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Strom NI, Gerring ZF, Galimberti M, Yu D, Halvorsen MW, Abdellaoui A, Rodriguez-Fontenla C, Sealock JM, Bigdeli T, Coleman JR, Mahjani B, Thorp JG, Bey K, Burton CL, Luykx JJ, Zai G, Alemany S, Andre C, Askland KD, Banaj N, Barlassina C, Nissen JB, Bienvenu OJ, Black D, Bloch MH, Boberg J, Børte S, Bosch R, Breen M, Brennan BP, Brentani H, Buxbaum JD, Bybjerg-Grauholm J, Byrne EM, Cabana-Dominguez J, Camarena B, Camarena A, Cappi C, Carracedo A, Casas M, Cavallini MC, Ciullo V, Cook EH, Crosby J, Cullen BA, De Schipper EJ, Delorme R, Djurovic S, Elias JA, Estivill X, Falkenstein MJ, Fundin BT, Garner L, German C, Gironda C, Goes FS, Grados MA, Grove J, Guo W, Haavik J, Hagen K, Harrington K, Havdahl A, Höffler KD, Hounie AG, Hucks D, Hultman C, Janecka M, Jenike E, Karlsson EK, Kelley K, Klawohn J, Krasnow JE, Krebs K, Lange C, Lanzagorta N, Levey D, Lindblad-Toh K, Macciardi F, Maher B, Mathes B, McArthur E, McGregor N, McLaughlin NC, Meier S, Miguel EC, Mulhern M, Nestadt PS, Nurmi EL, O’Connell KS, Osiecki L, Ousdal OT, Palviainen T, Pedersen NL, Piras F, Piras F, Potluri S, Rabionet R, Ramirez A, Rauch S, Reichenberg A, Riddle MA, Ripke S, Rosário MC, Sampaio AS, Schiele MA, Skogholt AH, Sloofman LGSG, Smit J, Soler AM, Thomas LF, Tifft E, Vallada H, van Kirk N, Veenstra-VanderWeele J, Vulink NN, Walker CP, Wang Y, Wendland JR, Winsvold BS, Yao Y, Zhou H, Agrawal A, Alonso P, Berberich G, Bucholz KK, Bulik CM, Cath D, Denys D, Eapen V, Edenberg H, Falkai P, Fernandez TV, Fyer AJ, Gaziano JM, Geller DA, Grabe HJ, Greenberg BD, Hanna GL, Hickie IB, Hougaard DM, Kathmann N, Kennedy J, Lai D, Landén M, Le Hellard S, Leboyer M, Lochner C, McCracken JT, Medland SE, Mortensen PB, Neale BM, Nicolini H, Nordentoft M, Pato M, Pato C, Pauls DL, Piacentini J, Pittenger C, Posthuma D, Ramos-Quiroga JA, Rasmussen SA, Richter MA, Rosenberg DR, Ruhrmann S, Samuels JF, Sandin S, Sandor P, Spalletta G, Stein DJ, Stewart SE, Storch EA, Stranger BE, Turiel M, Werge T, Andreassen OA, Børglum AD, Walitza S, Hveem K, Hansen BK, Rück CP, Martin NG, Milani L, Mors O, Reichborn-Kjennerud T, Ribasés M, Kvale G, Mataix-Cols D, Domschke K, Grünblatt E, Wagner M, Zwart JA, Breen G, Nestadt G, Kaprio J, Arnold PD, Grice DE, Knowles JA, Ask H, Verweij KJ, Davis LK, Smit DJ, Crowley JJ, Scharf JM, Stein MB, Gelernter J, Mathews CA, Derks EM, Mattheisen M. Genome-wide association study identifies 30 obsessive-compulsive disorder associated loci. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.13.24304161. [PMID: 38712091 PMCID: PMC11071577 DOI: 10.1101/2024.03.13.24304161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Obsessive-compulsive disorder (OCD) affects ~1% of the population and exhibits a high SNP-heritability, yet previous genome-wide association studies (GWAS) have provided limited information on the genetic etiology and underlying biological mechanisms of the disorder. We conducted a GWAS meta-analysis combining 53,660 OCD cases and 2,044,417 controls from 28 European-ancestry cohorts revealing 30 independent genome-wide significant SNPs and a SNP-based heritability of 6.7%. Separate GWAS for clinical, biobank, comorbid, and self-report sub-groups found no evidence of sample ascertainment impacting our results. Functional and positional QTL gene-based approaches identified 249 significant candidate risk genes for OCD, of which 25 were identified as putatively causal, highlighting WDR6, DALRD3, CTNND1 and genes in the MHC region. Tissue and single-cell enrichment analyses highlighted hippocampal and cortical excitatory neurons, along with D1- and D2-type dopamine receptor-containing medium spiny neurons, as playing a role in OCD risk. OCD displayed significant genetic correlations with 65 out of 112 examined phenotypes. Notably, it showed positive genetic correlations with all included psychiatric phenotypes, in particular anxiety, depression, anorexia nervosa, and Tourette syndrome, and negative correlations with a subset of the included autoimmune disorders, educational attainment, and body mass index.. This study marks a significant step toward unraveling its genetic landscape and advances understanding of OCD genetics, providing a foundation for future interventions to address this debilitating disorder.
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Affiliation(s)
- Nora I. Strom
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Psychiatric Phenomics and Genomics (IPPG), Ludwig-Maximilians University Munich, Munich, Germany
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Services, Region Stockholm , Stockholm, Sweden
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Zachary F. Gerring
- Department of Mental Health and Neuroscience, Translational Neurogenomics, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- Department of Population Health and Immunity, Healthy Development and Ageing, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Marco Galimberti
- Department of Psychiatry, Human Genetics, Yale University, New Haven, CT, USA
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Dongmei Yu
- Department of Center for Genomic Medicine, Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute, Cambridge, MA, USA
| | - Matthew W. Halvorsen
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Abdel Abdellaoui
- Department of Psychiatry, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Cristina Rodriguez-Fontenla
- CIMUS (Center for Research in Molecular Medicine and Chronic Diseases), Genomics and Bioinformatics, University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
- Grupo de Medicina Xenómica, Genetics, FIDIS (Instituto de Investigación Sanitaria de Santiago de Compostela), Santiago de Compostela, A Coruña, Spain
| | - Julia M. Sealock
- Vanderbilt Genetics Institute, Vanderbilt University, Nashville, TN, USA
| | - Tim Bigdeli
- Department of Psychiatry and Behavioral Sciences, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
- VA NY Harbor Healthcare System, Brooklyn, NY, USA
| | - Jonathan R. Coleman
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
- National Institute for Health and Care Research Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, London, United Kingdom
| | - Behrang Mahjani
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jackson G. Thorp
- Mental Health and Neuroscience Program, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- Faculty of Medicine, School of Biomedical Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Katharina Bey
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Christie L. Burton
- Department of Neurosciences and Mental Health, Hospital for Sick Children, Toronto, ON, Canada
| | - Jurjen J. Luykx
- Department of Psychiatry, Brain, University Medical Center Utrecht, Utrecht, The Netherlands
- Second opinion outpatient clinic, GGNet, Warnsveld, The Netherlands
| | - Gwyneth Zai
- Molecular Brain Science Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health,, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Silvia Alemany
- Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d’Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Mental Health, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain
| | - Christine Andre
- Obsessive-Compulsive Disorder Institute, McLean Hospital, Belmont, MA, USA
| | - Kathleen D. Askland
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Nerisa Banaj
- Laboratory of Neuropsychiatry, IRCCS Santa Lucia Foundation, Rome, Italy
| | | | - Judith Becker Nissen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Aarhus, Denmark
- Institute of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
| | - O. Joseph Bienvenu
- Department of Psychiatry and Behavioral Sciences, General Hospital Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Donald Black
- Departments of Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Michael H. Bloch
- Department of Child Study Center and Psychiatry, Yale University, New Haven, CT, USA
| | - Julia Boberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Services, Region Stockholm , Stockholm, Sweden
| | - Sigrid Børte
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, HUNT Center for Molecular and Clinical Epidemiology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
| | - Rosa Bosch
- Department of Child and Adolescent Mental Health, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Instituto de Salut Carlos III, Centro de Investigación Biomédica en Red de Salut Mental (CIBERSAM), Madrid, Spain
| | - Michael Breen
- Department of Psychiatry, Icahn School of Medicine At Mount Sinai, New York, NY, USA
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine At Mount Sinai, New York, NY, USA
- The Mindich Child Health and Development Institute, Icahn School of Medicine At Mount Sinai, New York, NY, USA
| | - Brian P. Brennan
- Obsessive-Compulsive Disorder Institute, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Helena Brentani
- Department of Psychiatry, Universidade De São Paulo, São Paulo, Brazil
| | - Joseph D. Buxbaum
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Enda M. Byrne
- Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
| | - Judit Cabana-Dominguez
- Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d’Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Mental Health, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain
| | - Beatriz Camarena
- Pharmacogenetics Department, Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramon de la Fuente Muñiz, Mexico City, México
| | | | - Carolina Cappi
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
- Department of Psychiatry, University of Sao Paulo, Sao Paulo, Brazil
| | - Angel Carracedo
- Center for Research in Molecular Medicine and Chronic Diseases (CiMUS), Genomics and Bioinformatics Group, University of Santiago de Compostela, Santiago de Compostela, Spain
- Galiician Foundation of Genomic Medicine, Grupo de Medicina Xenómica, Instituto de Investigación Sanitaria de Santiago -IDIS-, Santiago de Compostela, Spain
- Medicina Genómica, Centro de Investigación Biomédica en Red, Enfermedades Raras (CIBERER), Santiago de Compostela, Spain
| | - Miguel Casas
- Programa MIND Escoles, Hospital Sant Joan de Déu , Esplugues de Llobregat, Barcelona, Spain
- Departamento de Psiquiatría y Medicina Legal, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | | | - Valentina Ciullo
- Laboratory of Neuropsychiatry, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Edwin H. Cook
- Department of Psychiatry, University of Illinois Chicago, Chicago, IL, USA
| | - Jesse Crosby
- Obsessive-Compulsive Disorder Institute, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Bernadette A. Cullen
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medical Institutions, Baltimore , MD, USA
- Department of Mental Health, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elles J. De Schipper
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Services, Region Stockholm , Stockholm, Sweden
| | - Richard Delorme
- Child and Adolesccent Psycchiatry Department, APHP, Paris, France
| | - Srdjan Djurovic
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Jason A. Elias
- Psychiatry, McLean Hospital OCDI, Harvard Medical School, Belmont, MA, USA
- Adult Psychological Services, CBTeam LLC, Lexington, MA, USA
| | - Xavier Estivill
- qGenomics (Quantitative Genomics Laboratories), Esplugues de Llobregat, Barcelona, Spain
| | - Martha J. Falkenstein
- Obsessive-Compulsive Disorder Institute, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Bengt T. Fundin
- Department of Medical Epidemiology and Biostatistics, Center for Eating Disorders Innovation, Karolinska Institutet, Stockholm, Sweden
| | - Lauryn Garner
- Obsessive-Compulsive Disorder Institute, McLean Hospital, Belmont, MA, USA
| | | | - Christina Gironda
- Obsessive-Compulsive Disorder Institute, McLean Hospital, Belmont, MA, USA
| | - Fernando S. Goes
- Department of Psychiatry, Johns Hopkins University, Baltimore, MD, USA
| | - Marco A. Grados
- Department of Psychiatry and Behavioral Sciences, Child & Adolescent Psychiatry, Johns Hopkins University, Baltimore, MD, USA
| | - Jakob Grove
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Center for Genomics and Personalized Medicine, Aarhus, Denmark
- Bioinformatics Research Centre, Aarhus, Denmark
| | - Wei Guo
- Genetic Epidemiology Research Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Jan Haavik
- Department of Biomedicine, University of Bergen, Bergen, Norway
- Bergen Center for Brain Plasticity, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Kristen Hagen
- Department of Psychiatry, Møre og Romsdal Hospital Trust, Molde, Norway
- Bergen Center for Brain Plasticity, Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Mental Health, Norwegian University for Science and Technology, Trondheim, Norway
| | - Kelly Harrington
- Million Veteran Program (MVP) Coordinating Center, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Alexandra Havdahl
- PsychGen Centre for Genetic Epidemiology and Mental Health, Norwegian Institute of Public Health, Oslo, Norway
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Kira D. Höffler
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
- Department of Medical Genetics, Dr. Einar Martens Research Group for Biological Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Ana G. Hounie
- Department of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Donald Hucks
- Department of Medicine, Genetic Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christina Hultman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Magdalena Janecka
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Eric Jenike
- Obsessive-Compulsive Disorder Institute, McLean Hospital, Belmont, MA, USA
| | - Elinor K. Karlsson
- Department of Bioinformatics and Integrative Biology, University of Massachusetts Medical School, Worcester, MA, USA
- Department of Vertebrate Genomics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Kara Kelley
- Obsessive-Compulsive Disorder Institute, McLean Hospital, Belmont, MA, USA
| | - Julia Klawohn
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Medicine, MSB Medical School Berlin, Berlin, Germany
| | - Janice E. Krasnow
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Kristi Krebs
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Christoph Lange
- Department of Biostatistics, T.H. Chan School of Public Health, Boston, MA, USA
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | | | - Daniel Levey
- Department of Psychiatry, Yale University, West Haven, CT, USA
- Office of Research & Development, United States Department of Veterans Affairs, West Haven, CT, USA
| | - Kerstin Lindblad-Toh
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
- Department of Vertebrate Genomics, Broad Institute, Cambridge, MA, USA
| | - Fabio Macciardi
- Department of Psychiatry, University of California, Irvine (UCI), Irvine, CA, USA
| | - Brion Maher
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Brittany Mathes
- Obsessive-Compulsive Disorder Institute, McLean Hospital, Belmont, MA, USA
| | - Evonne McArthur
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Nicole C. McLaughlin
- Department of Psychiatry & Human Behavior, Alpert Medical School, Brown University, Providence, RI, USA
- Butler Hospital, Providence, RI, USA
| | - Sandra Meier
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Euripedes C. Miguel
- Department of Psychiatry, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Maureen Mulhern
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Paul S. Nestadt
- Department of Psychiatry and Behavioral Science, Johns Hopkins University, Baltimore, MD, USA
| | - Erika L. Nurmi
- Department of Psychiatry and Biobehavioral Sciences, Division of Child and Adolescent Psychiatry, University of California, Los Angeles, Los Angeles, CA, USA
| | - Kevin S. O’Connell
- Department of Clinical Medicine, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- NORMENT, University of Oslo, Oslo, Norway
| | - Lisa Osiecki
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Psychiatric and Neurodevelopmental Genetics Unit, Harvard Medical School, Boston, MA, USA
| | - Olga Therese Ousdal
- Department of Biomedicine, University of Bergen, Bergen, Norway
- Department of Biomedicine, Haukeland University Hospital, Bergen, Norway
| | - Teemu Palviainen
- Institute for Molecular Medicine Finland - FIMM, University of Helsinki, Helsinki, Finland
| | - Nancy L. Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Fabrizio Piras
- Laboratory of Neuropsychiatry, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Federica Piras
- Department of Clinical Neuroscience and Neurorehabilitation, Neuropsychiatry Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Sriramya Potluri
- Obsessive-Compulsive Disorder Institute, McLean Hospital, Belmont, MA, USA
| | - Raquel Rabionet
- Department of Genetics, microbiology and statistics, IBUB, Universitat de Barcelona, Barcelona, Spain
- CIBERER, Centro de investigación biomédica en red, Madrid, Spain
- Department of Human Molecular Genetics, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Alfredo Ramirez
- Department of Psychiatry and Psychotherapy, Division of Neurogenetics and Molecular Psychiatry, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Medical Faculty, Bonn, Germany
- DZNE Bonn, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Psychiatry and Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, UT Health San Antonio, San Antonio, TX, USA
- Cologne Excellence Cluster for Stress Responses in Ageing-associated diseases (CECAD), University of Cologne, Cologne, Germany
| | - Scott Rauch
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA, USA
| | - Abraham Reichenberg
- Department of Mental disorders, Norwegian Institute of Public Health, New York, NY, USA
| | - Mark A. Riddle
- Department of Psychiatry and Behavioral Sciences, Child and Adolescent, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stephan Ripke
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin, Berlin, Germany
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- site Berlin-Potsdam, German Center for Mental Health (DZPG), Berlin, Germany
| | - Maria C. Rosário
- Department of Psychiatry, Child and Adolescent Psychiatry Unit (UPIA), Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Aline S. Sampaio
- Department of Neurosciences and Mental Health, Medical School, Federal University of Bahia, Salvador, Brazil
| | - Miriam A. Schiele
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Freiburg, Medical Center - University of Freiburg, Freiburg, Germany
| | - Anne Heidi Skogholt
- Department of Public Health and Nursing, HUNT Center for Molecular and Clinical Epidemiology, Trondheim, Norway
| | | | - Jan Smit
- Department of Psychiatry, Faculty of Medicine, Locaion Vumc, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Artigas María Soler
- Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d’Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Mental Health, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain
- Department of Genetics, Microbiology, and Statistics, Faculty of Biology, Universitat de Barcelona (UB), Barcelona, Spain
| | - Laurent F. Thomas
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Public Health and Nursing, K. G. Jebsen Center for Genetic Epidemiology, Norwegian University of Science and Technology, Trondheim, Norway
- BioCore - Bioinformatics Core Facility, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Laboratory Medicine, St.Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Eric Tifft
- Obsessive-Compulsive Disorder Institute, McLean Hospital, Belmont, MA, USA
| | - Homero Vallada
- Department of Psychiatry, Universidade de Sao Paulo, São Paulo, Brazil
- Department of Molecular Medicine and Surgery, CMM, Karolinska Institutet, Stockholm, Sweden
| | - Nathanial van Kirk
- OCD Institute, Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Belmont, MA, USA
| | - Jeremy Veenstra-VanderWeele
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, Columbia University, New York, NY, USA
- Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - Nienke N. Vulink
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Ying Wang
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jens R. Wendland
- Laboratory of Clinical Science, NIMH Intramural Research Program, Bethesda, MD, USA
| | - Bendik S. Winsvold
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
