OCD & PANDAS

Townsend Letter for Doctors and Patients, Oct, 2004 by Jule Klotter

In an article published in Latitudes (Vol 6, Issue 2), Aristo Vojdani, PhD, MT, discusses the difference between nonautoimmune obsessive compulsive disorder (OCD) and PANDAS (pediatric autoimmune neuropsychiatric disorder associated with Group A streptococcal infection). Obsessive Compulsive Disorder involves an unintentional and uncontrollable replay of thoughts or actions. In an attempt to reduce the anxiety that arises when the obsession cannot be stopped, people with OCD develop a set of actions or rituals that involve washing and cleaning, checking (i.e., that the stove is off), symmetry, counting, repeating, redoing, and hoarding in order to hold their fear at bay. In many cases, OCD is preceded by a major stressor, such as a family member's illness or job loss. Children with OCD tendencies have linked hearing bad news about war or terrorism or seeing frightening movies to their developing "full-blown" OCD. The rituals that OCD patients use to calm their fears do not always have a noticeable link to the obsessive thought(s) plaguing them, and scientists do not understand why some have a compulsion to clean and others turn to hoarding--or why these symptoms may change. Scientists have discovered that adults with OCD have more activity in the caudate nucleus, orbital frontal regions of the brain, and basal ganglia. Basal ganglia, "the thought-filtering station," has many serotonin receptors. OCD patients respond to selective serotonin reuptake inhibitors and to behavior therapy, according to research by Dr. J. Schwartz and colleagues at UCLA.

About 25% to 30% of children with OCD may actually have PANDAS, a disorder in which the body's immune cells attack its own B-cells or the basal ganglia while fighting streptococcus. Chiildren who develop OCD, tic disorders, or anorexia nervosa after a streptococcal infection need to be checked for serum antibodies against streptococcal antigens and their cross-reactive epitopes on B-cells and nerve cells. (Immunosciences Lab, phone 310-657-1077 or 800-950-4686, offers a PANDAS panel.) In contrast to non-autoimmune OCD which may take years to develop, PANDAS symptoms appear quickly. Also, OCD symptoms increase and decrease sharply in PANDAS while changes in OCD symptoms among non-autoimmune OCD patients are more gradual. In addition to OCD, children with PANDAS may display numerous other symptoms that include tics, trembling, twitches, grimacing, clumsiness, loss of math skills, sensitivity to touch and clothing tags, poor attention span, distractibility, irritability, impulsivity, separation anxiety, and bedtime fears. Dr. Vojdani says that PANDAS treatments being investigated include plasmapheresis to remove autoantibodies reacting to B-cell receptors and basal ganglia cells, intravenous immunoglobulin, and daily doses of amoxicillin as a prophylactic measure.

Vojdani, Aristo, PhD, MT. Obsessive Compulsive Disorder and Differentiation between Non-Autoimmune OCD and the Autoimmune version of the disease called PANDAS. Latitudes, Vol. 6, Issue 2, 2003.