New idea: Strep and OCD in children

[Guest guest]

This article really got my attention - it surely presents a new wrinkle on the concept of MENTAL disorders being linked to PHYSICAL PROBLEMS. Well - I've always felt that was so, but haven't seen that much literature to back it up.

 

These ideas are very challenging and I felt you would all be interested in reading and possibly commenting on them.

 

Linda

 

Mental ailments in children being linked to strepBy Carey Goldberg, Globe Staff, 6/28/2003KENNEBUNKPORT, Maine -- Sammy Jelin, math whiz and natural comedian, sailedthrough fifth grade, a school enthusiast eager for the bus each morning. Bythe start of sixth grade last fall, he could barely make it to school atall: In just weeks, his world had turned into a minefield of germ phobias,invisible walls, and constant tics -- hallmarks of obsessive compulsive disorder and Tourette'ssyndrome. By this May, Sammy's mother, Beth Jelin, was nearing her wits' end. Then an acquaintance mentioned that her son had contracted similar mental ailmentsthrough a streptococcus infection. The idea sounded wild, especially becauseSammy had never had strep throat. But a prompt blood test did turn upunusually high levels of strep, and Sammy went on antibiotics.Within days, Sammy got so much better that Beth Jelin is convinced that undiagnosed strep was the culprit, and a growing body of research, thoughstill controversial, suggests she might be right.It could be that at least one child in every 1,000 suffers from obsessive compulsive disorder linked to strep, say federally financed researchers whohave been exploring the connection for several years.Garden-variety strep, bacteria best known for attacking the throat, is farmore common than that; virtually every child catches it once or twice awinter. And strep sometimes infects a child without bringing noticeablesymptoms.In contrast to strep, a child has only a small chance of developingstrep-related obsessive compulsive disorder, or OCD.But among children who do have OCD, up to one-half of those cases could be strep-related, said one specialist, Dr. Tanya Murphy of the University ofFlorida.Skeptics say strep is so common in schoolchildren that simple chance could dictate that it would sometimes coincide with the onset of OCD or Tourette's.But evidence is accumulating. Researchers in Rochester, N.Y., reported last year that over four years in one pediatric practice, they had linked 25cases of children with OCD and tics to strep.And when those children at Elmwood Pediatric Group were quickly given antibiotics, both the strep and the psychiatric symptoms went away, Drs.Michael Pichichero and Marie Lynd Murphy reported at conferences and in theArchives of Pediatrics & Adolescent Medicine.While no one advocates prescribing antibiotics more broadly as a precaution against OCD, some specialists say the link is now established enough thatpediatricians should order a strep test when a child comes in withsudden-onset OCD or tics.The connection remains little known among pediatricians, even though it is recognized enough to have a name: PANDAS, for Pediatric AutoimmuneNeuropsychiatric Disorders Associated with Streptococcal Infection. Anddozens of studies have focused on it recently. Several points about PANDASare already quite clear, said Dr. Susan Swedo, who helped discover the syndrome in the early 1990s and now leads the National Institute of Mental Health PANDAS research team.There is no question, she said, that a there is a group of children with a''fairly unique clinical presentation'': abrupt onset of OCD or tics alongwith other unusual behaviors, from frequent urination to high separationanxiety.Normally, OCD develops gradually, often over years; but with sudden onset, parents often say their child seemed to get ill overnight, or can name thedate when the symptoms started. Typical OCD involves obsessions, often withcleanliness or fears about safety, and can include compulsions, likerepeated hand-washing.With PANDAS, Swedo said, it is also clear that the children's psychiatric symptoms get worse with subsequent strep infections but fade when the strepdoes.Also, she and others said, this is not the first time that infections havebeen connected to psychiatric disorders. In its advanced stages, syphiliscan lead to insanity. Lyme disease has been known to bring on psychiatricproblems, and some researchers have reported that strep may also beconnected to anorexia.There is broad agreement, Swedo said, on a possible mechanism for PANDAS: Itcould be that in some children, strep triggers antibodies that mistakenlyattack the basal ganglia, a part of the brain that helps control movement,much as antibodies mistakenly attack the heart in rheumatic fever.But researchers have a ways to go before they really understand what happens, and why it happens only in certain children, Swedo said.There seems to be a genetic element involved as well, she noted; PANDAS children seem to have immune systems predisposed to the disorder.Other researchers are working to try to find biological markers or highly objective measures to distinguish PANDAS children from those withgarden-variety OCD or Tourette's. Still others are focusing on how best toprevent and fight PANDAS using antibiotics.If specialists' estimates are correct, tens of thousands of children between the toddler years and puberty may be affected.For the past month, Jelin has been doing a great deal of research on PANDAS and using the information to try to help Sammy. Most recently, she has been looking into the best ways to fight strep, and found a new study favoring amoxicillin.''We're approaching this like a military operation,'' she said in an e-mail describing the antibiotics her son is now taking. ''First, we dropped massive amounts of penicillin. Next we're sending in the ground troops -- Keflex and amoxicillin.''Before his improvement, Sammy had suffered through a wide range of OCD and Tourette's symptoms.He developed bruises on his arms and legs from using them, rather than his fingers, to flick light switches. He felt compelled to hop and clear histhroat at the same time. At one point, he needed to eat with his eyes closed.This month, Beth Jelin said, many of those behaviors have faded, though some remain in a less pronounced and less frequent form.During a 20-minute conversation last week at his kitchen table, Sammy seemed just slightly more squirmy than the average boy and was quietly hilarious ashe discussed his surfeit of self-confidence and his economic suggestions forPresident Bush.He did not want to talk about his OCD and recent improvement, but his mother said he recently told her, ''Mom, I'm a boy full of hope.''She is left wondering, she said, ''How many children are there out there with mental health diagnoses where we're not really looking for the physicalcause?'' Swedo cautions parents of children diagnosed with OCD not to gettheir hopes up. She has heard from many parents who were crushed when theirchildren's strep tests turned up nothing.Still, she said, if a child fits the PANDAS profile, ''it's really worth itto look for an asymptomatic strep infection.'' Prompt antibiotic treatment,she said, ''can cause a pretty dramatic improvement in the symptoms. It'snot very often, but it is worth it.''Or as Sammy put it when asked what he would tell other children who run into problems like his: ''It's very good to test this kind of thing out because,frankly, it's not very fun to have.''''It's exhausting,'' he said. ''Something you have to keep in mind is, don'tworry, it's not just you.''Carey Goldberg can be reached at goldberg.

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