- Department of Neurology, Oslo University Hospital, Oslo, Norway
- HUNT Center for Molecular and Clinical Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Yin Yao
- Department of Computional Biology, Institute of Life Science, Fudan University, Fudan, China
| | - Hang Zhou
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
- Section of Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, CT, USA
| | | | | | | | | | | | - Arpana Agrawal
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO, USA
| | - Pino Alonso
- Department of Psychiatry, OCD Clinical and Research Unit, Bellvitge Hospital, Barcelona, Spain
- Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
- Department of Psychiatry and Mental Health, Bellvitge Biomedical Research Institute IDIBELLL, Barcelona, Spain
- CIBERSAM, Mental Health Network Biomedical Research Center, Madrid, Spain
| | - Götz Berberich
- Psychosomatic Department, Windach Hospital of Neurobehavioural Research and Therapy, Windach, Germany
| | - Kathleen K. Bucholz
- Department of Psychiatry, Washington U. School of Medicine, St Louis, MO, USA
| | - Cynthia M. Bulik
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Danielle Cath
- Departments of Rijksuniversiteit Groningen and Psychiatry, University Medical Center Groninge, Groningen, The Netherlands
- Department of Specialized Training, Drenthe Mental Health Care Institute, Groningen, The Netherlands
| | - Damiaan Denys
- Department of Psychiatry, Institute of The Royal Netherlands Academy of Arts and Sciences (NIN-KNAW), Amsterdam, The Netherlands
| | - Valsamma Eapen
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW, Sydney, NSW, Australia
- Academic Unit of Child Psychiatry South-West Sydney (AUCS), South-West Sydney Clinical School, SWSLHD & Ingham Institute, Sydney, NSW, Australia
| | - Howard Edenberg
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany
- Department of Psychiatry, Max Planck Institute, Munich, Germany
| | - Thomas V. Fernandez
- Child Study Center and Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Abby J. Fyer
- Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, , Columbia University Medical Center, New York, NY, USA
| | - J M. Gaziano
- Department of Medicine, VA Boston Healthcare System, Boston, MA, USA
- Department of Medicine, Mass General Brigham, Boston, MA, USA
| | - Dan A. Geller
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Child Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Hans J. Grabe
- Department of Psychiatry & Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Benjamin D. Greenberg
- COBRE Center on Neuromodulation, Butler Hospital, Providence, RI, USA
- Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI, USA
| | - Gregory L. Hanna
- Department of Psychiatry, Child and Adolescent Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Ian B. Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - David M. Hougaard
- Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
| | - Norbert Kathmann
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - James Kennedy
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Dongbing Lai
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mikael Landén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, University of Gothenburg, Gothenburg, Sweden
| | - Stéphanie Le Hellard
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Bergen Center for brain plasticity, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Marion Leboyer
- Department of Addictology and Psychiatry, Univ Paris Est Créteil, AP-HP, Inserm, Paris, France
| | - Christine Lochner
- Department of Psychiatry, SA MRC Unit on Risk and Resilience in Mental Disorders, Stellenbosch University, Stellenbosch, South Africa
| | - James T. McCracken
- Department of Psychiatry and Biobehavioral Sciences, Division of Child and Adolescent Psychiatry, University of California, Los Angeles, Los Angeles, CA, USA
| | - Sarah E. Medland
- Department of Mental Health, Psychiatric Genetics, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Preben B. Mortensen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
- Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - Benjamin M. Neale
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, , Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Humberto Nicolini
- Department of Psychiatry, Psychiatry, Carracci Medical Group, Mexico City, México
- Psiquiatría, Instituto Nacional de Medicina Genómica, Mexico City, México
| | - Merete Nordentoft
- Mental Health Center Copenhagen, Copenhagen Research Center for Mental Health, Mental Health services in the Capital Region of Denmark, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Michele Pato
- Department of Psychiatry, Rutgers University, Piscataway, NJ, USA
| | - Carlos Pato
- Department of Psychiatry, Rutgers University, Piscataway, NJ, USA
| | - David L. Pauls
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | | | - Danielle Posthuma
- Department of Complex Trait Genetics, Vrije Universiteit Amsterdam, Center for Neurogenomics and Cognitive Research, Amsterdam Neuroscience, Amsterdam, The Netherlands
- Department of Child and Adolescent Psychiatric, Section Complex Trait Genetics, VU Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Josep Antoni Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Group of Psychiatry, Mental Health and Addictions, Psychiatric Genetics Unit, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Steven A. Rasmussen
- Department of Psychiatry & Human Behavior, Alpert Medical School, Brown University, Providence, RI, USA
| | - Margaret A. Richter
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - David R. Rosenberg
- Department of Psychiatry and Behavioral Neurosciences, Child and Adolescent Psychiatry, Wayne State University School of Medicine, Detroit, MI, USA
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Jack F. Samuels
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sven Sandin
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paul Sandor
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Gianfranco Spalletta
- Laboratory of Neuropsychiatry, IRCCS Santa Lucia Foundation, Rome, Italy
- Department of Psychiatry and Behavioral Sciences, Division of Neuropsychiatry, Baylor College of Medicine, Houston, TX, USA
| | - Dan J. Stein
- Dept of Psychiatry & Neuroscience Institute, SAMRC Unit on Risk & Reslience in Mental Disorders, University of Cape Town, Cape Town, Western Cape, South Africa
| | - S. Evelyn Stewart
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- British Columbia Children’s Hospital Research Institute, Vancouver, BC, Canada
- British Columbia Mental Health and Substance Use Services Research Institute (BCMHSUS), Vancouver, BC, Canada
| | - Eric A. Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Barbara E. Stranger
- Department of Pharmacology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Thomas Werge
- Institute of Biological Psychiatry, Mental Health Center Sct. Hans, Copenhagen University Hospital, Mental Health Services (RHP), Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ole A. Andreassen
- Institute of Clinical Medicine, NORMENT Centre, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Center for Precision Psychiatry, Oslo University Hospital, Oslo, , Norway
| | - Anders D. Børglum
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus University, Aarhus, Denmark
- Center for Genomics and Personalized Medicine, CGPM, Aarhus University, Aarhus, Denmark
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich (PUK), University of Zurich, Zürich, Switzerland
- Neuroscience Center Zurich, University of Zurich and the ETH Zuric, Zurich, Switzerland
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Kristian Hveem
- HUNT Center for Molecular and Clinical Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- HUNT Research Center, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Research, Innovation and Education, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Bjarne K. Hansen
- Bergen Center for Brain Plasticity (BCBP), Psychiatry, Haukeland University Hospital, Bergen, Norway
- Centre for Crisis Psychology, Psychology, University of Bergen, Bergen, Norway
| | - Christian P. Rück
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Services, Region Stockholm , Stockholm, Sweden
| | - Nicholas G. Martin
- Department of Genetic Epidemiology, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Lili Milani
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Ole Mors
- Psychosis Reasearch Unit, Aarhus University Hospital - Psychiatry, 8200 Aarhus N, Denmark
| | - Ted Reichborn-Kjennerud
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Marta Ribasés
- Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d’Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain
- Department of Genetics, Microbiology, and Statistics, Faculty of Biology, Universitat de Barcelona (UB), Barcelona, Spain
- Department of Mental Health, Hospital Universitari Vall d’Hebron , Barcelona, Spain
| | - Gerd Kvale
- Bergen Center for Brain Plasticity, Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Vestland
| | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Services, Region Stockholm , Stockholm, Sweden
| | - Katharina Domschke
- Department of Psychiatry, University of Freiburg - Medical Faculty, Freiburg, Germany
- German Center for Mental Health (DZPG), Partner Site Berlin, Berlin, Germany
| | - Edna Grünblatt
- Neuroscience Center Zurich, University of Zurich and the ETH Zuric, Zurich, Switzerland
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich (PUK), University of Zurich, Zürich, Schweiz
| | - Michael Wagner
- Departments of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - John-Anker Zwart
- HUNT Center for Molecular and Clinical Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Research and Innovation, Clinical Neuroscience, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Gerome Breen
- Social, Genetic, and Developmental Psychiatric Centre, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
| | - Gerald Nestadt
- Department of Psychiatry and Behavioral Science, Johns Hopkins University, Baltimore, MD, USA
| | - Jaakko Kaprio
- Institute for Molecular Medicine FIMM, University of Helsinki, Helsinki, Finland
| | - Paul D. Arnold
- Department of Psychiatry, The Mathison Centre for Mental Health Research & Education, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Program in Genetics and Genome Biology, Hospital for Sick Children, Toronto, ON, Canada
| | - Dorothy E. Grice
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - James A. Knowles
- Department of Genetics, Human Genetics Institute of New Jersey, Rutgers University, Piscataway, NJ, USA
| | - Helga Ask
- PsychGen Center for Genetic Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
- PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, Norway
| | - Karin J. Verweij
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Lea K. Davis
- Department of Medicine, Division of Genetic Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Dirk J. Smit
- Department of Psychiatry, Amsterdam UMC location AMC, Amsterdam, The Netherlands
| | - James J. Crowley
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Services, Region Stockholm , Stockholm, Sweden
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jeremiah M. Scharf
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Murray B. Stein
- Psychiatry Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry and School of Public Health, University of California San Diego, La Jolla, CA, USA
| | - Joel Gelernter
- Department of Psychiatry, Human Genetics (Psychiatry), Yale University School of Medicine, West Haven, CT, USA
- Department of Psychiatry, Veterans Affairs Connecticut Healthcare Center, West Haven, CT, USA
| | - Carol A. Mathews
- Psychiatry and Genetics Institute, Center for OCD, Anxiety and Related Disorders, University of Florida, Gainesville, FL, USA
| | - Eske M. Derks
- Department of Mental Health and Neuroscience, QIMR Berghofer, Brisbane, Australia
| | - Manuel Mattheisen
- Department of Psychiatric Phenomics and Genomics (IPPG), Ludwig-Maximilians University Munich, Munich, Germany
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
- Department of Community Health and Epidemiology and Faculty of Computer Science, Dalhousie University, Halifax, NS, Canada
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2
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Trau SP, Singer HS. Tourette Syndrome and Tic Disorders. Pediatr Rev 2024; 45:85-95. [PMID: 38296781 DOI: 10.1542/pir.2023-006014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Affiliation(s)
- Steven P Trau
- Division of Child Neurology, Department of Neurology, University of North Carolina-Chapel Hill School of Medicine, Chapel Hill, NC
| | - Harvey S Singer
- Department of Neurology, Johns Hopkins Hospital and the Kennedy Krieger Institute, Baltimore, MD
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3
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Hardin H, Shao W, Bernstein JA. An updated review of pediatric autoimmune neuropsychiatric disorders associated with Streptococcus/pediatric acute-onset neuropsychiatric syndrome, also known as idiopathic autoimmune encephalitis: What the allergist should know. Ann Allergy Asthma Immunol 2023; 131:567-575. [PMID: 37634580 DOI: 10.1016/j.anai.2023.08.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/20/2023] [Accepted: 08/21/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Pediatric acute-onset neuropsychiatric syndrome, further subcategorized as pediatric autoimmune neuropsychiatric disorders associated with streptococcus, is a form of idiopathic autoimmune encephalitis (IAE). Poststreptococcal autoimmunity seen in Idiopathic autoimmune encephalitis manifests as various neuropsychiatric symptoms such as obsessive rituals, tics, anxiety, depression, and many others. Idiopathic autoimmune encephalitis has clinically heterogeneous phenotypes that make accurate diagnosing difficult, although diagnostic testing such as the Cunningham Panel increases the likelihood of finding effective treatments. Current recommended treatments include psychiatric medication, behavioral intervention, antibiotics, anti-inflammatory therapy, and immunomodulating therapy. OBJECTIVE To provide an updated review on the diagnosis, management, and treatment of pediatric autoimmune neuropsychiatric disorder associated with streptococcus and pediatric autoimmune neuropsychiatric syndrome, also referred to as IAE. RESULTS Information from 47 sources was used to outline current knowledge of IAE pathophysiology, clinical manifestations, and epidemiology, and to outline diagnostic recommendations and current treatment guidelines. Gaps in knowledge, in addition to current controversy, were also outlined to provide a thorough background of this condition and future needs for IAE research. CONCLUSION Owing to the complexity and variability in ways patients with IAE may present to the allergist/immunologist office, an interdisciplinary approach is imperative to provide patients with the best medical care. Still, more research is needed to further elucidate the mechanism(s) and optimal treatment algorithm for IAE to facilitate broader recognition and acceptance of this condition by the medical community.
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Affiliation(s)
- Hannah Hardin
- Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio
| | - Wenhai Shao
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jonathan A Bernstein
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.
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4
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La Bella S, Scorrano G, Rinaldi M, Di Ludovico A, Mainieri F, Attanasi M, Spalice A, Chiarelli F, Breda L. Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS): Myth or Reality? The State of the Art on a Controversial Disease. Microorganisms 2023; 11:2549. [PMID: 37894207 PMCID: PMC10609001 DOI: 10.3390/microorganisms11102549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/04/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) syndrome is one of the most controversial diseases in pediatric rheumatology. Despite first being described more than 25 years ago as the sudden and rapid onset of obsessive-compulsive disorder (OCD) and/or tic disorder symptoms as complications of a Group A beta-hemolytic Streptococcus (GAS) infection, precise epidemiological data are still lacking, and there are no strong recommendations for its treatment. Recent advances in the comprehension of PANDAS pathophysiology are largely attributable to animal model studies and the understanding of the roles of Ca++/calmodulin-dependent protein kinase (CaM kinase) II, disrupted dopamine release in the basal ganglia, and striatal cholinergic interneurons. The diagnosis of PANDAS should be made after an exclusion process and should include prepubescent children with a sudden onset of OCD and/or a tic disorder, with a relapsing/remitting disease course, a clear temporal association between GAS infection and onset or exacerbation of symptoms, and the association with other neurological abnormalities such as motoric hyperactivity and choreiform movements. Antibiotic medications are the primary therapeutic modality. Nonetheless, there is a paucity of randomized studies and validated data, resulting in a scarcity of solid recommendations.
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Affiliation(s)
- Saverio La Bella
- Department of Pediatrics, “G. D’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy
| | - Giovanna Scorrano
- Department of Pediatrics, “G. D’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy
| | - Marta Rinaldi
- Department of Pediatrics, Buckinghamshire Healthcare NHS Trust, Aylesbury-Thames Valley Deanery, Aylesbury HP21 8AL, UK
| | - Armando Di Ludovico
- Department of Pediatrics, “G. D’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy
| | - Francesca Mainieri
- Department of Pediatrics, “G. D’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy
| | - Marina Attanasi
- Department of Pediatrics, “G. D’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy
| | - Alberto Spalice
- Child Neurology Division, Department of Pediatrics, “Sapienza” University of Rome, 00185 Rome, Italy
| | - Francesco Chiarelli
- Department of Pediatrics, “G. D’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy
| | - Luciana Breda
- Department of Pediatrics, “G. D’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy
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5
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Kulumani Mahadevan LS, Murphy M, Selenica M, Latimer E, Harris BT. Clinicopathologic Characteristics of PANDAS in a Young Adult: A Case Report. Dev Neurosci 2023; 45:335-341. [PMID: 37699369 PMCID: PMC10753865 DOI: 10.1159/000534061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 09/08/2023] [Indexed: 09/14/2023] Open
Abstract
Pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS) is an acute onset or exacerbation of neuropsychiatric symptoms following a group A streptococcus infection. It is believed to be a result of autoimmune response to streptococcal infection, but there is insufficient evidence to fully support this theory. Although this disease is primarily thought to be a disease of childhood, it is reported to occur also in adults. PANDAS is a well-defined clinical entity, but the neuropathology of this condition has not been established yet. We describe the clinical course of a 26-year-old female diagnosed with PANDAS. She committed suicide and her brain was biobanked for further studies. We examined the banked tissue and performed special stains, immunohistochemical, and immunofluorescence analyses to characterize the neuropathology of this condition. Histology of the temporal lobes, hippocampus, and basal ganglia shows mild gliosis and Alzheimer's type II astrocytes. Acute hypoxic ischemic changes were noted in hippocampus CA1 and CA2 areas. Immunostaining shows increased parenchymal/perivascular GFAP staining and many vessels with mild increases in CD3-, CD4-, and CD25-stained lymphocytes in the basal ganglia. The findings suggest that CD4- and CD25-positive T cells might have an important role in understanding the neuroinflammation and pathogenesis of this condition. The case represents the first neuropathological evaluation report for PANDAS.
