[wordup] Can Strep throat give you Tourette's Syndrome?

[Adam Shand]

This is fascinating, it reminds of a book by Bruce Sterling called
"Heavy Weather".   How long before our knowledge of what can make us ill
starts to make us crazy?

Adam.

Via: The Eristocracy <Eristocracy at merrymeet.com>

[Editor's note: I have resisted the urge for a cheap joke with a
Tourette's-like comment. You can probably supply your own that's at least
as funny. -- jdcc]

From: http://slate.msn.com/?id=2062577
More: http://www.theatlantic.com/issues/99feb/germs.htm

Can a sore throat lead to Tourette's syndrome?
By Emily Yoffe
Posted  Wednesday, February 27, 2002, at 12:22 PM PT

Last February a happy, confident 8-year-old girl went to bed and woke up
the next morning having turned into someone else. She came to her mother
with a series of shocking confessions. She said she had licked people's
bottoms and drunk her own urine. She listed the people to whom she had
shown her private parts. She asked if this made her a "bad person."

The mother was horrified and baffled. She calmed the girl down and sent
her to school. When her mother picked her up, the girl said she had
spread her feces around the school. The mother casually checked with a
teacher about the girl's behavior and was told she was fine. This went
on day after day. The girl said she had blinded her brother with a fork
in his eye. She said she wanted to step in front of a bus. She said she
had swear words stuck in her head. At first the mother suspected sexual
abuse, but the daughter said no one had touched her, and the parents
could find no evidence anyone had. The pediatrician said it sounded like
a case of obsessive-compulsive disorder, a condition of unknown origin,
and referred the family to a psychiatrist.

Surfing the Web, the mother discovered other cases just like her
daughter's: normal kids who suddenly become consumed by horrible
thoughts or, in some cases, begin twitching uncontrollably. Doctors at
the National Institutes of Health had a startling suspect: strep throat,
one of the most common illnesses of childhood. Two months before the
girl's transformation, she had come down with strep throat four times.

Virtually all elementary-school-age children will get a sore throat,
often many sore throats, caused by the Group A streptococcus bacterium,
and the overwhelming majority will recover uneventfully. Many will get
better without even seeing a doctor and getting antibiotics, the
standard treatment. But there is growing evidence that a range of
neurological disorders from temporary tics, such as eye-blinking and
head-scratching, to full-blown OCD and Tourette's syndrome are linked to
the bacteria. The scientists who connected these neurological maladies
to strep throat named the condition pediatric autoimmune
neuropsychiatric disorders associated with streptococcal infections, or
PANDAS. Some scientists even believe that strep throat might be a factor
in some cases of anorexia nervosa.

It is estimated that about 2 percent of the population suffers from OCD
and/or tics, which are diagnosed on the basis of behavior, making the
conditions more common than schizophrenia and manic-depression. But many
believe the incidence is likely far higher. No one knows the cause, and
not even researchers in the field know to what degree strep might turn
out to play a role in these cases.

That infections can trigger common mental illnesses is not a new idea.
It is a very old one, discredited for most of the 20th century. In the
middle of that century the cause for such disorders as schizophrenia,
manic-depression, Tourette's syndrome, and OCD was believed to be bad
parents. One theory was that OCD was the result of punitive toilet
training. Toward the end of the century, the blame shifted to bad genes.
That idea, which is still the most widely held in the scientific
community, is that the unfortunate few inherit a bad gene or genes that,
in the case of schizophrenia, make people hear voices or, in the case of
OCD, have obsessive thoughts. Yet, despite many seemingly promising
leads, no one has been able to identify this blighted DNA.

But what if the problem isn't bad genes but bad germs? Researchers are
making the connection between OCD and tics with evidence of an
infectious assault to the brain. For example, brain scans of children
with PANDAS show that they have an inflammation in the basal ganglia, a
portion of the brain that acts as a sort of gatekeeper for behavior and
movement. It is the same inflammation seen in a rare neurological
condition that arises from rheumatic fever, a disease caused by strep.

Scientists at both Brown Medical School and Yale University School of
Medicine have infused rats with the blood serum of patients with
Tourette's and/or OCD. How it affected the rats' thoughts is unknown,
but the infused rodents exhibited the tics and grunts stereotypical of
Tourette's. And, as just reported in the Journal of the American Medical
Association, researchers at the University of Rochester Medical Center
identified a small group of children when they first exhibited signs of
OCD and tics and eliminated the symptoms with early antibiotic
treatment.

The researchers themselves warn that these studies, while intriguing,
don't prove the infection connection and that each step forward raises
more questions. For instance, treatments that have been effective in the
newly diagnosed have been failures in people with chronic cases. Is that
because strep is responsible for only a small portion of these
neurological illnesses? If so, what causes the rest? Or could chronic
cases be linked to strep, but the available treatments are only
effective when the brain is newly under assault?

Paul Ewald, a professor of biology at Amherst College, is a leading
theorist of the germs-not-genes movement (read a full explanation of his
theories here). But if bad genes aren't responsible, why do disorders
such as OCD/Tourette's/tics run in families? Ewald says there is a place
for genetics in the theory. He posits that genes determine how an
individual's immune system reacts’Äîor overreacts’Äîto any given
infection. So, if that's the case, in the end what's the difference?
Either some of us inherit a gene that makes us crazy, or some of us
inherit a gene that makes us crazy because we got a certain infection.
One crucial difference is if the cause is infection, there's the
possibility of prevention or cure (for now, genes can't be fixed). Ewald
says, for example, that the discovery of penicillin is the "biggest
success story in all of psychiatry" because it ended one of the most
common mental illnesses, syphilitic insanity.

