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Friday, 1 October, 1999, 03:45 GMT 04:45 UK
Flushing out child mental disorders
mental
The disorders can cause psychiatric distress
Children with psychological problems that are made worse by the bacteria behind throat infections could benefit from an immune system cleansing treatment.

The announcement follows research into children with obsessive compulsive disorder (OCD) and tic disorders such as Tourette's syndrome at the US National Institute of Mental Health.

They looked in particular at children suffering from PANDAS - paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections - where the OCD or tic disorder gets worse following infection with streptococcal bacteria.

They found that by swapping old immune system material for new they could reduce the effect, offering the promise of an effective treatment for children in this position.

Mistaken threat

Doctors believe that PANDAS occur as an autoimmune response - where the immune system mistakes the body's own tissue for a threat and destroys it.

They suggest that when the body produces antibodies to fight off a streptococcal infection, some of them accidentally turn on the body, which in turn exacerbates the psychiatric disorder.

However, the US researchers think that their treatment has the potential to help children suffering from the disorders.

They looked at 30 children who had an OCD, a tic disorder or both. The children had all shown signs of their disorder before they hit puberty and had found that it interfered with at least two areas of their lives, such as school or home.

Twenty of the patients got replacement immune material, 10 were given a placebo.

Half of the 20 patients receiving treatment were given intravenous immunoglobulin (IVIG), the other half were given plasma exchange - both techniques effectively clean the blood of faulty antibodies.

Success

Publishing their findings in The Lancet medical journal, the researchers said: "Plasma exchange and IVIG were both effective in lessening symptom severity for children with infection-triggered OCD and tic disorders."

They followed the children for a year, and were surprised to find that not only did the treatment work, it only needed one course to produce lasting results.

Dr Susan Swedo, one of the researchers at the National Institute of Mental Health, said that although they could not be sure why the treatment worked, they had a theory why.

"It's a one-two punch - the first punch knocks out the antibodies that do the damage, the second punch restores the immune system so the Strep can't come back," she told BBC News Online.

"In these cases, it's an accidental reaction - unlike lupus or rheumatoid arthritis, where it's almost on purpose. What that means is that once the autoimmune reaction has been triggered it can't be stopped."

One-stop treatment

However, in the case of PANDAS, there was an active agent causing the body to accidentally attack its own tissue.

This raised the possibility that once the faulty antibodies were removed and new ones put in to stop the infection recurring, there would be no need for a further course of treatment.

"That was a wonderful discovery," she said.

However, further research would be needed to establish whether children outside the tight criteria applied in this study would benefit.

See also:

13 Oct 99 | Medical notes
Obsessive-Compulsive Disorder
03 Jun 98 | Latest News
Brain links taste and disgust
08 Sep 99 | Health
Taking control of Tourette's
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