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Affiliation(s)
| | | | - Marina Selenica
- Department of Neurology, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Elizabeth Latimer
- Latimer Neurology Center, Washington, DC, USA
- Department of Neurology, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Brent T. Harris
- Department of Pathology, Medstar Georgetown University Hospital, Washington, DC, USA
- Department of Neurology, Medstar Georgetown University Hospital, Washington, DC, USA
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Dufour BD, McBride E, Bartley T, Juarez P, Martínez-Cerdeño V. Distinct patterns of GABAergic interneuron pathology in autism are associated with intellectual impairment and stereotypic behaviors. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:1730-1745. [PMID: 36935610 PMCID: PMC10846597 DOI: 10.1177/13623613231154053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
LAY ABSTRACT Autism spectrum disorder is a neurodevelopmental condition characterized by deficits in sociability and communication and the presence of repetitive behaviors. How specific pathological alterations of the brain contribute to the clinical profile of autism spectrum disorder remains unknown. We previously found that a specific type of inhibitory interneuron is reduced in number in the autism spectrum disorder prefrontal cortex. Here, we assessed the relationship between interneuron reduction and autism spectrum disorder symptom severity. We collected clinical records from autism spectrum disorder (n = 20) and assessed the relationship between the severity of symptoms and interneuron number. We found that the reduced number of inhibitory interneurons that we previously reported is linked to specific symptoms of autism spectrum disorder, particularly stereotypic movements and intellectual impairments.
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Affiliation(s)
- Brett D Dufour
- UC Davis Department of Psychiatry and Behavioral Sciences, USA
- UC Davis School of Medicine, USA
- Institute for Pediatric Regenerative Medicine, USA
| | - Erin McBride
- UC Davis School of Medicine, USA
- Institute for Pediatric Regenerative Medicine, USA
- UC Davis Department of Pathology and Laboratory Medicine, USA
| | - Trevor Bartley
- UC Davis School of Medicine, USA
- Institute for Pediatric Regenerative Medicine, USA
- UC Davis Department of Pathology and Laboratory Medicine, USA
| | - Pablo Juarez
- UC Davis School of Medicine, USA
- Institute for Pediatric Regenerative Medicine, USA
| | - Verónica Martínez-Cerdeño
- UC Davis School of Medicine, USA
- Institute for Pediatric Regenerative Medicine, USA
- UC Davis Department of Pathology and Laboratory Medicine, USA
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7
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Barry D, Terry SF. Diagnose Quickly and Effectively: Now. Genet Test Mol Biomarkers 2023; 27:229-231. [PMID: 37643322 DOI: 10.1089/gtmb.2023.29075.persp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
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8
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Gagliano A, Carta A, Tanca MG, Sotgiu S. Pediatric Acute-Onset Neuropsychiatric Syndrome: Current Perspectives. Neuropsychiatr Dis Treat 2023; 19:1221-1250. [PMID: 37251418 PMCID: PMC10225150 DOI: 10.2147/ndt.s362202] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 05/03/2023] [Indexed: 05/31/2023] Open
Abstract
Pediatric acute-onset neuropsychiatric syndrome (PANS) features a heterogeneous constellation of acute obsessive-compulsive disorder (OCD), eating restriction, cognitive, behavioral and/or affective symptoms, often followed by a chronic course with cognitive deterioration. An immune-mediated etiology is advocated in which the CNS is hit by different pathogen-driven (auto)immune responses. This narrative review focused on recent clinical (ie, diagnostic criteria, pre-existing neurodevelopmental disorders, neuroimaging) and pathophysiological (ie, CSF, serum, genetic and autoimmune findings) aspects of PANS. We also summarized recent points to facilitate practitioners with the disease management. Relevant literature was obtained from PubMed database which included only English-written, full-text clinical studies, case reports, and reviews. Among a total of 1005 articles, 205 were pertinent to study inclusion. Expert opinions are converging on PANS as the effect of post-infectious events or stressors leading to "brain inflammation", as it is well-established for anti-neuronal psychosis. Interestingly, differentiating PANS from either autoimmune encephalitides and Sydenham's chorea or from alleged "pure" psychiatric disorders (OCD, tics, Tourette's syndrome), reveals several overlaps and more analogies than differences. Our review highlights the need for a comprehensive algorithm to help both patients during their acute distressing phase and physicians during their treatment decision. A full agreement on the hierarchy of each therapeutical intervention is missing owing to the limited number of randomized controlled trials. The current approach to PANS treatment emphasizes immunomodulation/anti-inflammatory treatments in association with both psychotropic and cognitive-behavioral therapies, while antibiotics are suggested when an active bacterial infection is established. A dimensional view, taking into account the multifactorial origin of psychiatric disorders, should suggest neuro-inflammation as a possible shared substrate of different psychiatric phenotypes. Hence, PANS and PANS-related disorders should be considered as a conceptual framework describing the etiological and phenotypical complexity of many psychiatric disorders.
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Affiliation(s)
- Antonella Gagliano
- Department of Health Science, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
- Department of Biomedical Sciences, University of Cagliari & "A. Cao" Paediatric Hospital, Child & Adolescent Neuropsychiatry Unit, Cagliari, Italy
| | - Alessandra Carta
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Unit of Child Neuropsychiatry, Sassari, Italy
| | - Marcello G Tanca
- Department of Biomedical Sciences, University of Cagliari & "A. Cao" Paediatric Hospital, Child & Adolescent Neuropsychiatry Unit, Cagliari, Italy
| | - Stefano Sotgiu
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Unit of Child Neuropsychiatry, Sassari, Italy
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9
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Case report: Varicella associated neuropsychiatric syndrome (VANS) in two pediatric cases. Brain Behav Immun Health 2023; 28:100602. [PMID: 36860280 PMCID: PMC9969201 DOI: 10.1016/j.bbih.2023.100602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/13/2023] [Accepted: 02/10/2023] [Indexed: 02/13/2023] Open
Abstract
Background Viral or bacterial infections can trigger auto-immune inflammatory reactions and conditions in children. Self-reactivity arises due to similarities in molecular structures between pathogenic microorganisms and regular body structures with consequent immune-cross reactions. Reactivation of latent Varicella Zoster Virus (VZV) infections can cause neurological sequalae, including cerebellitis, post-herpetic neuralgias, meningo/encephalitis, vasculopathy and myelopathy. We propose a syndrome caused by auto-immune reactivity triggered by molecular mimicry between VZV and the brain, culminating in a post-infectious psychiatric syndrome with childhood VZV infections. Case presentation Two individuals, a 6-year-old male and 10-year-old female developed a neuro-psychiatric syndrome 3-6 weeks following a confirmed VZV infection with intrathecal oligoclonal bands. The 6-year-old male presented with a myasthenic syndrome, behavior deterioration and regression in school, he was poorly responsive to IVIG and risperidone, however had a pronounced response to steroid treatment. The 10-year-old female presented with marked insomnia, agitation, and behavioral regression as well as mild bradykinesia. A trial of neuroleptics and sedatives resulted in a mild unsustained reduction in psychomotor agitation and IVIG was also unsuccessful, however the patient was very responsive to steroid therapy. Conclusion Psychiatric syndromes with evidence of intrathecal inflammation temporally related to VZV infections that are responsive to immune modulation have not been described before. Here we report two cases demonstrating neuro-psychiatric symptoms following VZV infection, with evidence of persistent CNS inflammation following the resolution of infection, and response to immune modulation.
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10
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Efe A. SARS-CoV-2/COVID-19 associated pediatric acute-onset neuropsychiatric syndrome a case report of female twin adolescents. PSYCHIATRY RESEARCH CASE REPORTS 2022; 1:100074. [PMID: 36267397 PMCID: PMC9562621 DOI: 10.1016/j.psycr.2022.100074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/11/2022] [Accepted: 10/13/2022] [Indexed: 11/07/2022]
Abstract
“Pediatric acute-onset neuropsychiatric syndrome”, or PANS, is a rare syndrome characterized by an acute onset of obsessive-compulsive disorder (OCD), and/or severely restricted food intake accompanied by a variety of neuropsychiatric symptoms. To our knowledge, this is the first case report of twin adolescents with COVID-19-associated PANS. Dizygotic twin sisters in late teens, with abrupt and acute onset of severely restrictive food intake, weight loss, OCD, anxiety with intermittent auditory and visual hallucinations, depression, attention deficit, and sleep disturbances, simultaneously accompanied by milder neurologic symptoms such as hand tremor, tinnitus, dizziness, headache, and weakness of proximal muscles, were applied to child and adolescent psychiatry clinic. The only relevant agent underlying those neuropsychiatric and somatic complaints was COVID-19, and it was validated with laboratory testing, such as positive IgG titers of SARS-CoV-2 and negative biomarkers for other possible bacterial or viral agents. Generalized epileptic anomaly and a vermian/folial atrophy in the cerebellum were detected in further evaluations. Treatment options consisted of psychotropic agents, antibiotics, antiepileptic, and intravenous immunoglobulin transfusion finely treated the neuropsychiatric symptoms. Clinicians should consider SARS-CoV-2 as a potential agent, when a child presents with abrupt onset, dramatic neuropsychiatric symptoms also consisting of PANS, even in asymptomatic patients or with mild respiratory symptoms.
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11
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Prus K, Weidner K, Alquist C. Therapeutic plasma exchange in adolescent and adult patients with autoimmune neuropsychiatric disorders associated with streptococcal infections. J Clin Apher 2022; 37:597-599. [PMID: 36251457 PMCID: PMC10092170 DOI: 10.1002/jca.22023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 09/09/2022] [Accepted: 09/30/2022] [Indexed: 11/10/2022]
Abstract
Pediatric autoimmune neuropsychiatric disorders associated with streptococcal (PANDAS) infections and pediatric acute-onset neuropsychiatric syndrome (PANS) are typically diagnosed in childhood. Therapeutic plasma exchange (TPE) has been recommended to remove relevant antibodies and treat symptomatic presentations in children and adolescents, but there are no studies that evaluate the use of TPE in patients who are diagnosed later in life. It is therefore unclear if using an accepted treatment for pediatric PANS/PANDAS patients would be beneficial in adults with prolonged PANDAS/PANS symptomatic histories. This study investigated 16 late adolescent and adult PANDAS/PANS patients' responses to TPE. Improvement was noted in over half of the patients with available follow-up information.
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Affiliation(s)
- Kristina Prus
- Biomedical Services, American Red Cross, Portland, Oregon, USA
| | - Krystol Weidner
- Hoxworth Blood Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Caroline Alquist
- Hoxworth Blood Center, University of Cincinnati, Cincinnati, Ohio, USA
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12
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Boyd TM, Moyer SM, Lambert D. Interdisciplinary Collaboration to Care for Students Diagnosed with PANDAS: An Education and Referral Intervention. J Sch Nurs 2022:10598405221129553. [PMID: 36177527 DOI: 10.1177/10598405221129553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) is an autoimmune disorder associated with sudden onset of behavior changes. The prevalence of PANDAS is increasing in schools and interdisciplinary collaboration, knowledge, and the use of referrals to the school nurse are important for supporting students. This project sought to provide education on PANDAS to the interdisciplinary school team and implement a referral process for students exhibiting behavior changes. A self-directed online educational intervention was employed. A pretest-posttest design was utilized to assess knowledge before, immediately after, and six-weeks after the educational intervention. A referral log was implemented to track the number of referrals to the school nurse. The final sample size included 19 participants. Mean scores increased from pretest to posttest, and the implementation of a referral system produced 12 new school nurse referrals. Further strategies are needed to enhance interdisciplinary collaboration and support students experiencing health-related issues.
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Affiliation(s)
- Tiffany M Boyd
- Department of Nursing, 5482Millersville University, Millersville, PA, USA
| | - Susan M Moyer
- Department of Nursing, 5482Millersville University, Millersville, PA, USA
| | - Dawn Lambert
- Department of Nursing, 5482Millersville University, Millersville, PA, USA
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13
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Hutanu A, Reddy LN, Mathew J, Avanthika C, Jhaveri S, Tummala N. Pediatric Autoimmune Neuropsychiatric Disorders Associated With Group A Streptococci: Etiopathology and Diagnostic Challenges. Cureus 2022; 14:e27729. [PMID: 36106298 PMCID: PMC9447625 DOI: 10.7759/cureus.27729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2022] [Indexed: 11/06/2022] Open
Abstract
Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) have attracted a lot of interest and discussion since it was originally characterized in 1998. The role of streptococcal infection in children with abrupt-onset obsessive-compulsive disorder (OCD) and new-onset tics, the natural history of this entity, and the role of symptomatic and disease-modifying therapies, such as antibiotics, immunotherapy, and psychoactive drugs, are still unresolved issues. Alternative therapies for acute-onset OCD have been developed based on this postulated pathophysiology, including antibiotics and immunomodulatory therapy. The literature on PANDAS therapy is varied but there is no clinical consensus on the treatment of choice. While there is no convincing evidence for the autoimmune rationale for PANDAS, given the increased attention to this entity and the apparent growth in usage of this diagnostic category, it is critical to address concerns about the condition's diagnosis, treatment, and pathogenesis. We conducted a multi-language literature search on Medline, Cochrane, Embase, and Google Scholar for a period spanning until October 2021. The following search strings and Medical Subject Heading (MeSH) terms were used: “PANDAS,” “Group A Streptococcus,” “OCD,” and “tics.” We explored the literature on PANDAS in terms of its epidemiology, pathophysiology, the role of group A streptococcal infection, associated complications, and prophylactic and treatment modalities. We examined current working definitions of PANDAS, analyzed differential diagnoses, and published pieces of evidence for therapies associated with this entity, with a view to proposing a therapeutic strategy for children with acute symptoms that meet PANDAS criteria, in this review article.
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14
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Trifiletti R, Lachman HM, Manusama O, Zheng D, Spalice A, Chiurazzi P, Schornagel A, Serban AM, van Wijck R, Cunningham JL, Swagemakers S, van der Spek PJ. Identification of ultra-rare genetic variants in pediatric acute onset neuropsychiatric syndrome (PANS) by exome and whole genome sequencing. Sci Rep 2022; 12:11106. [PMID: 35773312 PMCID: PMC9246359 DOI: 10.1038/s41598-022-15279-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 06/21/2022] [Indexed: 12/13/2022] Open
Abstract
Abrupt onset of severe neuropsychiatric symptoms including obsessive-compulsive disorder, tics, anxiety, mood swings, irritability, and restricted eating is described in children with Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS). Symptom onset is often temporally associated with infections, suggesting an underlying autoimmune/autoinflammatory etiology, although direct evidence is often lacking. The pathological mechanisms are likely heterogeneous, but we hypothesize convergence on one or more biological pathways. Consequently, we conducted whole exome sequencing (WES) on a U.S. cohort of 386 cases, and whole genome sequencing (WGS) on ten cases from the European Union who were selected because of severe PANS. We focused on identifying potentially deleterious genetic variants that were de novo or ultra-rare (MAF) < 0.001. Candidate mutations were found in 11 genes (PPM1D, SGCE, PLCG2, NLRC4, CACNA1B, SHANK3, CHK2, GRIN2A, RAG1, GABRG2, and SYNGAP1) in 21 cases, which included two or more unrelated subjects with ultra-rare variants in four genes. These genes converge into two broad functional categories. One regulates peripheral immune responses and microglia (PPM1D, CHK2, NLRC4, RAG1, PLCG2). The other is expressed primarily at neuronal synapses (SHANK3, SYNGAP1, GRIN2A, GABRG2, CACNA1B, SGCE). Mutations in these neuronal genes are also described in autism spectrum disorder and myoclonus-dystonia. In fact, 12/21 cases developed PANS superimposed on a preexisting neurodevelopmental disorder. Genes in both categories are also highly expressed in the enteric nervous system and the choroid plexus. Thus, genetic variation in PANS candidate genes may function by disrupting peripheral and central immune functions, neurotransmission, and/or the blood-CSF/brain barriers following stressors such as infection.
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Affiliation(s)
| | - Herbert M Lachman
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA.
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.
- Department of Genetics, Albert Einstein College of Medicine, Bronx, NY, USA.
- Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Olivia Manusama
- Department of Immunology, Erasmus MC, Rotterdam, The Netherlands
| | - Deyou Zheng
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Alberto Spalice
- Department of Pediatrics, Pediatric Neurology, Sapienza University of Rome, Rome, Italy
| | - Pietro Chiurazzi
- Sezione di Medicina Genomica, Dipartimento Scienze della Vita e Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento Scienze di Laboratorio e Infettivologiche, UOC Genetica Medica, Rome, Italy
| | - Allan Schornagel
- GGZ-Delfland, Kinderpraktijk Zoetermeer, Zoetermeer, The Netherlands
| | - Andreea M Serban
- Department of Pathology and Clinical Bioinformatics, Erasmus MC, Rotterdam, The Netherlands
| | - Rogier van Wijck
- Department of Pathology and Clinical Bioinformatics, Erasmus MC, Rotterdam, The Netherlands
| | - Janet L Cunningham
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Sigrid Swagemakers
- Department of Pathology and Clinical Bioinformatics, Erasmus MC, Rotterdam, The Netherlands
| | - Peter J van der Spek
- Department of Pathology and Clinical Bioinformatics, Erasmus MC, Rotterdam, The Netherlands
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15
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Neuropsychiatric Disorders in Pediatric Long COVID-19: A Case Series. Brain Sci 2022; 12:brainsci12050514. [PMID: 35624901 PMCID: PMC9138973 DOI: 10.3390/brainsci12050514] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/10/2022] [Accepted: 04/14/2022] [Indexed: 01/13/2023] Open
Abstract
Few data are available regarding the incidence and the evolution of neuropsychiatric manifestations in children with a history of COVID-19. We herein report five consequent cases of pediatric patients with psychiatric and neurological symptoms of long COVID-19. All patients, mainly males, reported asymptomatic-to-mild COVID-19 and underwent home self-isolation. Abnormal movements, anxiety, and emotional dysregulation were the most recurrent symptoms observed from a few weeks to months after the resolution of the acute infection. A later onset was observed in younger patients. Blood tests and brain imaging resulted in negative results in all subjects; pharmacological and cognitive behavioral therapy was set. A multifactorial etiology could be hypothesized in these cases, as a result of a complex interplay between systemic and brain inflammation and environmental stress in vulnerable individuals. Longer follow-up is required to observe the evolution of neuropsychiatric manifestation in the present cohort and other young patients with previous SARS-CoV-2 infection.
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16
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Fernell E, Sundin M, Fasth A, Dinkler L, Galazka M, Gillberg C, Johnson M. Paediatric Acute onset Neuropsychiatric Syndrome: Exploratory study finds no evidence of HLA class II association but high rate of autoimmunity in first-degree relatives. Acta Paediatr 2022; 111:820-824. [PMID: 33566388 DOI: 10.1111/apa.15805] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 02/01/2021] [Accepted: 02/09/2021] [Indexed: 11/28/2022]
Abstract
AIM Paediatric acute-onset neuropsychiatric syndrome (PANS) is defined by an acute onset of obsessive-compulsive disorder and/or eating restrictions and at least two other severe neuropsychiatric symptoms. The condition is suspected to have an immune-mediated pathophysiology, but reliable biomarkers have not been identified. METHODS We hypothesised that PANS, like narcolepsy, might have a human leucocyte antigen (HLA) association, as found in 95% of children developing narcolepsy after H1N1 immunisation. Low resolution genotyping of the MHC class II antigens HLA-DRB1 and HLA-DQB1 was performed using two different PCR-based methods. In addition, parents were interviewed regarding a detailed family history of autoimmune diseases in first-degree relatives. A total of 18 children, aged 5-14 (mean 8.2) years at onset of PANS met symptom criteria. RESULTS No evident association between PANS and the specific HLA alleles examined was observed. In first-degree relatives of 10 of the 18 children, an autoimmune disease had been diagnosed, and three of the 18 children themselves had an autoimmune disease. CONCLUSION No HLA allele association such as seen in children with narcolepsy after H1N1 immunisation could be confirmed in this group of children with PANS. However, more than half the group had a first-degree relative with a diagnosed autoimmune disease.
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Affiliation(s)
- Elisabeth Fernell
- Gillberg Neuropsychiatry Centre Sahlgrenska Academy Gothenburg University Gothenburg Sweden
- Child Neuropsychiatry Clinic Sahlgrenska University Hospital Gothenburg Sweden
| | - Mikael Sundin
- Division of Clinical Science, Intervention and Technology Department of Pediatrics Karolinska Institutet Stockholm Sweden
- Section of Pediatric Hematology, Immunology and HCT Astrid Lindgren Children's Hospital Karolinska University Hospital Huddinge Stockholm Sweden
| | - Anders Fasth
- Department of Pediatrics Institute of Clinical Sciences Sahlgrenska Academy Gothenburg University Gothenburg Sweden
| | - Lisa Dinkler
- Gillberg Neuropsychiatry Centre Sahlgrenska Academy Gothenburg University Gothenburg Sweden
| | - Martyna Galazka
- Gillberg Neuropsychiatry Centre Sahlgrenska Academy Gothenburg University Gothenburg Sweden
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre Sahlgrenska Academy Gothenburg University Gothenburg Sweden
- Child Neuropsychiatry Clinic Sahlgrenska University Hospital Gothenburg Sweden
| | - Mats Johnson
- Gillberg Neuropsychiatry Centre Sahlgrenska Academy Gothenburg University Gothenburg Sweden
- Child Neuropsychiatry Clinic Sahlgrenska University Hospital Gothenburg Sweden
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17
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Cocuzza S, Maniaci A, La Mantia I, Nocera F, Caruso D, Caruso S, Iannella G, Vicini C, Privitera E, Lechien JR, Pavone P. Obsessive-Compulsive Disorder in PANS/PANDAS in Children: In Search of a Qualified Treatment-A Systematic Review and Metanalysis. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9020155. [PMID: 35204876 PMCID: PMC8869780 DOI: 10.3390/children9020155] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/18/2022] [Indexed: 12/05/2022]
Abstract
Background: Several treatment options have been proposed for pediatric acute-onset neuropsychiatric syndrome/pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (PANS/PANDAS). Still, no clear therapeutic protocol has been recognized to prevent these neuropsychiatric diseases. The study aims to report on the literature evidence and different treatment strategies related to these disorders. Methods: We analyzed the last 20 years’ English language literature and performed a comprehensive review of the PANS/PANDAS treatment, including studies reporting OCD outcomes post-treatment follow-up. Results: We covered 11 articles in our systematic literature review for a total of 473 patients, of which four studies included 129 surgical subjects and seven papers with 326 medically treated patients. Pooled outcomes analysis, surgical and medical treatment reported an OCD reduction, but no statistical significance was obtained (p < 0.05 for both). Conclusions: Surgical therapy in selected patients can lead to promising results, although further evidence is needed. On the other hand, the role of medical therapy remains controversial, often due to the lack of univocal curative protocols and variable responses depending on the drug used and the timing of administration. Therefore, further investigations are necessary to clarify the most appropriate therapeutic procedure.
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Affiliation(s)
- Salvatore Cocuzza
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, 95123 Catania, Italy; (S.C.); (A.M.); (I.L.M.); (F.N.); (S.C.); (E.P.)
| | - Antonino Maniaci
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, 95123 Catania, Italy; (S.C.); (A.M.); (I.L.M.); (F.N.); (S.C.); (E.P.)
| | - Ignazio La Mantia
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, 95123 Catania, Italy; (S.C.); (A.M.); (I.L.M.); (F.N.); (S.C.); (E.P.)
| | - Francesco Nocera
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, 95123 Catania, Italy; (S.C.); (A.M.); (I.L.M.); (F.N.); (S.C.); (E.P.)
| | - Daniela Caruso
- Unit of Clinical Pediatrics, A.O.U. “Policlinico”, P.O. “G. Rodolico”, University of Catania, 95123 Catania, Italy;
| | - Sebastiano Caruso
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, 95123 Catania, Italy; (S.C.); (A.M.); (I.L.M.); (F.N.); (S.C.); (E.P.)
| | - Giannicola Iannella
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, 47121 Forlì, Italy; (G.I.); (C.V.)
- Department of Sensory Organs, Sapienza University of Rome, 00194 Rome, Italy
| | - Claudio Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, 47121 Forlì, Italy; (G.I.); (C.V.)
| | - Elio Privitera
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, 95123 Catania, Italy; (S.C.); (A.M.); (I.L.M.); (F.N.); (S.C.); (E.P.)
| | - Jerome Rene Lechien
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), 7000 Mons, Belgium;
| | - Piero Pavone
- Unit of Clinical Pediatrics, A.O.U. “Policlinico”, P.O. “G. Rodolico”, University of Catania, 95123 Catania, Italy;
- Correspondence:
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18
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Pfeiffer HCV, Wickstrom R, Skov L, Sørensen CB, Sandvig I, Gjone IH, Ygberg S, Visscher C, Idring Nordstrom S, Herner LB, Hesselmark E, Hedderly T, Lim M, Debes NM. Clinical guidance for diagnosis and management of suspected Pediatric Acute-onset Neuropsychiatric Syndrome in the Nordic countries. Acta Paediatr 2021; 110:3153-3160. [PMID: 33848371 DOI: 10.1111/apa.15875] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/16/2021] [Accepted: 03/19/2021] [Indexed: 12/13/2022]
Abstract
Pediatric acute-onset neuropsychiatric syndrome is a clinical concept used to describe a subgroup of children with sudden onset of psychiatric and somatic symptoms. The diagnostic term and especially management of children differs depending on the clinical setting to which they present, and the diagnosis and management is controversial. The aim of this paper is to propose a clinical guidance including homogenous diagnostic work-up and management of paediatric acute onset neuropsychiatric syndrome within the Nordic countries. The guidance is authored by a Nordic-UK working group consisting of paediatric neurologist, child psychiatrists and psychologists from Denmark, Norway, Sweden and Great Britain, and is the result of broad consensus. CONCLUSION: Consensus was achieved in the collaboration on work-up and treatment of patients with paediatric acute-onset neuropsychiatric syndrome, which we hope will improve and homogenise patient care and enable future collaborative research in the field.
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Affiliation(s)
- Helle Cecilie Viekilde Pfeiffer
- Department of Child Neurology Oslo University Hospital Oslo Norway
- Department of Pediatrics and Adolescence Medicine Copenhagen University Hospital Hvidovre Copenhagen Denmark
| | - Ronny Wickstrom
- Department of Women´s and Children's Health Neuropediatric Unit Karolinska Institutet Stockholm Sweden
| | - Liselotte Skov
- Department of Pediatrics and Adolescence Medicin Copenhagen University Hospital Herlev Copenhagen Denmark
| | - Camilla Birgitte Sørensen
- Department of Pediatrics and Adolescence Medicin Copenhagen University Hospital Herlev Copenhagen Denmark
| | - Inger Sandvig
- Department of Child Neurology Oslo University Hospital Oslo Norway
| | - Inger Helene Gjone
- Division of Pediatric and Adolescent Medicine Department of Child and Adolescent Mental Health in Hospitals Oslo University Hospital Oslo Norway
| | - Sofia Ygberg
- Department of Women´s and Children's Health Neuropediatric Unit Karolinska Institutet Stockholm Sweden
| | - Caroline Visscher
- Centre for Psychiatry Research Department of Clinical Neuroscience Region Stockholm, Child and Adolescent Psychiatry Research Center Karolinska Institutet & Stockholm Healthcare Services Stockholm Sweden
| | - Selma Idring Nordstrom
- Centre for Psychiatry Research Department of Clinical Neuroscience Region Stockholm, Child and Adolescent Psychiatry Research Center Karolinska Institutet & Stockholm Healthcare Services Stockholm Sweden
| | - Linn Breen Herner
- Division of Pediatric and Adolescent Medicine Department of Child and Adolescent Mental Health in Hospitals Oslo University Hospital Oslo Norway
| | - Eva Hesselmark
- Centre for Psychiatry Research Department of Clinical Neuroscience Region Stockholm, Child and Adolescent Psychiatry Research Center Karolinska Institutet & Stockholm Healthcare Services Stockholm Sweden
| | - Tammy Hedderly
- Tic and Neurodevelopmental Movements Service (TANDeM) Children's Neurosciences Centre Evelina London Children's Hospital, Guys and St Thomas NHS Foundation Trust London UK
| | - Ming Lim
- Children's Neurosciences Evelina London Children's Hospital at Guy's and St Thomas’ NHS Foundation Trust King's Health Partners Academic Health Science Centre London UK
| | - Nanette Marinette Debes
- Department of Pediatrics and Adolescence Medicin Copenhagen University Hospital Herlev Copenhagen Denmark
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19
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Johnson M, Fernell E, Gillberg C, Fasth A, Dinkler L, Blennow K, Zetterberg H. No neurochemical evidence of neuronal injury or glial activation in children with Paediatric Acute-onset Neuropsychiatric Syndrome. An explorative pilot study. World J Biol Psychiatry 2021; 22:800-804. [PMID: 33792486 DOI: 10.1080/15622975.2021.1907716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: Paediatric Acute-onset Neuropsychiatric Syndrome (PANS) is characterised by an acute onset of obsessive compulsive disorder, combined with at least two other neuropsychiatric symptoms with acute onset. Diagnostic criteria also require that no specific medical aetiology is identified. Although there are no verified aetiological biomarkers, PANS is assumed to be a neuroinflammatory disorder with a possible autoimmune aetiology. Neurochemical markers such as neurofilament light (NfL, a neuronal injury marker) and glial fibrillary acidic protein (GFAP, an astrocytic activation marker) have not been published for this patient group.Method: Blood samples from 17 children meeting diagnostic criteria for PANS, after assessment at a child neuropsychiatry clinic were analysed for serum concentrations of NfL and GFAP. Ten age-matched children without any neurological or psychiatric disorder served as a comparison group.Results: No difference was found in mean NfL and mean GFAP serum concentrations between children with PANS and controls.Conclusion: Neuronal injury and astrocyte activation do not seem to be a major event in PANS. The study group was small, and even if findings may be reassuring for parents and patients, they should be interpreted with caution and verified in larger cohorts and possibly with other markers in both serum and CSF.
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Affiliation(s)
- Mats Johnson
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Child Neuropsychiatry Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Elisabeth Fernell
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Child Neuropsychiatry Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Child Neuropsychiatry Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anders Fasth
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Lisa Dinkler
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience & Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience & Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK.,UK Dementia Research Institute at UCL, London, UK
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20
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Taylor K, Muscal E, Van Mater H. The Role of Pediatric Rheumatologists in Autoimmune Brain Disease. Rheum Dis Clin North Am 2021; 48:343-369. [PMID: 34798957 DOI: 10.1016/j.rdc.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The spectrum of autoimmune and inflammatory brain diseases continues to evolve with medical advances facilitating both the detection of inflammation of the central nervous system and the discovery of novel disease mechanisms. The clinical overlap of these disorders with primary rheumatic diseases and the efficacy of immunotherapy have led to strong partnerships between pediatric rheumatologists, neurologists, psychiatrists, and other providers in the care of children with these conditions. Early diagnosis and initiation of targeted therapy improve clinical outcomes, highlighting the importance of interdisciplinary collaborative care.
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Affiliation(s)
- Kathryn Taylor
- Pediatrics, Division of Neurology, Duke University, Durham, NC, USA.
| | - Eyal Muscal
- Division of Rheumatology and Co-appointment in Neurology and Developmental Neuroscience, Baylor College of Medicine, Houston, TX, USA
| | - Heather Van Mater
- Pediatrics, Division of Rheumatology, Duke University, Durham, NC, USA
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21
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Sharawat IK, Panda PK, Gupta R. Pediatric Acute-Onset Neuropsychiatric Syndrome with Capgras Syndrome. Ann Indian Acad Neurol 2021; 24:600-601. [PMID: 34728963 PMCID: PMC8513957 DOI: 10.4103/aian.aian_959_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 09/17/2020] [Accepted: 10/11/2020] [Indexed: 11/08/2022] Open
Affiliation(s)
- Indar Kumar Sharawat
- Department of Pediatrics, Pediatric Neurology Division, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Prateek Kumar Panda
- Department of Pediatrics, Pediatric Neurology Division, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Ravi Gupta
- Department of Psychiatry, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Szejko N, Dunalska A, Lombroso A, McGuire JF, Piacentini J. Genomics of Obsessive-Compulsive Disorder-Toward Personalized Medicine in the Era of Big Data. Front Pediatr 2021; 9:685660. [PMID: 34746045 PMCID: PMC8564378 DOI: 10.3389/fped.2021.685660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 09/20/2021] [Indexed: 01/11/2023] Open
Abstract
Pathogenesis of obsessive-compulsive disorder (OCD) mainly involves dysregulation of serotonergic neurotransmission, but a number of other factors are involved. Genetic underprints of OCD fall under the category of "common disease common variant hypothesis," that suggests that if a disease that is heritable is common in the population (a prevalence >1-5%), then the genetic contributors-specific variations in the genetic code-will also be common in the population. Therefore, the genetic contribution in OCD is believed to come from multiple genes simultaneously and it is considered a polygenic disorder. Genomics offers a number of advanced tools to determine causal relationship between the exposure and the outcome of interest. Particularly, methods such as polygenic risk score (PRS) or Mendelian Randomization (MR) enable investigation of new pathways involved in OCD pathogenesis. This premise is also facilitated by the existence of publicly available databases that include vast study samples. Examples include population-based studies such as UK Biobank, China Kadoorie Biobank, Qatar Biobank, All of US Program sponsored by National Institute of Health or Generations launched by Yale University, as well as disease-specific databases, that include patients with OCD and co-existing pathologies, with the following examples: Psychiatric Genomics Consortium (PGC), ENIGMA OCD, The International OCD Foundation Genetics Collaborative (IOCDF-GC) or OCD Collaborative Genetic Association Study. The aim of this review is to present a comprehensive overview of the available Big Data resources for the study of OCD pathogenesis in the context of genomics and demonstrate that OCD should be considered a disorder which requires the approaches offered by personalized medicine.
