Neuroinflammation in Obsessive-Compulsive Disorder: Sydenham Chorea, Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections, and Pediatric Acute Onset Neuropsychiatric Syndrome

Allison Vreeland; Margo Thienemann; Madeleine Cunningham; Eyal Muscal; Christopher Pittenger; Jennifer Frankovich

doi:10.1016/j.psc.2022.11.004

Neuroinflammation in Obsessive-Compulsive Disorder: Sydenham Chorea, Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections, and Pediatric Acute Onset Neuropsychiatric Syndrome

Psychiatr Clin North Am. 2023 Mar;46(1):69-88. doi: 10.1016/j.psc.2022.11.004.

Authors

Allison Vreeland¹, Margo Thienemann², Madeleine Cunningham³, Eyal Muscal⁴, Christopher Pittenger⁵, Jennifer Frankovich⁶

Affiliations

¹ Division of Child and Adolescent Psychiatry and Child Development, Department of Psychiatry, Stanford University School of Medicine, Stanford, CA, USA; Stanford Children's Health, PANS Clinic and Research Program, Stanford University School of Medicine, Stanford, CA, USA. Electronic address: vreeland@stanford.edu.
² Division of Child and Adolescent Psychiatry and Child Development, Department of Psychiatry, Stanford University School of Medicine, Stanford, CA, USA; Stanford Children's Health, PANS Clinic and Research Program, Stanford University School of Medicine, Stanford, CA, USA.
³ Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
⁴ Department of Rheumatology, Texas Children's Hospital, Houston, TX, USA.
⁵ Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
⁶ Stanford Children's Health, PANS Clinic and Research Program, Stanford University School of Medicine, Stanford, CA, USA; Division of Pediatrics, Department of Allergy, Immunology, Rheumatology, Stanford University School of Medicine, Stanford, CA, USA.

PMID: 36740356
DOI: 10.1016/j.psc.2022.11.004

Abstract

Sydenham chorea (SC), pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) and pediatric acute-onset neuropsychiatric syndrome (PANS) are postinfectious neuroinflammatory diseases that involve the basal ganglia and have obsessive-compulsive disorder as a major manifestation. As is true for many childhood rheumatological diseases and neuroinflammatory diseases, SC, PANDAS and PANS lack clinically available, rigorous diagnostic biomarkers and randomized clinical trials. Research on the treatment of these disorders depend on three complementary modes of intervention including: treating the symptoms, treating the source of inflammation, and treating disturbances of the immune system. Future studies should aim to integrate neuroimaging, inflammation, immunogenetic, and clinical data (noting the stage in the clinical course) to increase our understanding and treatment of SC, PANDAS, PANS, and all other postinfectious/immune-mediated behavioral disorders.

Keywords: Obsessive compulsive disorder; Pediatric acute-onset neuropsychiatric syndrome; Pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections.

Publication types

Review

MeSH terms

Autoimmune Diseases* / complications
Autoimmune Diseases* / diagnosis
Autoimmune Diseases* / drug therapy
Child
Chorea* / complications
Chorea* / diagnosis
Humans
Inflammation / complications
Neuroinflammatory Diseases
Obsessive-Compulsive Disorder* / complications
Streptococcal Infections* / complications
Streptococcal Infections* / diagnosis
Streptococcal Infections* / drug therapy

Supplementary concepts

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections
Pediatric acute-onset neuropsychiatric syndrome