline with him too.  It made an immediate improvement - my son came

home

> (not knowing anything about the antibiotic - he just takes his pills) from

> school and said " I had a great day today Mom! My brain actually worked!! "   

But

> it also made him very nauseous and he didn't make it past 3 days, and it went

> right back to where he had been.  Other antibiotics did not have the same

> impact.  I hope we can try it again later but nausea is intolerable to him,

and

> it afflicts him easily.  Anyway, I don't know of Dr G or Dr R using that one

> regularly - maybe because most of the kids are too young for it - you need to

be

> 9 or so and have all your teeth in.  But I'm a big believer in it and if your

> kid is old enough, I would suggest asking for it.  But although it says to

take

> it without food, take it with food!  And don't take it long-term if you don't

> have an antifungal to complement it - no way could someone prone to yeast

> tolerate it without in my opinion.

>

> No matter what antibiotic you have, as long as you're seeing the ASO titers go

> down, you're making progress.  You don't always see an immediate change, but

you

> should see some reduction.  It's going to take time for all the symptoms to

> diminish.  I've been on and off doxycycline 3+ years, but only a little over

a

> year the right way w/Dr giving it long-term at the right dose along

with

> an antifungal.  Only in the past few months have I started to feel like I've

> gotten over it (mostly).  So I started backing off to once a day

w/doxycycline,

> but my ASO went back up to 700.  However, I've usually been able to tell if

my

> titers were going up or down by my symptoms, and this time I could have sworn

> they had gone down below 500 or less, so I was surprised to find that they had

> gone up.  But my iron stores did go down - as my ASO goes up, my iron goes

down.

>

> One other thing sometimes overlooked - probiotics can aggrevate probiotics. 

L

> bacillus is bad for me, and acidophilus will bother it too.  I don't remember

> about kyodophilus.  But ABSOLUTELY avoid culturelle at all costs - or any

> probiotic w/ l. rhamuses.  It specifically triggers some cytokines (a

positive

> in some illnesses like Crohn's or Ulcerative colitis) that are bad news in

> PANDAS.

>

> HTH  - sorry so long.

>

>

>

>

>

> ________________________________

> From: and Freeman <freemanbk@...>

>

> Sent: Thu, August 19, 2010 8:19:15 AM

> Subject: RE: Microbes and Mental Illness: Insel PANDAS

>

>  

> My son is now on 500 mg of zithromycin/week as our dr is treating him for

> PANDAS. Is this antibiotic helpful for PANDAS? What does Dr. G and Dr.

> recommend? Thank you.

>

> From: [mailto: ] On Behalf Of

>

> Sent: August-19-10 9:49 AM

>

> Subject: Re: Microbes and Mental Illness: Insel PANDAS

>

> Hey

> I have PANDAS but I'm 41. I did have my first episode at age 9 though, so I

> don't if they continue thru life I assume it's still pediatric onset. They

> don't really have it defined for adults.

>

> Dr is treating me by the protocol. NOT IVIG, not plasma exchange.

> There are significant issues possible with both treatments if you look at

> as a whole.

>

> I'll give more info later if needed (time) but I've benefited a lot over the

> last year. Time is a necessary factor, as well as antibiotics AND antifungals.

> The type of antibiotic matters too.

>

> More later,

>

>

> ________________________________

> From: " erikadyan71@... <mailto:erikadyan71%40> "

> <erikadyan71@... <mailto:erikadyan71%40> >

> <mailto:%40>

> Sent: Wed, August 18, 2010 10:51:47 PM

> Subject: Re: Microbes and Mental Illness: Insel PANDAS

>

> This is some very interesting information!

> Is anyone having their child treated for PANDAS by Dr Goldberg or Dr ?

I

> am curious to know if they treat it the same way, with IVIG or plasma

exchange?

> And, their success rate!

>

> Thanks.

>

> -

> Sent on the Sprint® Now Network from my BlackBerry®

>

> Microbes and Mental Illness: Insel PANDAS

>

> Microbes and Mental Illness

> Posted by Insel

>

> August 13, 2010

> http://www.nimh.nih.gov/about/director/2010/microbes-and-mental-illness.shtml

>

> Hints that some mental illness may be linked to infectious agents and/or

> autoimmune processes date back to at least the early 20th Century. In the 21st

> Century, the field of microbiomics, which is mapping the microbial environment

> of the human organism, may transform the way we think about human physical and

> mental development.1 It is already clear that 90% of “our DNA†is

microbial, not

>

>

> human. “We†are, in fact, “super-organisms†made up of thousands of

species,

> many of which are being identified for the first time. And there are

persistent

> individual differences in our microbial ecology established early in life.

> Insights from microbiomics have proven important for understanding obesity2

and

> Type 1 diabetes,3 but microbiomics has not yet been a focus for research on

> mental illness. Yet, there are many clues linking microbiology and mental

> disorders, such as epidemiologic evidence of increased risk

> for schizophrenia associated with prenatal exposure to influenza. Probably the

> most compelling case for such involvement is children who develop obsessive

> compulsive disorder (OCD) and/or tic disorders “overnight,†following a

strep

> infection. Despite continuing debate over its parameters, evidence is mounting

> in support of Pediatric Autoimmune Neuropsychiatric Disorders Associated with

> Streptococcal Infections (PANDAS) †" or at least a syndrome modeled on it.

> Last month, the NIMH Pediatric Developmental Neuroscience Branch convened

dozens

>

>

> of experts from the field †" including prominent PANDAS critics †" to update

the

> science and attempt to achieve consensus on criteria defining the syndrome.