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Affiliation(s)
- Natalia Szejko
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
- Department of Bioethics, Medical University of Warsaw, Warsaw, Poland
| | - Anna Dunalska
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Adam Lombroso
- Child Study Center, Yale School of Medicine, New Haven, CT, United States
| | - Joseph F. McGuire
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MS, United States
- Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
| | - John Piacentini
- Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
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Vaiman M, Mametov K, Roitblat Y, Abba M, Nehuliaieva L, Foonberg M, Frank C, Kaliberdenko VB, Shterenshis M. Reassessment of Pediatric Tension-Type Headaches. JOURNAL OF PEDIATRIC NEUROLOGY 2021. [DOI: 10.1055/s-0040-1721460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AbstractA retrospective multicenter chart review was conducted with the objective of evaluating the hypothesis that certain cases diagnosed as tension-type headache (TTH) in pediatric neurology are not stress-related or central sensitization-related conditions but may mimic an autoimmune disorder of the dura mater. Of the 29,642 patient charts reviewed, 12,424 charts (42%) were excluded because of incomplete data and 17,218 cases were analyzed. For all the 29,642 charts, TTH or chronic daily headaches were diagnosed in 29.2% of cases. Among the 17,218 cases subjected to detailed diagnostic procedures, TTH was diagnosed in only 5%. In 7,044 cases, the initial diagnosis of TTH was changed to headache attributed to infection (87.4%), which was supported by the presence of meningeal signs, high antistreptolysin-O titers, and, in 46% of cases, magnetic resonance imaging (MRI)-detected thickening of the cranial dura mater. The initial diagnosis of migraine was confirmed in 87.7% of cases (8,034/9,162). In some cases of treatment-resistant pediatric recurrent headaches, which are initially diagnosed as TTH, a secondary type of headache may be suspected as the underlying cause. Usually this type of headache has streptococcal infection-related laboratory findings, the meninges as the site of the lesion, and meningism as the clinical presentation.
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Affiliation(s)
- Michael Vaiman
- Department of Otorhinolaryngology, Assaf Harofeh Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Kadri Mametov
- Emergency Department, Crimean Republican Center for Disaster Medicine and Emergency Medical Aid, Simferopol, Russia
| | - Yulia Roitblat
- Science Research Department, Alexander Muss High School in Israel affiliated with Alexander Muss Institute for Israel Education, Hod HaSharon, Israel
| | - Michael Abba
- Department of Oral and Maxillofacial Surgery, Barzilai Medical Center, Ashkelon, Israel
| | - Liliia Nehuliaieva
- Department of Pediatrics, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Maya Foonberg
- Science Research Department, Alexander Muss High School in Israel affiliated with Alexander Muss Institute for Israel Education, Hod HaSharon, Israel
- Department of Advanced Research and Design, Milken Community High School, Los Angeles, California, United States
| | - Charles Frank
- Science Research Department, Alexander Muss High School in Israel affiliated with Alexander Muss Institute for Israel Education, Hod HaSharon, Israel
- Department of Advanced Research and Design, Milken Community High School, Los Angeles, California, United States
| | - Vitalii B. Kaliberdenko
- Department of Internal Medicine, V.I. Vernadsky Crimean Federal University, Simferopol, Russia
| | - Michael Shterenshis
- Science Research Department, Alexander Muss High School in Israel affiliated with Alexander Muss Institute for Israel Education, Hod HaSharon, Israel
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24
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Teixeira AL, Vasconcelos LP, Nunes MDCP, Singer H. Sydenham's chorea: from pathophysiology to therapeutics. Expert Rev Neurother 2021; 21:913-922. [PMID: 34353207 DOI: 10.1080/14737175.2021.1965883] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Sydenham's chorea is an autoimmune chorea emerging after a group A beta-hemolytic streptococcal (GABHS) infection, i.e. a rheumatic chorea with or without the presence of carditis or arthritis. The disorder, defined by the presence of chorea, is also associated with cognitive and behavioral symptoms, including emotional lability, anxiety, depressive and obsessive-compulsive symptoms. The authors review the pathophysiology, clinical characteristics, and available evidence on therapeutic strategies, the latter including the secondary prevention of GABHS infections, reduction of chorea, and immune modulation. Sydenham's chorea has been regarded as a model for pediatric autoimmune neuropsychiatric disorders, however, the field is marked by conflicting results and controversies. Regarding therapeutics, there are limited high-quality interventional studies and the selection of treatment strategy often relies on the clinician's experience. A serial treatment algorithm is presented based upon the severity of clinical presentation and response to symptomatic pharmacotherapy.
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Affiliation(s)
- Antonio L Teixeira
- Infectious Diseases and Tropical Medicine Graduation Program, School of Medicine, Universidade Federal De Minas Gerais, Belo Horizonte, Brazil.,Institute of Education and Research, Santa Casa Bh, Belo Horizonte, Brazil.,Neuropsychiatry Program, Ut Health Science Center at Houston, USA
| | - Luiz P Vasconcelos
- Infectious Diseases and Tropical Medicine Graduation Program, School of Medicine, Universidade Federal De Minas Gerais, Belo Horizonte, Brazil
| | - Maria do Carmo Pereira Nunes
- Infectious Diseases and Tropical Medicine Graduation Program, School of Medicine, Universidade Federal De Minas Gerais, Belo Horizonte, Brazil
| | - Harvey Singer
- Department of Neurology, Johns Hopkins Medicine and Kennedy Krieger Institute, Baltimore, MD, USA
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25
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Garone G, Graziola F, Grasso M, Capuano A. Acute Movement Disorders in Childhood. J Clin Med 2021; 10:jcm10122671. [PMID: 34204464 PMCID: PMC8234395 DOI: 10.3390/jcm10122671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 12/14/2022] Open
Abstract
Acute-onset movement disorders (MDs) are an increasingly recognized neurological emergency in both adults and children. The spectrum of possible causes is wide, and diagnostic work-up is challenging. In their acute presentation, MDs may represent the prominent symptom or an important diagnostic clue in a broader constellation of neurological and extraneurological signs. The diagnostic approach relies on the definition of the overall clinical syndrome and on the recognition of the prominent MD phenomenology. The recognition of the underlying disorder is crucial since many causes are treatable. In this review, we summarize common and uncommon causes of acute-onset movement disorders, focusing on clinical presentation and appropriate diagnostic investigations. Both acquired (immune-mediated, infectious, vascular, toxic, metabolic) and genetic disorders causing acute MDs are reviewed, in order to provide a useful clinician’s guide to this expanding field of pediatric neurology.
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Affiliation(s)
- Giacomo Garone
- Movement Disorders Clinic, Department of Neurosciences, Bambino Gesù Children’s Hospital, IRCCS, viale San Paolo 15, 00146 Rome, Italy; (G.G.); (F.G.); (M.G.)
- University Department of Pediatrics, Bambino Gesù Children’s Hospital, 00165 Rome, Italy
| | - Federica Graziola
- Movement Disorders Clinic, Department of Neurosciences, Bambino Gesù Children’s Hospital, IRCCS, viale San Paolo 15, 00146 Rome, Italy; (G.G.); (F.G.); (M.G.)
| | - Melissa Grasso
- Movement Disorders Clinic, Department of Neurosciences, Bambino Gesù Children’s Hospital, IRCCS, viale San Paolo 15, 00146 Rome, Italy; (G.G.); (F.G.); (M.G.)
| | - Alessandro Capuano
- Movement Disorders Clinic, Department of Neurosciences, Bambino Gesù Children’s Hospital, IRCCS, viale San Paolo 15, 00146 Rome, Italy; (G.G.); (F.G.); (M.G.)
- Correspondence:
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26
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Hart SJ, Worley G, Kishnani PS, Van Mater H. Case Report: Improvement Following Immunotherapy in an Individual With Seronegative Down Syndrome Disintegrative Disorder. Front Neurol 2021; 12:621637. [PMID: 33841297 PMCID: PMC8032932 DOI: 10.3389/fneur.2021.621637] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/03/2021] [Indexed: 11/13/2022] Open
Abstract
Down syndrome disintegrative disorder (DSDD) is a condition of unknown etiology characterized by acute cognitive decline, catatonia, insomnia, and autistic features in individuals with Down syndrome. A prior report of four patients with DSDD suggested a potential autoimmune etiology based on the presence of autoantibodies and on successful treatment with immunotherapy that included intravenous immunoglobulin (IVIG). Herein, we present the case of an 8-year old girl who developed acute cognitive decline to a dementia-like state, insomnia, catatonia, and autistic features. In contrast to the four patients with DSDD above, she had no evidence of autoimmunity and presented at a younger age. Given the gravity of her acute deterioration and the exclusion of other etiologies, she was treated with immunotherapy presumptively. She responded with near complete resolution of symptoms, but demonstrated a pattern of mild decline as she approached each monthly dosing of IVIG and steroids, reversed by treatment. Mycophenolate mofetil (MMF) was therefore added, with stability throughout the month and the ability to taper off IVIG. After stopping IVIG, she had a mild recurrence of symptoms that again resolved with repeat IVIG followed by tapering off. Outcome was assessed at 2.5 years after presentation, at which time she was back to her premorbid condition, except for persistent tics off immunotherapy. This case supports the contention that patients with a rapid onset of severe symptoms consistent with DSDD, who have a thorough evaluation with the exclusion of other etiologies, may warrant a trial of immunotherapy with steroids, IVIG and/or other agents like MMF even in the absence of evidence of autoimmunity on standard evaluation.
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Affiliation(s)
- Sarah J Hart
- Department of Pediatrics, Division of Medical Genetics, Duke University Medical Center, Durham, NC, United States
| | - Gordon Worley
- Department of Pediatrics, Division of Pediatric Neurology, Duke University Medical Center, Durham, NC, United States
| | - Priya S Kishnani
- Department of Pediatrics, Division of Medical Genetics, Duke University Medical Center, Durham, NC, United States
| | - Heather Van Mater
- Department of Pediatrics, Division of Pediatric Rheumatology, Duke University Medical Center, Durham, NC, United States
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27
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Martino D, Schrag A, Anastasiou Z, Apter A, Benaroya-Milstein N, Buttiglione M, Cardona F, Creti R, Efstratiou A, Hedderly T, Heyman I, Huyser C, Madruga M, Mir P, Morer A, Mol Debes N, Moll N, Müller N, Müller-Vahl K, Munchau A, Nagy P, Plessen KJ, Porcelli C, Rizzo R, Roessner V, Schnell J, Schwarz M, Skov L, Steinberg T, Tarnok Z, Walitza S, Dietrich A, Hoekstra PJ. Association of Group A Streptococcus Exposure and Exacerbations of Chronic Tic Disorders: A Multinational Prospective Cohort Study. Neurology 2021; 96:e1680-e1693. [PMID: 33568537 DOI: 10.1212/wnl.0000000000011610] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 12/14/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine prospectively the association between group A Streptococcus (GAS) pharyngeal exposures and exacerbations of tics in a large multicenter population of youth with chronic tic disorders (CTD) across Europe. METHODS We followed up 715 children with CTD (age 10.7 ± 2.8 years, 76.8% boys), recruited by 16 specialist clinics from 9 countries, and followed up for 16 months on average. Tic, obsessive-compulsive symptom (OCS), and attention-deficit/hyperactivity disorder (ADHD) severity was assessed during 4-monthly study visits and telephone interviews. GAS exposures were analyzed using 4 possible combinations of measures based on pharyngeal swab and serologic testing. The associations between GAS exposures and tic exacerbations or changes of tic, OC, and ADHD symptom severity were measured, respectively, using multivariate logistic regression plus multiple failure time analyses and mixed effects linear regression. RESULTS A total of 405 exacerbations occurred in 308 of 715 (43%) participants. The proportion of exacerbations temporally associated with GAS exposure ranged from 5.5% to 12.9%, depending on GAS exposure definition. We did not detect any significant association of any of the 4 GAS exposure definitions with tic exacerbations (odds ratios ranging between 1.006 and 1.235, all p values >0.3). GAS exposures were associated with longitudinal changes of hyperactivity-impulsivity symptom severity ranging from 17% to 21%, depending on GAS exposure definition. CONCLUSIONS This study does not support GAS exposures as contributing factors for tic exacerbations in children with CTD. Specific workup or active management of GAS infections is unlikely to help modify the course of tics in CTD and is therefore not recommended.
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Affiliation(s)
- Davide Martino
- From the Department of Clinical Neurosciences (D.M.), Cumming School of Medicine & Hotchkiss Brain Institute, University of Calgary, Canada; Department of Clinical Neuroscience (A.S., Z.A.), UCL Institute of Neurology, University College London, UK; Child and Adolescent Psychiatry Department (A.A., N.B.-M., T.S.), Schneider Children's Medical Center of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari "Aldo Moro"; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology, Directorate National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Department of Child and Adolescent Psychiatry (C.H.), De Bascule, Amsterdam UMC, the Netherlands; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (M.M.), Seville; Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville; Department of Child and Adolescent Psychiatry and Psychology (A. Morer), Institute of Neurosciences, Hospital Clínic; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (A. Morer), Barcelona; Centro de Investigación en Red de Salud Mental (CIBERSAM) (A. Morer), Instituto Carlos III, Madrid; Department of Medicine (A. Morer), University of Barcelona, Spain; Child and Adolescent Mental Health Center (N.M.D., K.J.P., L.S.), Mental Health Services, Capital Region of Denmark and University of Copenhagen, Denmark; Institute of Laboratory Medicine (N. Moll, M.S.) and Department of Psychiatry and Psychotherapy (N. Müller, J.S.), University Hospital LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.M.-V.), Hannover Medical School; Institute of Neurogenetics (A. Munchau), University of Lübeck, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (P.N., Z.T.), Budapest, Hungary; Division of Child and Adolescent Psychiatry, Department of Psychiatry (K.J.P.), Lausanne University Hospital, Switzerland; ASL BA, Mental Health Department (C.P.), Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry, Department of Clinical and Experimental Medicine (R.R.), University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Clinic of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and Department of Child and Adolescent Psychiatry (A.D., P.J.H.), University of Groningen, University Medical Center Groningen, the Netherlands.
