Has your child experienced sudden, abrupt and explosive onset of tics (movements or sounds) or obsessive compulsive disorder (OCD) symptoms — which can consist of intrusive thoughts, worries and rituals — following a strep throat or upper respiratory illness?
Dr. Susan Swedo at the NIH first reported this phenomenon in 50 children who experienced acute onset of tic disorders and/or OCD in association with a streptococcal infection in 1998 as Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus (PANDAS). Since then other triggers such as refusal to eat or other environmental triggers in association with non-streptococcal infections have redefined the PANDAS concept as Pediatric Neuropsychiatric Syndrome (PANS).
Why some children may be unusually susceptible to the development of these behavioral symptoms following an infection remains unknown. It is possible that these symptoms occur in some children as manifestations of an underlying vulnerability to an autoimmune disorder or neuroinflammatory illness. Other children may be susceptible because of a family history of tics, Tourette Syndrome, or OCD.
Unfortunately, scientific investigation has not yet uncovered the biological mechanisms as to why some children appear to develop these acute neurobehavioral symptoms.
What we do know is that new streptococcal bacteria exposures are very frequent in young children. Some studies have documented that exposure to streptococcal bacteria precedes onset of tics and/or OCD in some cases. Exposure to strep at some point during childhood is nearly universal. Thus, it is quite understandable that some children who come to clinics with a tic or OCD onset or exacerbation have signs of a recent streptococcal bacterial exposure.
The University of Miami Health System has put together a multi-disciplinary team of faculty including child and adolescent psychiatry, pediatrics, pediatric rheumatology, pediatric neurology and pediatric infectious disease to help treat these conditions. In fact, the UHealth Tics, OCD, and Related Problems program was recently designated as a Tourette Association of America Center of Excellence, one of only a select few in the United States.
This designation recognizes medical institutions that offer the highest level of care, conduct groundbreaking research, provide training and education, and serve as advocates for patients and families dealing with Tourette syndrome and other tic disorders.
For more information, call 305-243-6489.
Dr. Barbara Coffey is the division chief of Child and Adolescent Psychiatry at the University of Miami Miller School of Medicine and the director of the UHealth Tics, OCD & Related Problems program. She was recently awarded the 2019 Virginia Q. Anthony Outstanding Woman Leader Award from the American Academy of Child and Adolescent Psychiatry.