Sudden Onset Complex Tic Associated with Streptococcal Infection in a Neonate: The First Case of Neonatal PANDAS

Richard E Frye

Abstract


Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) is defined by acute onset of neuropsychiatric symptoms, most notably simple or complex motor or vocal tics, with an abrupt onset before adulthood associated with a Group A Streptococcal infection. This disorder is most commonly diagnosed in childhood presumably because of the high incidence of Group A Streptococcal infections during this time in development. This is the first report of a neonate with PANDAS. The neonate presented with clinical and laboratory evidence of a non-invasive Group A Streptococcal infection and concomitantly developed a complex tic. The complex tic waned as the Group A Streptococcal antibody titers decreased suggesting a temporal relation between the two. Infection and other triggers should be considered when abrupt changes in behavior or development occur early in life. Such an increased index-of-suspicious of PANDAS or Pediatric Acute-Onset Neuropsychiatric Syndromes (PANS) early in life may lead to improved neurodevelopmental outcomes.


Keywords


movement disorder, neonate, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, pediatric acute-onset neuropsychiatric syndromes, streptococcal infection

Full Text:

PDF

References


Rossignol DA, Frye RE. A review of research trends in physiological abnormalities in autism spectrum disorders: immune dysregulation, inflammation, oxidative stress, mitochondrial dysfunction and environmental toxicant exposures. Mol Psychiatry. 2012;17:389-401.

Swedo SE, Leonard HL, Mittleman BB, et al. Identification of children with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections by a marker associated with rheumatic fever. Am J Psychiatry. 1997;154:110-112.

Chmelik E, Awadallah N, Hadi FS, Quinn K, Franco K. Varied presentation of PANDAS: a case series. Clin Pediatr. 2004;43:379-382.

Kurlan R, Kaplan EL. The pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) etiology for tics and obsessive-compulsive symptoms: hypothesis or entity? Practical considerations for the clinician. Pediatrics. 2004;113:883-886.

Chang K, Frankovich J, Cooperstock M, et al. Clinical Evaluation of Youth with Pediatric Acute Onset Neuropsychiatric Syndrome (PANS): Recommendations from the 2013 PANS Consensus Conference. J Child Adolesc Psychopharmacol. 2015;25:3-13.

Cox CJ, Sharma M, Leckman JF, et al. Brain human monoclonal autoantibody from sydenham chorea targets dopaminergic neurons in transgenic mice and signals dopamine D2 receptor: implications in human disease. J Immunol. 2013;191:5524-5541.

Lotan D, Benhar I, Alvarez K, et al. Behavioral and neural effects of intra-striatal infusion of anti-streptococcal antibodies in rats. Brain Behav Immun. 2014;38:249-262.

Swedo SE, Leckman JF, Rose NR. From Research Subgroup to Clinical Syndrome: Modifying the PANDAS Criteria to Describe PANS (Pediatric Acute-onset Neuropsychiatric Syndrome). Pediatrics & Therapeutics. 2012;2:113.

Rose J, Vassar R. Movement disorders due to bilirubin toxicity. Semin Fetal Neonatal Med. 2015;20:20-25.

O'Brien C, Hunt R, Jeffery HE. Measurement of movement is an objective method to assist in assessment of opiate withdrawal in newborns. Arch Dis Child Fetal Neonatal Ed. 2004;89:F305-309.

Kayser MA. Inherited metabolic diseases in neurodevelopmental and neurobehavioral disorders. Semin Pediatr Neurol. 2008;15:127-131.

Suzuki Y, Toshikawa H, Kimizu T, et al. Benign neonatal sleep myoclonus: Our experience of 15 Japanese cases. Brain Dev. 2015;37:71-75.

Huber BM. Cellulitis-adenitis in a neonate with group a streptococcal sepsis. Klin Padiatr. 2014;226:82-83.

Larru B, Gerber JS. Cutaneous bacterial infections caused by Staphylococcus aureus and Streptococcus pyogenes in infants and children. Pediatr Clin North Am. 2014;61:457-478.

Cohrs S, Rasch T, Altmeyer S, et al. Decreased sleep quality and increased sleep related movements in patients with Tourette's syndrome. J Neurol Neurosurg Psychiatry. 2001;70:192-197.

Murphy TK, Storch EA, Lewin AB, Edge PJ, Goodman WK. Clinical Factors Associated with Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. J Pediatr. 2012;160:314-319.

Kurlan R, Kaplan EL. The Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infection (PANDAS) Etiology for Tics and Obsessive-Compulsive Symptoms: Hypothesis or Entity? Practical Considerations for the Clinician. Pediatrics. 2004;113:883-886.

Williams KA, Swedo SE. Post-infectious autoimmune disorders: Sydenham's chorea, PANDAS and beyond. Brain Res. 2014; in press.


Refbacks

  • There are currently no refbacks.