| | - Anette Schrag
- From the Department of Clinical Neurosciences (D.M.), Cumming School of Medicine & Hotchkiss Brain Institute, University of Calgary, Canada; Department of Clinical Neuroscience (A.S., Z.A.), UCL Institute of Neurology, University College London, UK; Child and Adolescent Psychiatry Department (A.A., N.B.-M., T.S.), Schneider Children's Medical Center of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari "Aldo Moro"; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology, Directorate National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Department of Child and Adolescent Psychiatry (C.H.), De Bascule, Amsterdam UMC, the Netherlands; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (M.M.), Seville; Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville; Department of Child and Adolescent Psychiatry and Psychology (A. Morer), Institute of Neurosciences, Hospital Clínic; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (A. Morer), Barcelona; Centro de Investigación en Red de Salud Mental (CIBERSAM) (A. Morer), Instituto Carlos III, Madrid; Department of Medicine (A. Morer), University of Barcelona, Spain; Child and Adolescent Mental Health Center (N.M.D., K.J.P., L.S.), Mental Health Services, Capital Region of Denmark and University of Copenhagen, Denmark; Institute of Laboratory Medicine (N. Moll, M.S.) and Department of Psychiatry and Psychotherapy (N. Müller, J.S.), University Hospital LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.M.-V.), Hannover Medical School; Institute of Neurogenetics (A. Munchau), University of Lübeck, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (P.N., Z.T.), Budapest, Hungary; Division of Child and Adolescent Psychiatry, Department of Psychiatry (K.J.P.), Lausanne University Hospital, Switzerland; ASL BA, Mental Health Department (C.P.), Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry, Department of Clinical and Experimental Medicine (R.R.), University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Clinic of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and Department of Child and Adolescent Psychiatry (A.D., P.J.H.), University of Groningen, University Medical Center Groningen, the Netherlands
| | - Zacharias Anastasiou
- From the Department of Clinical Neurosciences (D.M.), Cumming School of Medicine & Hotchkiss Brain Institute, University of Calgary, Canada; Department of Clinical Neuroscience (A.S., Z.A.), UCL Institute of Neurology, University College London, UK; Child and Adolescent Psychiatry Department (A.A., N.B.-M., T.S.), Schneider Children's Medical Center of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari "Aldo Moro"; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology, Directorate National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Department of Child and Adolescent Psychiatry (C.H.), De Bascule, Amsterdam UMC, the Netherlands; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (M.M.), Seville; Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville; Department of Child and Adolescent Psychiatry and Psychology (A. Morer), Institute of Neurosciences, Hospital Clínic; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (A. Morer), Barcelona; Centro de Investigación en Red de Salud Mental (CIBERSAM) (A. Morer), Instituto Carlos III, Madrid; Department of Medicine (A. Morer), University of Barcelona, Spain; Child and Adolescent Mental Health Center (N.M.D., K.J.P., L.S.), Mental Health Services, Capital Region of Denmark and University of Copenhagen, Denmark; Institute of Laboratory Medicine (N. Moll, M.S.) and Department of Psychiatry and Psychotherapy (N. Müller, J.S.), University Hospital LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.M.-V.), Hannover Medical School; Institute of Neurogenetics (A. Munchau), University of Lübeck, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (P.N., Z.T.), Budapest, Hungary; Division of Child and Adolescent Psychiatry, Department of Psychiatry (K.J.P.), Lausanne University Hospital, Switzerland; ASL BA, Mental Health Department (C.P.), Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry, Department of Clinical and Experimental Medicine (R.R.), University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Clinic of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and Department of Child and Adolescent Psychiatry (A.D., P.J.H.), University of Groningen, University Medical Center Groningen, the Netherlands
| | - Alan Apter
- From the Department of Clinical Neurosciences (D.M.), Cumming School of Medicine & Hotchkiss Brain Institute, University of Calgary, Canada; Department of Clinical Neuroscience (A.S., Z.A.), UCL Institute of Neurology, University College London, UK; Child and Adolescent Psychiatry Department (A.A., N.B.-M., T.S.), Schneider Children's Medical Center of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari "Aldo Moro"; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology, Directorate National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Department of Child and Adolescent Psychiatry (C.H.), De Bascule, Amsterdam UMC, the Netherlands; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (M.M.), Seville; Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville; Department of Child and Adolescent Psychiatry and Psychology (A. Morer), Institute of Neurosciences, Hospital Clínic; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (A. Morer), Barcelona; Centro de Investigación en Red de Salud Mental (CIBERSAM) (A. Morer), Instituto Carlos III, Madrid; Department of Medicine (A. Morer), University of Barcelona, Spain; Child and Adolescent Mental Health Center (N.M.D., K.J.P., L.S.), Mental Health Services, Capital Region of Denmark and University of Copenhagen, Denmark; Institute of Laboratory Medicine (N. Moll, M.S.) and Department of Psychiatry and Psychotherapy (N. Müller, J.S.), University Hospital LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.M.-V.), Hannover Medical School; Institute of Neurogenetics (A. Munchau), University of Lübeck, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (P.N., Z.T.), Budapest, Hungary; Division of Child and Adolescent Psychiatry, Department of Psychiatry (K.J.P.), Lausanne University Hospital, Switzerland; ASL BA, Mental Health Department (C.P.), Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry, Department of Clinical and Experimental Medicine (R.R.), University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Clinic of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and Department of Child and Adolescent Psychiatry (A.D., P.J.H.), University of Groningen, University Medical Center Groningen, the Netherlands
| | - Noa Benaroya-Milstein
- From the Department of Clinical Neurosciences (D.M.), Cumming School of Medicine & Hotchkiss Brain Institute, University of Calgary, Canada; Department of Clinical Neuroscience (A.S., Z.A.), UCL Institute of Neurology, University College London, UK; Child and Adolescent Psychiatry Department (A.A., N.B.-M., T.S.), Schneider Children's Medical Center of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari "Aldo Moro"; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology, Directorate National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Department of Child and Adolescent Psychiatry (C.H.), De Bascule, Amsterdam UMC, the Netherlands; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (M.M.), Seville; Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville; Department of Child and Adolescent Psychiatry and Psychology (A. Morer), Institute of Neurosciences, Hospital Clínic; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (A. Morer), Barcelona; Centro de Investigación en Red de Salud Mental (CIBERSAM) (A. Morer), Instituto Carlos III, Madrid; Department of Medicine (A. Morer), University of Barcelona, Spain; Child and Adolescent Mental Health Center (N.M.D., K.J.P., L.S.), Mental Health Services, Capital Region of Denmark and University of Copenhagen, Denmark; Institute of Laboratory Medicine (N. Moll, M.S.) and Department of Psychiatry and Psychotherapy (N. Müller, J.S.), University Hospital LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.M.-V.), Hannover Medical School; Institute of Neurogenetics (A. Munchau), University of Lübeck, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (P.N., Z.T.), Budapest, Hungary; Division of Child and Adolescent Psychiatry, Department of Psychiatry (K.J.P.), Lausanne University Hospital, Switzerland; ASL BA, Mental Health Department (C.P.), Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry, Department of Clinical and Experimental Medicine (R.R.), University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Clinic of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and Department of Child and Adolescent Psychiatry (A.D., P.J.H.), University of Groningen, University Medical Center Groningen, the Netherlands
| | - Maura Buttiglione
- From the Department of Clinical Neurosciences (D.M.), Cumming School of Medicine & Hotchkiss Brain Institute, University of Calgary, Canada; Department of Clinical Neuroscience (A.S., Z.A.), UCL Institute of Neurology, University College London, UK; Child and Adolescent Psychiatry Department (A.A., N.B.-M., T.S.), Schneider Children's Medical Center of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari "Aldo Moro"; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology, Directorate National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Department of Child and Adolescent Psychiatry (C.H.), De Bascule, Amsterdam UMC, the Netherlands; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (M.M.), Seville; Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville; Department of Child and Adolescent Psychiatry and Psychology (A. Morer), Institute of Neurosciences, Hospital Clínic; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (A. Morer), Barcelona; Centro de Investigación en Red de Salud Mental (CIBERSAM) (A. Morer), Instituto Carlos III, Madrid; Department of Medicine (A. Morer), University of Barcelona, Spain; Child and Adolescent Mental Health Center (N.M.D., K.J.P., L.S.), Mental Health Services, Capital Region of Denmark and University of Copenhagen, Denmark; Institute of Laboratory Medicine (N. Moll, M.S.) and Department of Psychiatry and Psychotherapy (N. Müller, J.S.), University Hospital LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.M.-V.), Hannover Medical School; Institute of Neurogenetics (A. Munchau), University of Lübeck, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (P.N., Z.T.), Budapest, Hungary; Division of Child and Adolescent Psychiatry, Department of Psychiatry (K.J.P.), Lausanne University Hospital, Switzerland; ASL BA, Mental Health Department (C.P.), Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry, Department of Clinical and Experimental Medicine (R.R.), University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Clinic of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and Department of Child and Adolescent Psychiatry (A.D., P.J.H.), University of Groningen, University Medical Center Groningen, the Netherlands
| | - Francesco Cardona
- From the Department of Clinical Neurosciences (D.M.), Cumming School of Medicine & Hotchkiss Brain Institute, University of Calgary, Canada; Department of Clinical Neuroscience (A.S., Z.A.), UCL Institute of Neurology, University College London, UK; Child and Adolescent Psychiatry Department (A.A., N.B.-M., T.S.), Schneider Children's Medical Center of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari "Aldo Moro"; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology, Directorate National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Department of Child and Adolescent Psychiatry (C.H.), De Bascule, Amsterdam UMC, the Netherlands; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (M.M.), Seville; Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville; Department of Child and Adolescent Psychiatry and Psychology (A. Morer), Institute of Neurosciences, Hospital Clínic; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (A. Morer), Barcelona; Centro de Investigación en Red de Salud Mental (CIBERSAM) (A. Morer), Instituto Carlos III, Madrid; Department of Medicine (A. Morer), University of Barcelona, Spain; Child and Adolescent Mental Health Center (N.M.D., K.J.P., L.S.), Mental Health Services, Capital Region of Denmark and University of Copenhagen, Denmark; Institute of Laboratory Medicine (N. Moll, M.S.) and Department of Psychiatry and Psychotherapy (N. Müller, J.S.), University Hospital LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.M.-V.), Hannover Medical School; Institute of Neurogenetics (A. Munchau), University of Lübeck, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (P.N., Z.T.), Budapest, Hungary; Division of Child and Adolescent Psychiatry, Department of Psychiatry (K.J.P.), Lausanne University Hospital, Switzerland; ASL BA, Mental Health Department (C.P.), Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry, Department of Clinical and Experimental Medicine (R.R.), University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Clinic of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and Department of Child and Adolescent Psychiatry (A.D., P.J.H.), University of Groningen, University Medical Center Groningen, the Netherlands
| | - Roberta Creti
- From the Department of Clinical Neurosciences (D.M.), Cumming School of Medicine & Hotchkiss Brain Institute, University of Calgary, Canada; Department of Clinical Neuroscience (A.S., Z.A.), UCL Institute of Neurology, University College London, UK; Child and Adolescent Psychiatry Department (A.A., N.B.-M., T.S.), Schneider Children's Medical Center of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari "Aldo Moro"; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology, Directorate National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Department of Child and Adolescent Psychiatry (C.H.), De Bascule, Amsterdam UMC, the Netherlands; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (M.M.), Seville; Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville; Department of Child and Adolescent Psychiatry and Psychology (A. Morer), Institute of Neurosciences, Hospital Clínic; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (A. Morer), Barcelona; Centro de Investigación en Red de Salud Mental (CIBERSAM) (A. Morer), Instituto Carlos III, Madrid; Department of Medicine (A. Morer), University of Barcelona, Spain; Child and Adolescent Mental Health Center (N.M.D., K.J.P., L.S.), Mental Health Services, Capital Region of Denmark and University of Copenhagen, Denmark; Institute of Laboratory Medicine (N. Moll, M.S.) and Department of Psychiatry and Psychotherapy (N. Müller, J.S.), University Hospital LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.M.-V.), Hannover Medical School; Institute of Neurogenetics (A. Munchau), University of Lübeck, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (P.N., Z.T.), Budapest, Hungary; Division of Child and Adolescent Psychiatry, Department of Psychiatry (K.J.P.), Lausanne University Hospital, Switzerland; ASL BA, Mental Health Department (C.P.), Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry, Department of Clinical and Experimental Medicine (R.R.), University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Clinic of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and Department of Child and Adolescent Psychiatry (A.D., P.J.H.), University of Groningen, University Medical Center Groningen, the Netherlands
| | - Androulla Efstratiou
- From the Department of Clinical Neurosciences (D.M.), Cumming School of Medicine & Hotchkiss Brain Institute, University of Calgary, Canada; Department of Clinical Neuroscience (A.S., Z.A.), UCL Institute of Neurology, University College London, UK; Child and Adolescent Psychiatry Department (A.A., N.B.-M., T.S.), Schneider Children's Medical Center of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari "Aldo Moro"; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology, Directorate National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Department of Child and Adolescent Psychiatry (C.H.), De Bascule, Amsterdam UMC, the Netherlands; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (M.M.), Seville; Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville; Department of Child and Adolescent Psychiatry and Psychology (A. Morer), Institute of Neurosciences, Hospital Clínic; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (A. Morer), Barcelona; Centro de Investigación en Red de Salud Mental (CIBERSAM) (A. Morer), Instituto Carlos III, Madrid; Department of Medicine (A. Morer), University of Barcelona, Spain; Child and Adolescent Mental Health Center (N.M.D., K.J.P., L.S.), Mental Health Services, Capital Region of Denmark and University of Copenhagen, Denmark; Institute of Laboratory Medicine (N. Moll, M.S.) and Department of Psychiatry and Psychotherapy (N. Müller, J.S.), University Hospital LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.M.-V.), Hannover Medical School; Institute of Neurogenetics (A. Munchau), University of Lübeck, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (P.N., Z.T.), Budapest, Hungary; Division of Child and Adolescent Psychiatry, Department of Psychiatry (K.J.P.), Lausanne University Hospital, Switzerland; ASL BA, Mental Health Department (C.P.), Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry, Department of Clinical and Experimental Medicine (R.R.), University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Clinic of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and Department of Child and Adolescent Psychiatry (A.D., P.J.H.), University of Groningen, University Medical Center Groningen, the Netherlands
| | - Tammy Hedderly
- From the Department of Clinical Neurosciences (D.M.), Cumming School of Medicine & Hotchkiss Brain Institute, University of Calgary, Canada; Department of Clinical Neuroscience (A.S., Z.A.), UCL Institute of Neurology, University College London, UK; Child and Adolescent Psychiatry Department (A.A., N.B.-M., T.S.), Schneider Children's Medical Center of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari "Aldo Moro"; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology, Directorate National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Department of Child and Adolescent Psychiatry (C.H.), De Bascule, Amsterdam UMC, the Netherlands; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (M.M.), Seville; Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville; Department of Child and Adolescent Psychiatry and Psychology (A. Morer), Institute of Neurosciences, Hospital Clínic; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (A. Morer), Barcelona; Centro de Investigación en Red de Salud Mental (CIBERSAM) (A. Morer), Instituto Carlos III, Madrid; Department of Medicine (A. Morer), University of Barcelona, Spain; Child and Adolescent Mental Health Center (N.M.D., K.J.P., L.S.), Mental Health Services, Capital Region of Denmark and University of Copenhagen, Denmark; Institute of Laboratory Medicine (N. Moll, M.S.) and Department of Psychiatry and Psychotherapy (N. Müller, J.S.), University Hospital LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.M.-V.), Hannover Medical School; Institute of Neurogenetics (A. Munchau), University of Lübeck, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (P.N., Z.T.), Budapest, Hungary; Division of Child and Adolescent Psychiatry, Department of Psychiatry (K.J.P.), Lausanne University Hospital, Switzerland; ASL BA, Mental Health Department (C.P.), Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry, Department of Clinical and Experimental Medicine (R.R.), University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Clinic of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and Department of Child and Adolescent Psychiatry (A.D., P.J.H.), University of Groningen, University Medical Center Groningen, the Netherlands
| | - Isobel Heyman
- From the Department of Clinical Neurosciences (D.M.), Cumming School of Medicine & Hotchkiss Brain Institute, University of Calgary, Canada; Department of Clinical Neuroscience (A.S., Z.A.), UCL Institute of Neurology, University College London, UK; Child and Adolescent Psychiatry Department (A.A., N.B.-M., T.S.), Schneider Children's Medical Center of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari "Aldo Moro"; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology, Directorate National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Department of Child and Adolescent Psychiatry (C.H.), De Bascule, Amsterdam UMC, the Netherlands; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (M.M.), Seville; Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville; Department of Child and Adolescent Psychiatry and Psychology (A. Morer), Institute of Neurosciences, Hospital Clínic; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (A. Morer), Barcelona; Centro de Investigación en Red de Salud Mental (CIBERSAM) (A. Morer), Instituto Carlos III, Madrid; Department of Medicine (A. Morer), University of Barcelona, Spain; Child and Adolescent Mental Health Center (N.M.D., K.J.P., L.S.), Mental Health Services, Capital Region of Denmark and University of Copenhagen, Denmark; Institute of Laboratory Medicine (N. Moll, M.S.) and Department of Psychiatry and Psychotherapy (N. Müller, J.S.), University Hospital LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.M.-V.), Hannover Medical School; Institute of Neurogenetics (A. Munchau), University of Lübeck, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (P.N., Z.T.), Budapest, Hungary; Division of Child and Adolescent Psychiatry, Department of Psychiatry (K.J.P.), Lausanne University Hospital, Switzerland; ASL BA, Mental Health Department (C.P.), Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry, Department of Clinical and Experimental Medicine (R.R.), University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Clinic of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and Department of Child and Adolescent Psychiatry (A.D., P.J.H.), University of Groningen, University Medical Center Groningen, the Netherlands
