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Ocular Tics and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS)
Stefano Dore1,2, Daniele Satta1, Angelo Zinellu3
1Department of Medicine, Surgery, and Pharmacy, University of Sassari, 07100 Sassari, Italy.
Insights
Ocular tics are common in children with Pediatric Autoimmune Neuropsychiatric Disorders associated with Streptococcal infections (PANDAS). Higher anti-DNase B antibody titers may indicate ocular tic development, and antibiotics showed symptom improvement.
Area of Science:
- Ophthalmology
- Pediatric Neurology
- Infectious Diseases
Background:
- Ocular tics are not well-understood in Pediatric Autoimmune Neuropsychiatric Disorders associated with Streptococcal infections (PANDAS).
- This study investigates the prevalence and characteristics of ocular tics in children with PANDAS.
Purpose of the Study:
- To determine the frequency of ocular tics in children with motor tics.
- To explore the association between ocular tics and specific immunological markers in PANDAS patients.
- To evaluate the efficacy of antibiotic treatment for ocular tics in this population.
Main Methods:
- Retrospective analysis of clinical records from children with motor tics.
- Investigation of ocular tic presence and recording of immunological data (ASO, anti-DNase B, ESR, CRP).
- Comparison of immunological markers between children with and without ocular tics, including those diagnosed with PANDAS.
Main Results:
- Out of 40 children with motor tics, 33 (82.5%) exhibited ocular tics.
- Children with ocular tics showed significantly higher anti-DNase B antibody titers and CRP levels.
- A PANDAS diagnosis was made in 60% of cases, with higher anti-DNase B titers in PANDAS children with ocular tics.
- Antibiotic treatment led to significant symptom improvement or resolution in most patients.
Conclusions:
- Elevated anti-DNase B antibody titers may play a role in the development of ocular tics in PANDAS.
- Antibiotic therapy appears beneficial for managing ocular tics in children with PANDAS.
- Further research is warranted to validate these findings and elucidate the underlying mechanisms.
Abstract:
Little is known about ocular tics in Pediatric Autoimmune Neuropsychiatric Disorders associated with Streptococcal infections (PANDAS). In this retrospective study, we examined the clinical records of children with motor tics referred to the Ophthalmology Unit, Azienda Ospedaliero-Universitaria di Sassari, Italy, in 2010-2019. The presence of ocular tics was investigated. Data about antistreptolysin O (ASO) and anti-DNase B antibody titers, erythrocyte sedimentation rate (ESR), plasma C-reactive protein (CRP), and antibiotic use were recorded. Forty children (thirty-four boys and six girls; mean age: 7.65 ± 2.5 years) with motor tics were identified; thirty-three (82.5%) showed ocular tics. Children with ocular tics had significantly higher titers of anti-DNase B antibodies (p = 0.04) and CRP (p = 0.016) than those with extraocular tics. A diagnosis of PANDAS was made in 24 (60%) children. PANDAS children with oculomotor tics had significantly higher titers of anti-DNase B antibodies (p = 0.05) than those with extraocular tics. Oral antibiotics were given to 25/33 (76%) children with ocular tics and 21/24 (87.5%) with PANDAS. All treated patients showed marked improvement/complete resolution of symptoms. Results suggest that higher titers of anti-DNase B antibodies may be implicated in the pathogenesis of ocular tics in PANDAS. Oral antibiotics may be beneficial in improving ocular tics. Further research is necessary to confirm our findings.
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