For germ-theory proponents, the case that strep throat can cause a
variety of mental disorders otherwise believed to be either
psychological or genetic in origin is tantalizing. And a model for how
that might happen already exists.

In the early 1990s, Dr. Susan Swedo, a senior investigator at NIH, was
hoping to better understand OCD by studying a rare and ancient malady
when a chance remark by a patient's mother led to the description of
PANDAS. Swedo was looking at Sydenham's chorea, known in the Middle Ages
as St. Vitus' dance, a disorder that causes facial grimacing and
flailing limbs. Sydenham's occurs as a result of rheumatic fever, an
autoimmune reaction to untreated strep throat that can cause
inflammation of the heart. It was once the major killer of young
children in the United States. But since the use of penicillin to treat
strep throat became widespread in the 1940s, rheumatic fever incidence
has declined dramatically. What intrigued Swedo about Sydenham's is that
before the onset of physical symptoms, the young victims often
experience OCD.

About 25 years ago, researchers discovered the likely neurological basis
of Sydenham's. When we contract strep, our immune system recognizes the
invading proteins on the outside of the bacteria, the antigens, and
creates antibodies that attach themselves to the invader. That sends a
signal to our white blood cells to kill the trespasser. But in an
unfortunate quirk of nature known as "molecular mimicry," proteins in
the human heart closely resemble strep antigens. In vulnerable
individuals, the immune system, instead of stopping when the strep is
vanquished, continues on an autoimmune rampage against its own heart. In
the case of Sydenham's, the molecular mimicry, and the damage, is found
in the neurons of the basal ganglia of the brain.

Swedo was evaluating a boy thought to have Sydenham's. He didn't, but he
did have OCD and tics, and because these things often run in families,
Swedo was not surprised to find that his older brother had Tourette's
syndrome. As Swedo was talking to the boys' mother, the woman mentioned
that it had become a family joke that whenever her kids' tics got worse,
it was time to take them in for a throat culture because an increase in
tics inevitably meant a strep throat.

It clicked. Swedo theorized that Sydenham's could just be one
manifestation of neurological damage due to strep. Perhaps there were
children who never got rheumatic fever or Sydenham's but who got OCD or
tics directly as a result of an unremarkable sore throat. If that was
the case, it meant there might be something they could do to cure it.
Antibiotics were not the answer for the patients Swedo saw. Because it
was so long between the onset of symptoms and her patients' arrival at
NIH, the initial strep infection had cleared up. What was needed was a
way to stop the autoimmune damage occurring in the brain.

So Swedo and her colleagues used a procedure called plasma exchange or
plasmapheresis. It's like a high-tech bloodletting. She performed a
series of five on each patient’Äîthe patient's blood was removed, and
the fluid part, the plasma, where the antibodies are found, was
discarded and replaced.

Swedo's initial study was much too small to be considered definitive. In
all, she has treated only about 30 children with the most devastating
cases. But the results are striking. Last April, two months after the
onset of her symptoms, the 8-year-old girl was admitted to NIH for a
two-week course of plasma exchange. During her first three days in the
hospital, she was unable to eat because of the extreme distress of
seeing other sick people; she was convinced she had made all of them
ill. By the third plasma exchange, the girl was less fraught with worry.
By the fifth, she was almost herself again. Within a week of returning
home she was completely better. Over the course of the plasma exchange
study, 80 percent of the children receiving it maintained a remarkable
improvement in their symptoms a year later.

Will there be other neurological disorders linked to strep infection?
Dr. Mae Sokol, a specialist in eating disorders at Children's Hospital
in Omaha, Neb., believes some of her patients with anorexia nervosa had
strep-triggered onset. Like the PANDAS patients, they tend to be
preteens, and their parents can usually pinpoint exactly when, even to
the day, the obsession with food began, usually within a few weeks of a
strep infection. One 10-year-old patient, after an inadequately treated
strep infection, became consumed with the idea that she couldn't swallow
solid food. As she began losing weight, she liked the result. Six months
and 30 pounds after the onset of her symptoms, she was referred to
Sokol. At that time, the girl had a sinus infection, and Sokol treated
her with a high dose of antibiotics. The girl began eating two days
later. Sokol says there is a possible physiological explanation for such
cases: The part of the brain thought to be responsible for body image is
close to the basal ganglia, which is inflamed in children with PANDAS.

Could other infections trigger PANDAS-like symptoms? Dr. Louise
Kiessling, a professor at Brown Medical School, says there is some
evidence Lyme disease can provoke similar behaviors. And once the immune
system is primed to overreact, other invaders besides strep can set off
the process. For example, says Kiessling, children with Sydenham's have
had recurrences of writhing after infection with the chicken pox virus
or bacteria called Haemophilus influenzae.

While the connection between strep and neurological disorders is
intriguing, it is far from proved. Research to find out to what degree
strep is responsible for what percentage of OCD and tic disorders is
continuing on everything from the chemical level to the epidemiological
one. Researchers are trying to find out if there is a molecule produced
in the brain unique to PANDAS patients. They are also following large
groups of children to see if they can better correlate strep throat and
subsequent behavior disorders. And if the work on a strep vaccine is
successful, widespread inoculation could result in a dramatic decline of
OCD and tics. (The doctors involved in the research all warn against
rampant use of antibiotics, which is more likely to cause dangerous
antibiotic resistance than prevent PANDAS.)

For now, Swedo doesn't have much better advice than teaching children
about washing their hands and not sharing drinking glasses, and for
parents of children who have shown neurological symptoms following
strep, even minor ones such as eye-blinking, to be vigilant about sore
throats. As the mother of the 8-year old says, "I can't let her get
strep."Emily Yoffe is a frequent contributor to Slate. You can e-mail
her at eyoffe at hotmail.com.