| | - Chaim Huyser
- From the Department of Clinical Neurosciences (D.M.), Cumming School of Medicine & Hotchkiss Brain Institute, University of Calgary, Canada; Department of Clinical Neuroscience (A.S., Z.A.), UCL Institute of Neurology, University College London, UK; Child and Adolescent Psychiatry Department (A.A., N.B.-M., T.S.), Schneider Children's Medical Center of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari "Aldo Moro"; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology, Directorate National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Department of Child and Adolescent Psychiatry (C.H.), De Bascule, Amsterdam UMC, the Netherlands; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (M.M.), Seville; Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville; Department of Child and Adolescent Psychiatry and Psychology (A. Morer), Institute of Neurosciences, Hospital Clínic; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (A. Morer), Barcelona; Centro de Investigación en Red de Salud Mental (CIBERSAM) (A. Morer), Instituto Carlos III, Madrid; Department of Medicine (A. Morer), University of Barcelona, Spain; Child and Adolescent Mental Health Center (N.M.D., K.J.P., L.S.), Mental Health Services, Capital Region of Denmark and University of Copenhagen, Denmark; Institute of Laboratory Medicine (N. Moll, M.S.) and Department of Psychiatry and Psychotherapy (N. Müller, J.S.), University Hospital LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.M.-V.), Hannover Medical School; Institute of Neurogenetics (A. Munchau), University of Lübeck, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (P.N., Z.T.), Budapest, Hungary; Division of Child and Adolescent Psychiatry, Department of Psychiatry (K.J.P.), Lausanne University Hospital, Switzerland; ASL BA, Mental Health Department (C.P.), Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry, Department of Clinical and Experimental Medicine (R.R.), University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Clinic of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and Department of Child and Adolescent Psychiatry (A.D., P.J.H.), University of Groningen, University Medical Center Groningen, the Netherlands
| | - Marcos Madruga
- From the Department of Clinical Neurosciences (D.M.), Cumming School of Medicine & Hotchkiss Brain Institute, University of Calgary, Canada; Department of Clinical Neuroscience (A.S., Z.A.), UCL Institute of Neurology, University College London, UK; Child and Adolescent Psychiatry Department (A.A., N.B.-M., T.S.), Schneider Children's Medical Center of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari "Aldo Moro"; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology, Directorate National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Department of Child and Adolescent Psychiatry (C.H.), De Bascule, Amsterdam UMC, the Netherlands; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (M.M.), Seville; Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville; Department of Child and Adolescent Psychiatry and Psychology (A. Morer), Institute of Neurosciences, Hospital Clínic; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (A. Morer), Barcelona; Centro de Investigación en Red de Salud Mental (CIBERSAM) (A. Morer), Instituto Carlos III, Madrid; Department of Medicine (A. Morer), University of Barcelona, Spain; Child and Adolescent Mental Health Center (N.M.D., K.J.P., L.S.), Mental Health Services, Capital Region of Denmark and University of Copenhagen, Denmark; Institute of Laboratory Medicine (N. Moll, M.S.) and Department of Psychiatry and Psychotherapy (N. Müller, J.S.), University Hospital LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.M.-V.), Hannover Medical School; Institute of Neurogenetics (A. Munchau), University of Lübeck, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (P.N., Z.T.), Budapest, Hungary; Division of Child and Adolescent Psychiatry, Department of Psychiatry (K.J.P.), Lausanne University Hospital, Switzerland; ASL BA, Mental Health Department (C.P.), Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry, Department of Clinical and Experimental Medicine (R.R.), University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Clinic of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and Department of Child and Adolescent Psychiatry (A.D., P.J.H.), University of Groningen, University Medical Center Groningen, the Netherlands
| | - Pablo Mir
- From the Department of Clinical Neurosciences (D.M.), Cumming School of Medicine & Hotchkiss Brain Institute, University of Calgary, Canada; Department of Clinical Neuroscience (A.S., Z.A.), UCL Institute of Neurology, University College London, UK; Child and Adolescent Psychiatry Department (A.A., N.B.-M., T.S.), Schneider Children's Medical Center of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari "Aldo Moro"; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology, Directorate National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Department of Child and Adolescent Psychiatry (C.H.), De Bascule, Amsterdam UMC, the Netherlands; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (M.M.), Seville; Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville; Department of Child and Adolescent Psychiatry and Psychology (A. Morer), Institute of Neurosciences, Hospital Clínic; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (A. Morer), Barcelona; Centro de Investigación en Red de Salud Mental (CIBERSAM) (A. Morer), Instituto Carlos III, Madrid; Department of Medicine (A. Morer), University of Barcelona, Spain; Child and Adolescent Mental Health Center (N.M.D., K.J.P., L.S.), Mental Health Services, Capital Region of Denmark and University of Copenhagen, Denmark; Institute of Laboratory Medicine (N. Moll, M.S.) and Department of Psychiatry and Psychotherapy (N. Müller, J.S.), University Hospital LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.M.-V.), Hannover Medical School; Institute of Neurogenetics (A. Munchau), University of Lübeck, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (P.N., Z.T.), Budapest, Hungary; Division of Child and Adolescent Psychiatry, Department of Psychiatry (K.J.P.), Lausanne University Hospital, Switzerland; ASL BA, Mental Health Department (C.P.), Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry, Department of Clinical and Experimental Medicine (R.R.), University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Clinic of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and Department of Child and Adolescent Psychiatry (A.D., P.J.H.), University of Groningen, University Medical Center Groningen, the Netherlands
| | - Astrid Morer
- From the Department of Clinical Neurosciences (D.M.), Cumming School of Medicine & Hotchkiss Brain Institute, University of Calgary, Canada; Department of Clinical Neuroscience (A.S., Z.A.), UCL Institute of Neurology, University College London, UK; Child and Adolescent Psychiatry Department (A.A., N.B.-M., T.S.), Schneider Children's Medical Center of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari "Aldo Moro"; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology, Directorate National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Department of Child and Adolescent Psychiatry (C.H.), De Bascule, Amsterdam UMC, the Netherlands; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (M.M.), Seville; Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville; Department of Child and Adolescent Psychiatry and Psychology (A. Morer), Institute of Neurosciences, Hospital Clínic; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (A. Morer), Barcelona; Centro de Investigación en Red de Salud Mental (CIBERSAM) (A. Morer), Instituto Carlos III, Madrid; Department of Medicine (A. Morer), University of Barcelona, Spain; Child and Adolescent Mental Health Center (N.M.D., K.J.P., L.S.), Mental Health Services, Capital Region of Denmark and University of Copenhagen, Denmark; Institute of Laboratory Medicine (N. Moll, M.S.) and Department of Psychiatry and Psychotherapy (N. Müller, J.S.), University Hospital LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.M.-V.), Hannover Medical School; Institute of Neurogenetics (A. Munchau), University of Lübeck, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (P.N., Z.T.), Budapest, Hungary; Division of Child and Adolescent Psychiatry, Department of Psychiatry (K.J.P.), Lausanne University Hospital, Switzerland; ASL BA, Mental Health Department (C.P.), Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry, Department of Clinical and Experimental Medicine (R.R.), University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Clinic of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and Department of Child and Adolescent Psychiatry (A.D., P.J.H.), University of Groningen, University Medical Center Groningen, the Netherlands
| | - Nanette Mol Debes
- From the Department of Clinical Neurosciences (D.M.), Cumming School of Medicine & Hotchkiss Brain Institute, University of Calgary, Canada; Department of Clinical Neuroscience (A.S., Z.A.), UCL Institute of Neurology, University College London, UK; Child and Adolescent Psychiatry Department (A.A., N.B.-M., T.S.), Schneider Children's Medical Center of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari "Aldo Moro"; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology, Directorate National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Department of Child and Adolescent Psychiatry (C.H.), De Bascule, Amsterdam UMC, the Netherlands; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (M.M.), Seville; Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville; Department of Child and Adolescent Psychiatry and Psychology (A. Morer), Institute of Neurosciences, Hospital Clínic; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (A. Morer), Barcelona; Centro de Investigación en Red de Salud Mental (CIBERSAM) (A. Morer), Instituto Carlos III, Madrid; Department of Medicine (A. Morer), University of Barcelona, Spain; Child and Adolescent Mental Health Center (N.M.D., K.J.P., L.S.), Mental Health Services, Capital Region of Denmark and University of Copenhagen, Denmark; Institute of Laboratory Medicine (N. Moll, M.S.) and Department of Psychiatry and Psychotherapy (N. Müller, J.S.), University Hospital LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.M.-V.), Hannover Medical School; Institute of Neurogenetics (A. Munchau), University of Lübeck, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (P.N., Z.T.), Budapest, Hungary; Division of Child and Adolescent Psychiatry, Department of Psychiatry (K.J.P.), Lausanne University Hospital, Switzerland; ASL BA, Mental Health Department (C.P.), Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry, Department of Clinical and Experimental Medicine (R.R.), University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Clinic of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and Department of Child and Adolescent Psychiatry (A.D., P.J.H.), University of Groningen, University Medical Center Groningen, the Netherlands
| | - Natalie Moll
- From the Department of Clinical Neurosciences (D.M.), Cumming School of Medicine & Hotchkiss Brain Institute, University of Calgary, Canada; Department of Clinical Neuroscience (A.S., Z.A.), UCL Institute of Neurology, University College London, UK; Child and Adolescent Psychiatry Department (A.A., N.B.-M., T.S.), Schneider Children's Medical Center of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari "Aldo Moro"; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology, Directorate National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Department of Child and Adolescent Psychiatry (C.H.), De Bascule, Amsterdam UMC, the Netherlands; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (M.M.), Seville; Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville; Department of Child and Adolescent Psychiatry and Psychology (A. Morer), Institute of Neurosciences, Hospital Clínic; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (A. Morer), Barcelona; Centro de Investigación en Red de Salud Mental (CIBERSAM) (A. Morer), Instituto Carlos III, Madrid; Department of Medicine (A. Morer), University of Barcelona, Spain; Child and Adolescent Mental Health Center (N.M.D., K.J.P., L.S.), Mental Health Services, Capital Region of Denmark and University of Copenhagen, Denmark; Institute of Laboratory Medicine (N. Moll, M.S.) and Department of Psychiatry and Psychotherapy (N. Müller, J.S.), University Hospital LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.M.-V.), Hannover Medical School; Institute of Neurogenetics (A. Munchau), University of Lübeck, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (P.N., Z.T.), Budapest, Hungary; Division of Child and Adolescent Psychiatry, Department of Psychiatry (K.J.P.), Lausanne University Hospital, Switzerland; ASL BA, Mental Health Department (C.P.), Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry, Department of Clinical and Experimental Medicine (R.R.), University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Clinic of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and Department of Child and Adolescent Psychiatry (A.D., P.J.H.), University of Groningen, University Medical Center Groningen, the Netherlands
| | - Norbert Müller
- From the Department of Clinical Neurosciences (D.M.), Cumming School of Medicine & Hotchkiss Brain Institute, University of Calgary, Canada; Department of Clinical Neuroscience (A.S., Z.A.), UCL Institute of Neurology, University College London, UK; Child and Adolescent Psychiatry Department (A.A., N.B.-M., T.S.), Schneider Children's Medical Center of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari "Aldo Moro"; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology, Directorate National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Department of Child and Adolescent Psychiatry (C.H.), De Bascule, Amsterdam UMC, the Netherlands; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (M.M.), Seville; Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville; Department of Child and Adolescent Psychiatry and Psychology (A. Morer), Institute of Neurosciences, Hospital Clínic; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (A. Morer), Barcelona; Centro de Investigación en Red de Salud Mental (CIBERSAM) (A. Morer), Instituto Carlos III, Madrid; Department of Medicine (A. Morer), University of Barcelona, Spain; Child and Adolescent Mental Health Center (N.M.D., K.J.P., L.S.), Mental Health Services, Capital Region of Denmark and University of Copenhagen, Denmark; Institute of Laboratory Medicine (N. Moll, M.S.) and Department of Psychiatry and Psychotherapy (N. Müller, J.S.), University Hospital LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.M.-V.), Hannover Medical School; Institute of Neurogenetics (A. Munchau), University of Lübeck, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (P.N., Z.T.), Budapest, Hungary; Division of Child and Adolescent Psychiatry, Department of Psychiatry (K.J.P.), Lausanne University Hospital, Switzerland; ASL BA, Mental Health Department (C.P.), Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry, Department of Clinical and Experimental Medicine (R.R.), University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Clinic of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and Department of Child and Adolescent Psychiatry (A.D., P.J.H.), University of Groningen, University Medical Center Groningen, the Netherlands
| | - Kirsten Müller-Vahl
- From the Department of Clinical Neurosciences (D.M.), Cumming School of Medicine & Hotchkiss Brain Institute, University of Calgary, Canada; Department of Clinical Neuroscience (A.S., Z.A.), UCL Institute of Neurology, University College London, UK; Child and Adolescent Psychiatry Department (A.A., N.B.-M., T.S.), Schneider Children's Medical Center of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari "Aldo Moro"; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology, Directorate National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Department of Child and Adolescent Psychiatry (C.H.), De Bascule, Amsterdam UMC, the Netherlands; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (M.M.), Seville; Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville; Department of Child and Adolescent Psychiatry and Psychology (A. Morer), Institute of Neurosciences, Hospital Clínic; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (A. Morer), Barcelona; Centro de Investigación en Red de Salud Mental (CIBERSAM) (A. Morer), Instituto Carlos III, Madrid; Department of Medicine (A. Morer), University of Barcelona, Spain; Child and Adolescent Mental Health Center (N.M.D., K.J.P., L.S.), Mental Health Services, Capital Region of Denmark and University of Copenhagen, Denmark; Institute of Laboratory Medicine (N. Moll, M.S.) and Department of Psychiatry and Psychotherapy (N. Müller, J.S.), University Hospital LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.M.-V.), Hannover Medical School; Institute of Neurogenetics (A. Munchau), University of Lübeck, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (P.N., Z.T.), Budapest, Hungary; Division of Child and Adolescent Psychiatry, Department of Psychiatry (K.J.P.), Lausanne University Hospital, Switzerland; ASL BA, Mental Health Department (C.P.), Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry, Department of Clinical and Experimental Medicine (R.R.), University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Clinic of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and Department of Child and Adolescent Psychiatry (A.D., P.J.H.), University of Groningen, University Medical Center Groningen, the Netherlands
| | - Alexander Munchau
- From the Department of Clinical Neurosciences (D.M.), Cumming School of Medicine & Hotchkiss Brain Institute, University of Calgary, Canada; Department of Clinical Neuroscience (A.S., Z.A.), UCL Institute of Neurology, University College London, UK; Child and Adolescent Psychiatry Department (A.A., N.B.-M., T.S.), Schneider Children's Medical Center of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari "Aldo Moro"; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology, Directorate National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Department of Child and Adolescent Psychiatry (C.H.), De Bascule, Amsterdam UMC, the Netherlands; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (M.M.), Seville; Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville; Department of Child and Adolescent Psychiatry and Psychology (A. Morer), Institute of Neurosciences, Hospital Clínic; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (A. Morer), Barcelona; Centro de Investigación en Red de Salud Mental (CIBERSAM) (A. Morer), Instituto Carlos III, Madrid; Department of Medicine (A. Morer), University of Barcelona, Spain; Child and Adolescent Mental Health Center (N.M.D., K.J.P., L.S.), Mental Health Services, Capital Region of Denmark and University of Copenhagen, Denmark; Institute of Laboratory Medicine (N. Moll, M.S.) and Department of Psychiatry and Psychotherapy (N. Müller, J.S.), University Hospital LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.M.-V.), Hannover Medical School; Institute of Neurogenetics (A. Munchau), University of Lübeck, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (P.N., Z.T.), Budapest, Hungary; Division of Child and Adolescent Psychiatry, Department of Psychiatry (K.J.P.), Lausanne University Hospital, Switzerland; ASL BA, Mental Health Department (C.P.), Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry, Department of Clinical and Experimental Medicine (R.R.), University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Clinic of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and Department of Child and Adolescent Psychiatry (A.D., P.J.H.), University of Groningen, University Medical Center Groningen, the Netherlands
| | - Peter Nagy
