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Tic disorders and obsessive-compulsive disorder: is autoimmunity involved?
Pieter J Hoekstra1, Ruud B Minderaa
1Child and Adolescent Psychiatry Centre, Groningen, The Netherlands. p.hoekstra@accare.nl
International Review of Psychiatry (Abingdon, England)
|January 13, 2006
Summary
Autoimmunity may contribute to tic disorders and obsessive-compulsive disorder (OCD) in children, potentially following streptococcal infections. Research is exploring anti-basal ganglia antibodies and immune treatments, but more studies are needed.
Area of Science:
- Neuroimmunology
- Pediatric Psychiatry
- Infectious Disease
Background:
- The exact causes of tic disorders and pediatric obsessive-compulsive disorder (OCD) remain unclear.
- Genetic factors are implicated, alongside a potential role for autoimmunity, possibly triggered by streptococcal infections in susceptible children.
- Recent research (post-July 2003) investigates the link between tics/OCD and autoimmunity.
Purpose of the Study:
- To review recent findings on the relationship between tics/OCD and autoimmunity.
- To examine the evidence for streptococcal infections as a trigger for these conditions.
- To discuss potential biomarkers and future research directions.
Main Methods:
- Literature review of studies published from July 2003 onwards.
- Analysis of evidence correlating streptococcal infections with tic disorders and OCD.
- Evaluation of findings related to anti-basal ganglia auto-antibodies and D8/17 B cell expression.
- Review of therapeutic interventions and their efficacy.
Main Results:
- Accumulating evidence suggests a correlation between streptococcal infections and tic disorders/OCD.
- Paediatric Autoimmune Disorders Associated with Streptococcal infections (PANDAS) criteria exist, but general autoimmunity may also be involved in tics/OCD.
- Anti-basal ganglia auto-antibodies are a potential indicator of autoimmunity; specific auto-antigens may be involved.
- Replication of earlier findings on D8/17 B cell expression was unsuccessful.
- Therapeutic plasma exchange showed improvement in PANDAS, and antibiotics may prevent exacerbations, but immune treatments are not routinely recommended.
Conclusions:
- Autoimmunity is a potential factor in tic disorders and OCD, possibly linked to streptococcal infections.
- Further research is needed to confirm the pathogenetic role of anti-basal ganglia antibodies, ideally through animal models.
- Longitudinal studies are crucial to understand the relationship between symptom exacerbations, infections, and immune parameters, potentially incorporating gene expression analysis.