27,42 They may also benefit from the use of glutamate modulating agents.55 Pediatric autoimmune PLX 4720 neuropsychiatrie disorders associated

with streptococcal infections It has been hypothesized that some susceptible individuals develop OC symptoms and tics as a result of postinfectious autoimmune processes. Infections with group A P-hemolytic streptococci (GABHS) have been hypothesized to be responsible. Swedo Inhibitors,research,lifescience,medical and colleagues have proposed that this subgroup, identified by the acronym PANDAS (pediatric autoimmune neuropsychiatrie disorders associated with streptococcal infections), follows a unique “sawtooth” waxing and waning clinical course that is closely temporally linked to GABHS infections.56 These sudden fluctuations complicate clinical management Inhibitors,research,lifescience,medical as well as the interpretation of efficacy and effectiveness of treatment studies. The strongest, evidence that GABHS may be involved in the onset, of Tourette syndrome (TS) and OCD comes from a recent report by Mell et al.57 TTiis is a case-control study of 144 children

4 to 13 years old who received their first, diagnosis of OCD, TS, or tic disorder between January 1992 and December 1999. Cases were matched to controls by birth date, sex, primary physician, and propensity to seek health care. Inhibitors,research,lifescience,medical Patients with OCD,TS, or tic disorder were more likely than controls to have had streptococcal infection in the

3 months before onset date. The risk was higher among children with multiple streptococcal infections within 12 months. Indeed, having multiple infections with group A P-hemolytic streptococcus within a 12-month period was associated with an increased risk of TS Inhibitors,research,lifescience,medical with an odds ratio of 13.6 (95% confidence interval 1.93-51.0). In addition to OCD,TS, and tic disorders, a specific Inhibitors,research,lifescience,medical link between ADHD and GABHS has been hypothesized,58,59 and there is at least one case report and one epidemiological study where a link between GABHS and major depressive disorder (MDD) was also suggested.58,60 Brain imaging studies of PANDAS cases have consistently implicated the basal ganglia. Specific findings include the transient enlargement of the striatum and the basal ganglia as a whole.59,61,62 Although before it has been postulated that GABHS infection must, be the initial autoimmune response-inciting event but that subsequent, symptom exacerbations can be triggered by other infectious agents,63 a number of other précipitants have been identified, including the common cold and Mycoplasma pneumoniae infections.64-66 Future prospective longitudinal studies are needed to confirm these findings and to clarify whether there is a common underlying immunological response that triggers symptom worsening. In clinical longitudinal studies the results have been mixed.