Post-streptococcal autoimmune psychiatric and movement disorders in children.

In the past decade there has been renewed interest in psychiatric and movement dis-interest in psychiatric and movement disorders that develop in the context of orders that develop in the context of streptococcal infection. There is increasing streptococcal infection. There is increasing evidence that these disorders are auto-evidence that these disorders are auto-immune and are mediated by antibodies immune and are mediated by antibodies that bind and cause dysfunction within that bind and cause dysfunction within the central nervous system, specifically in the central nervous system, specifically in the basal ganglia. The classical post-the basal ganglia. The classical post-infectious autoimmune basal ganglia dis-infectious autoimmune basal ganglia disorder is Sydenham's chorea known for order is Sydenham's chorea known for centuries to be associated with behavioural centuries to be associated with behavioural disturbance; however, recent studies have disturbance; however, recent studies have provided more systematic evidence of provided more systematic evidence of related psychopathology (Swedo related psychopathology (Swedo et al et al, , 1989). It now appears that a wide range 1989). It now appears that a wide range of psychiatric and movement disorders of psychiatric and movement disorders can occur following streptococcal infection, can occur following streptococcal infection, in patients who do not meet diagnostic in patients who do not meet diagnostic criteria for Sydenham's chorea. The best criteria for Sydenham's chorea. The best described group have been given the described group have been given the acronym PANDAS (paediatric autoimmune acronym PANDAS (paediatric autoimmune neuropsychiatric disorders associated with neuropsychiatric disorders associated with streptococcal infection; Swedo streptococcal infection; Swedo et al et al, , 1998). Children with PANDAS have tics 1998). Children with PANDAS have tics and/or obsessive–compulsive disorder and/or obsessive–compulsive disorder (OCD) temporally related to streptococcal (OCD) temporally related to streptococcal infections. The accumulating data on the infections. The accumulating data on the variability of post-streptococcal neuro-variability of post-streptococcal neuro-behavioural syndromes, as well as new find-behavioural syndromes, as well as new findings in relation ings in relation to the cell and molecular to the cell and molecular biology of the neuro biology of the neuroimmunological mechan-immunological mechanisms , could help improve understanding of isms, could help improve understanding of environmental factors involved in the patho-environmental factors involved in the patho-genesis of movement and psychiatric disor-genesis of movement and psychiatric disorders. In this editorial we consider the ders. In this editorial we consider the hypothesis that group A beta-haemolytic hypothesis that group …