The

> mere fact that the conference took place signals a change in the scientific

> climate. Until now, whether a child presenting with sudden onset of OCD and/or

> tic symptoms gets checked for possible involvement of strep has varied†" often

> depending on which medical journals a practitioner happens to read. I am

hopeful

>

>

> that will begin to change in light of the new evidence.

> Interest in PANDAS has also been spurred by an increasingly vocal network of

> affected families and the clinicians who are treating their often

> severely-impaired children. Conference participants heard reports from the

front

>

>

> lines by some of these clinicians, who largely corroborated key features of

the

> syndrome, originally identified by NIMH’s Dr. Swedo in the mid-l990s.

> These include sudden onset of mood swings, impulsivity, anxiety, impaired

> attention and poor handwriting in addition to obsessions, compulsions and

tics.

> Dr. Swedo’s studies have identified brain mechanisms through which

> strep antibodies act. They have also demonstrated that cleansing the blood of

> the antibodies, via plasma exchange or intravenous immunoglobulin,

significantly

>

>

> diminishes the symptoms.

> Impetus for the July conference came, in part, from publication of two

> independent studies within the past year that lend new credence to the PANDAS

> concept.

> In the first, Columbia University researchers demonstrated, for the first

time,

> that strep-triggered antibodies alone are necessary and sufficient to trigger

a

> PANDAS-like syndrome in mice.4 In an autoimmune-disease susceptible strain of

> mice, exposure to strep triggered OCD-like repetitive behaviors and antibodies

> that attacked specific molecules in the brain. PANDAS-like behaviors also

> emerged in naïve mice after they received antibodies from such PANDAS mice.

> These included impaired learning and memory and social interaction. As in

humans

>

>

> with PANDAS, these impairments were more common in males than females.

> In the second study, a Yale University research team reported that OCD

> and Tourette Syndrome (tic) symptoms worsened slightly following a strep

> infection in some affected children. Moreover, the strep infection triggered

the

>

>

> worsened symptoms by increasing the impact of psycho-social stress.5 The

> findings suggest that a subset of children with these disorders may be at

> increased risk of strep infection, which could interact with stress to

> exacerbate the course, as is seen in other infectious and autoimmune diseases.

> Granted, these new findings are still preliminary and need to be replicated.

> However, the data relating to PANDAS is compelling enough to warrant following

> up such leads. NIMH is preparing to launch a new trial of intravenous

> immunoglobulin (IVIG) treatment for PANDAS this Fall, with support from a NIH

> Clinical Center “Bench to Bedside†award. The intramural NIMH will provide

the

> clinical care, while data analysis will be carried out by independent teams of

> investigators at Yale University and the Oklahoma University Health Sciences

> Center. Dr. Swedo and her team are hoping to recruit 50 children with

clear-cut

> PANDAS. They are predicting that IVIG treatment will produce striking benefits

> for OCD and other neuropsychiatric symptoms, and will be most effective for

> those children who start out with the highest levels of strep-triggered

> antibodies that go astray and attack parts of the brain.

> Moreover, monoclonal antibodies derived from these patients will be used to

> develop animal models of OCD that could lead to improved treatments.

> Do infectious agents influence the development of autism, anxiety, or mood

> disorders? This remains a frontier area for NIMH research. The increasing

> evidence linking strep infection to OCD in children suggests that microbiomics

> may prove an important research area for understanding and treating mental

> disorders.

> References

> 1Bacterial community variation in human body habitats across space and time.

> Costello EK, Lauber CL, Hamady M, Fierer N, Gordon JI, Knight R.

> Science. 2009 Dec 18;326(5960):1694-7. Epub 2009 Nov 5.PMID: 19892944

> 2A core gut microbiome in obese and lean twins.

> Turnbaugh PJ, Hamady M, Yatsunenko T, Cantarel BL, Duncan A, Ley RE, Sogin ML,

> WJ, Roe BA, Affourtit JP, Egholm M, Henrissat B, Heath AC, Knight R,

> Gordon JI.

> Nature. 2009 Jan 22;457(7228):480-4. Epub 2008 Nov 30.PMID: 19043404

> 3Innate immunity and intestinal microbiota in the development of Type 1

> diabetes.

> Wen L, Ley RE, Volchkov PY, Stranges PB, Avanesyan L, Stonebraker AC, Hu C,

Wong

>

>

> FS, Szot GL, Bluestone JA, Gordon JI, Chervonsky AV.

> Nature. 2008 Oct 23;455(7216):1109-13. Epub 2008 Sep 21.PMID: 18806780

> 4Passive transfer of streptococcus-induced antibodies reproduces behavioral

> disturbances in a mouse model of pediatric autoimmune neuropsychiatric

disorders

>

>

> associated with streptococcal infection.

> Yaddanapudi K, Hornig M, Serge R, De Miranda J, Baghban A, Villar G, Lipkin

WI.

> Mol Psychiatry. 2010 Jul;15(7):712-26. Epub 2009 Aug 11.PMID: 19668249.

> 5Streptococcal upper respiratory tract infections and psychosocial stress

> predict future tic and obsessive-compulsive symptom severity in children and

> adolescents with Tourette syndrome and obsessive-compulsive disorder.

> Lin H, KA, Katsovich L, Findley DB, Grantz H, Lombroso PJ, King RA,

> Bessen DE, D, Kaplan EL, Landeros-Weisenberger A, Zhang H, Leckman JF.

> Biol Psychiatry. 2010 Apr 1;67(7):684-91. Epub 2009 Oct 14.PMID: 19833320.

>

>