- From the Department of Clinical Neurosciences (D.M.), Cumming School of Medicine & Hotchkiss Brain Institute, University of Calgary, Canada; Department of Clinical Neuroscience (A.S., Z.A.), UCL Institute of Neurology, University College London, UK; Child and Adolescent Psychiatry Department (A.A., N.B.-M., T.S.), Schneider Children's Medical Center of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari "Aldo Moro"; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology, Directorate National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Department of Child and Adolescent Psychiatry (C.H.), De Bascule, Amsterdam UMC, the Netherlands; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (M.M.), Seville; Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville; Department of Child and Adolescent Psychiatry and Psychology (A. Morer), Institute of Neurosciences, Hospital Clínic; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (A. Morer), Barcelona; Centro de Investigación en Red de Salud Mental (CIBERSAM) (A. Morer), Instituto Carlos III, Madrid; Department of Medicine (A. Morer), University of Barcelona, Spain; Child and Adolescent Mental Health Center (N.M.D., K.J.P., L.S.), Mental Health Services, Capital Region of Denmark and University of Copenhagen, Denmark; Institute of Laboratory Medicine (N. Moll, M.S.) and Department of Psychiatry and Psychotherapy (N. Müller, J.S.), University Hospital LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.M.-V.), Hannover Medical School; Institute of Neurogenetics (A. Munchau), University of Lübeck, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (P.N., Z.T.), Budapest, Hungary; Division of Child and Adolescent Psychiatry, Department of Psychiatry (K.J.P.), Lausanne University Hospital, Switzerland; ASL BA, Mental Health Department (C.P.), Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry, Department of Clinical and Experimental Medicine (R.R.), University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Clinic of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and Department of Child and Adolescent Psychiatry (A.D., P.J.H.), University of Groningen, University Medical Center Groningen, the Netherlands
| | - Kerstin Jessica Plessen
- From the Department of Clinical Neurosciences (D.M.), Cumming School of Medicine & Hotchkiss Brain Institute, University of Calgary, Canada; Department of Clinical Neuroscience (A.S., Z.A.), UCL Institute of Neurology, University College London, UK; Child and Adolescent Psychiatry Department (A.A., N.B.-M., T.S.), Schneider Children's Medical Center of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari "Aldo Moro"; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology, Directorate National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Department of Child and Adolescent Psychiatry (C.H.), De Bascule, Amsterdam UMC, the Netherlands; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (M.M.), Seville; Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville; Department of Child and Adolescent Psychiatry and Psychology (A. Morer), Institute of Neurosciences, Hospital Clínic; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (A. Morer), Barcelona; Centro de Investigación en Red de Salud Mental (CIBERSAM) (A. Morer), Instituto Carlos III, Madrid; Department of Medicine (A. Morer), University of Barcelona, Spain; Child and Adolescent Mental Health Center (N.M.D., K.J.P., L.S.), Mental Health Services, Capital Region of Denmark and University of Copenhagen, Denmark; Institute of Laboratory Medicine (N. Moll, M.S.) and Department of Psychiatry and Psychotherapy (N. Müller, J.S.), University Hospital LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.M.-V.), Hannover Medical School; Institute of Neurogenetics (A. Munchau), University of Lübeck, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (P.N., Z.T.), Budapest, Hungary; Division of Child and Adolescent Psychiatry, Department of Psychiatry (K.J.P.), Lausanne University Hospital, Switzerland; ASL BA, Mental Health Department (C.P.), Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry, Department of Clinical and Experimental Medicine (R.R.), University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Clinic of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and Department of Child and Adolescent Psychiatry (A.D., P.J.H.), University of Groningen, University Medical Center Groningen, the Netherlands
| | - Cesare Porcelli
- From the Department of Clinical Neurosciences (D.M.), Cumming School of Medicine & Hotchkiss Brain Institute, University of Calgary, Canada; Department of Clinical Neuroscience (A.S., Z.A.), UCL Institute of Neurology, University College London, UK; Child and Adolescent Psychiatry Department (A.A., N.B.-M., T.S.), Schneider Children's Medical Center of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari "Aldo Moro"; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology, Directorate National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Department of Child and Adolescent Psychiatry (C.H.), De Bascule, Amsterdam UMC, the Netherlands; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (M.M.), Seville; Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville; Department of Child and Adolescent Psychiatry and Psychology (A. Morer), Institute of Neurosciences, Hospital Clínic; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (A. Morer), Barcelona; Centro de Investigación en Red de Salud Mental (CIBERSAM) (A. Morer), Instituto Carlos III, Madrid; Department of Medicine (A. Morer), University of Barcelona, Spain; Child and Adolescent Mental Health Center (N.M.D., K.J.P., L.S.), Mental Health Services, Capital Region of Denmark and University of Copenhagen, Denmark; Institute of Laboratory Medicine (N. Moll, M.S.) and Department of Psychiatry and Psychotherapy (N. Müller, J.S.), University Hospital LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.M.-V.), Hannover Medical School; Institute of Neurogenetics (A. Munchau), University of Lübeck, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (P.N., Z.T.), Budapest, Hungary; Division of Child and Adolescent Psychiatry, Department of Psychiatry (K.J.P.), Lausanne University Hospital, Switzerland; ASL BA, Mental Health Department (C.P.), Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry, Department of Clinical and Experimental Medicine (R.R.), University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Clinic of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and Department of Child and Adolescent Psychiatry (A.D., P.J.H.), University of Groningen, University Medical Center Groningen, the Netherlands
| | - Renata Rizzo
- From the Department of Clinical Neurosciences (D.M.), Cumming School of Medicine & Hotchkiss Brain Institute, University of Calgary, Canada; Department of Clinical Neuroscience (A.S., Z.A.), UCL Institute of Neurology, University College London, UK; Child and Adolescent Psychiatry Department (A.A., N.B.-M., T.S.), Schneider Children's Medical Center of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari "Aldo Moro"; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology, Directorate National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Department of Child and Adolescent Psychiatry (C.H.), De Bascule, Amsterdam UMC, the Netherlands; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (M.M.), Seville; Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville; Department of Child and Adolescent Psychiatry and Psychology (A. Morer), Institute of Neurosciences, Hospital Clínic; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (A. Morer), Barcelona; Centro de Investigación en Red de Salud Mental (CIBERSAM) (A. Morer), Instituto Carlos III, Madrid; Department of Medicine (A. Morer), University of Barcelona, Spain; Child and Adolescent Mental Health Center (N.M.D., K.J.P., L.S.), Mental Health Services, Capital Region of Denmark and University of Copenhagen, Denmark; Institute of Laboratory Medicine (N. Moll, M.S.) and Department of Psychiatry and Psychotherapy (N. Müller, J.S.), University Hospital LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.M.-V.), Hannover Medical School; Institute of Neurogenetics (A. Munchau), University of Lübeck, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (P.N., Z.T.), Budapest, Hungary; Division of Child and Adolescent Psychiatry, Department of Psychiatry (K.J.P.), Lausanne University Hospital, Switzerland; ASL BA, Mental Health Department (C.P.), Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry, Department of Clinical and Experimental Medicine (R.R.), University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Clinic of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and Department of Child and Adolescent Psychiatry (A.D., P.J.H.), University of Groningen, University Medical Center Groningen, the Netherlands
| | - Veit Roessner
- From the Department of Clinical Neurosciences (D.M.), Cumming School of Medicine & Hotchkiss Brain Institute, University of Calgary, Canada; Department of Clinical Neuroscience (A.S., Z.A.), UCL Institute of Neurology, University College London, UK; Child and Adolescent Psychiatry Department (A.A., N.B.-M., T.S.), Schneider Children's Medical Center of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari "Aldo Moro"; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology, Directorate National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Department of Child and Adolescent Psychiatry (C.H.), De Bascule, Amsterdam UMC, the Netherlands; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (M.M.), Seville; Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville; Department of Child and Adolescent Psychiatry and Psychology (A. Morer), Institute of Neurosciences, Hospital Clínic; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (A. Morer), Barcelona; Centro de Investigación en Red de Salud Mental (CIBERSAM) (A. Morer), Instituto Carlos III, Madrid; Department of Medicine (A. Morer), University of Barcelona, Spain; Child and Adolescent Mental Health Center (N.M.D., K.J.P., L.S.), Mental Health Services, Capital Region of Denmark and University of Copenhagen, Denmark; Institute of Laboratory Medicine (N. Moll, M.S.) and Department of Psychiatry and Psychotherapy (N. Müller, J.S.), University Hospital LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.M.-V.), Hannover Medical School; Institute of Neurogenetics (A. Munchau), University of Lübeck, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (P.N., Z.T.), Budapest, Hungary; Division of Child and Adolescent Psychiatry, Department of Psychiatry (K.J.P.), Lausanne University Hospital, Switzerland; ASL BA, Mental Health Department (C.P.), Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry, Department of Clinical and Experimental Medicine (R.R.), University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Clinic of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and Department of Child and Adolescent Psychiatry (A.D., P.J.H.), University of Groningen, University Medical Center Groningen, the Netherlands
| | - Jaana Schnell
- From the Department of Clinical Neurosciences (D.M.), Cumming School of Medicine & Hotchkiss Brain Institute, University of Calgary, Canada; Department of Clinical Neuroscience (A.S., Z.A.), UCL Institute of Neurology, University College London, UK; Child and Adolescent Psychiatry Department (A.A., N.B.-M., T.S.), Schneider Children's Medical Center of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari "Aldo Moro"; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology, Directorate National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Department of Child and Adolescent Psychiatry (C.H.), De Bascule, Amsterdam UMC, the Netherlands; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (M.M.), Seville; Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville; Department of Child and Adolescent Psychiatry and Psychology (A. Morer), Institute of Neurosciences, Hospital Clínic; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (A. Morer), Barcelona; Centro de Investigación en Red de Salud Mental (CIBERSAM) (A. Morer), Instituto Carlos III, Madrid; Department of Medicine (A. Morer), University of Barcelona, Spain; Child and Adolescent Mental Health Center (N.M.D., K.J.P., L.S.), Mental Health Services, Capital Region of Denmark and University of Copenhagen, Denmark; Institute of Laboratory Medicine (N. Moll, M.S.) and Department of Psychiatry and Psychotherapy (N. Müller, J.S.), University Hospital LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.M.-V.), Hannover Medical School; Institute of Neurogenetics (A. Munchau), University of Lübeck, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (P.N., Z.T.), Budapest, Hungary; Division of Child and Adolescent Psychiatry, Department of Psychiatry (K.J.P.), Lausanne University Hospital, Switzerland; ASL BA, Mental Health Department (C.P.), Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry, Department of Clinical and Experimental Medicine (R.R.), University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Clinic of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and Department of Child and Adolescent Psychiatry (A.D., P.J.H.), University of Groningen, University Medical Center Groningen, the Netherlands
| | - Markus Schwarz
- From the Department of Clinical Neurosciences (D.M.), Cumming School of Medicine & Hotchkiss Brain Institute, University of Calgary, Canada; Department of Clinical Neuroscience (A.S., Z.A.), UCL Institute of Neurology, University College London, UK; Child and Adolescent Psychiatry Department (A.A., N.B.-M., T.S.), Schneider Children's Medical Center of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari "Aldo Moro"; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology, Directorate National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Department of Child and Adolescent Psychiatry (C.H.), De Bascule, Amsterdam UMC, the Netherlands; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (M.M.), Seville; Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville; Department of Child and Adolescent Psychiatry and Psychology (A. Morer), Institute of Neurosciences, Hospital Clínic; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (A. Morer), Barcelona; Centro de Investigación en Red de Salud Mental (CIBERSAM) (A. Morer), Instituto Carlos III, Madrid; Department of Medicine (A. Morer), University of Barcelona, Spain; Child and Adolescent Mental Health Center (N.M.D., K.J.P., L.S.), Mental Health Services, Capital Region of Denmark and University of Copenhagen, Denmark; Institute of Laboratory Medicine (N. Moll, M.S.) and Department of Psychiatry and Psychotherapy (N. Müller, J.S.), University Hospital LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.M.-V.), Hannover Medical School; Institute of Neurogenetics (A. Munchau), University of Lübeck, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (P.N., Z.T.), Budapest, Hungary; Division of Child and Adolescent Psychiatry, Department of Psychiatry (K.J.P.), Lausanne University Hospital, Switzerland; ASL BA, Mental Health Department (C.P.), Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry, Department of Clinical and Experimental Medicine (R.R.), University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Clinic of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and Department of Child and Adolescent Psychiatry (A.D., P.J.H.), University of Groningen, University Medical Center Groningen, the Netherlands
| | - Liselotte Skov
- From the Department of Clinical Neurosciences (D.M.), Cumming School of Medicine & Hotchkiss Brain Institute, University of Calgary, Canada; Department of Clinical Neuroscience (A.S., Z.A.), UCL Institute of Neurology, University College London, UK; Child and Adolescent Psychiatry Department (A.A., N.B.-M., T.S.), Schneider Children's Medical Center of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari "Aldo Moro"; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology, Directorate National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Department of Child and Adolescent Psychiatry (C.H.), De Bascule, Amsterdam UMC, the Netherlands; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (M.M.), Seville; Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville; Department of Child and Adolescent Psychiatry and Psychology (A. Morer), Institute of Neurosciences, Hospital Clínic; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (A. Morer), Barcelona; Centro de Investigación en Red de Salud Mental (CIBERSAM) (A. Morer), Instituto Carlos III, Madrid; Department of Medicine (A. Morer), University of Barcelona, Spain; Child and Adolescent Mental Health Center (N.M.D., K.J.P., L.S.), Mental Health Services, Capital Region of Denmark and University of Copenhagen, Denmark; Institute of Laboratory Medicine (N. Moll, M.S.) and Department of Psychiatry and Psychotherapy (N. Müller, J.S.), University Hospital LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.M.-V.), Hannover Medical School; Institute of Neurogenetics (A. Munchau), University of Lübeck, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (P.N., Z.T.), Budapest, Hungary; Division of Child and Adolescent Psychiatry, Department of Psychiatry (K.J.P.), Lausanne University Hospital, Switzerland; ASL BA, Mental Health Department (C.P.), Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry, Department of Clinical and Experimental Medicine (R.R.), University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Clinic of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and Department of Child and Adolescent Psychiatry (A.D., P.J.H.), University of Groningen, University Medical Center Groningen, the Netherlands
| | - Tamar Steinberg
- From the Department of Clinical Neurosciences (D.M.), Cumming School of Medicine & Hotchkiss Brain Institute, University of Calgary, Canada; Department of Clinical Neuroscience (A.S., Z.A.), UCL Institute of Neurology, University College London, UK; Child and Adolescent Psychiatry Department (A.A., N.B.-M., T.S.), Schneider Children's Medical Center of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari "Aldo Moro"; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology, Directorate National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Department of Child and Adolescent Psychiatry (C.H.), De Bascule, Amsterdam UMC, the Netherlands; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (M.M.), Seville; Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville; Department of Child and Adolescent Psychiatry and Psychology (A. Morer), Institute of Neurosciences, Hospital Clínic; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (A. Morer), Barcelona; Centro de Investigación en Red de Salud Mental (CIBERSAM) (A. Morer), Instituto Carlos III, Madrid; Department of Medicine (A. Morer), University of Barcelona, Spain; Child and Adolescent Mental Health Center (N.M.D., K.J.P., L.S.), Mental Health Services, Capital Region of Denmark and University of Copenhagen, Denmark; Institute of Laboratory Medicine (N. Moll, M.S.) and Department of Psychiatry and Psychotherapy (N. Müller, J.S.), University Hospital LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.M.-V.), Hannover Medical School; Institute of Neurogenetics (A. Munchau), University of Lübeck, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (P.N., Z.T.), Budapest, Hungary; Division of Child and Adolescent Psychiatry, Department of Psychiatry (K.J.P.), Lausanne University Hospital, Switzerland; ASL BA, Mental Health Department (C.P.), Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry, Department of Clinical and Experimental Medicine (R.R.), University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Clinic of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and Department of Child and Adolescent Psychiatry (A.D., P.J.H.), University of Groningen, University Medical Center Groningen, the Netherlands
| | - Zsanett Tarnok
- From the Department of Clinical Neurosciences (D.M.), Cumming School of Medicine & Hotchkiss Brain Institute, University of Calgary, Canada; Department of Clinical Neuroscience (A.S., Z.A.), UCL Institute of Neurology, University College London, UK; Child and Adolescent Psychiatry Department (A.A., N.B.-M., T.S.), Schneider Children's Medical Center of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari "Aldo Moro"; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology, Directorate National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Department of Child and Adolescent Psychiatry (C.H.), De Bascule, Amsterdam UMC, the Netherlands; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (M.M.), Seville; Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville; Department of Child and Adolescent Psychiatry and Psychology (A. Morer), Institute of Neurosciences, Hospital Clínic; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (A. Morer), Barcelona; Centro de Investigación en Red de Salud Mental (CIBERSAM) (A. Morer), Instituto Carlos III, Madrid; Department of Medicine (A. Morer), University of Barcelona, Spain; Child and Adolescent Mental Health Center (N.M.D., K.J.P., L.S.), Mental Health Services, Capital Region of Denmark and University of Copenhagen, Denmark; Institute of Laboratory Medicine (N. Moll, M.S.) and Department of Psychiatry and Psychotherapy (N. Müller, J.S.), University Hospital LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.M.-V.), Hannover Medical School; Institute of Neurogenetics (A. Munchau), University of Lübeck, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (P.N., Z.T.), Budapest, Hungary; Division of Child and Adolescent Psychiatry, Department of Psychiatry (K.J.P.), Lausanne University Hospital, Switzerland; ASL BA, Mental Health Department (C.P.), Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry, Department of Clinical and Experimental Medicine (R.R.), University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Clinic of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and Department of Child and Adolescent Psychiatry (A.D., P.J.H.), University of Groningen, University Medical Center Groningen, the Netherlands
| | - Susanne Walitza
- From the Department of Clinical Neurosciences (D.M.), Cumming School of Medicine & Hotchkiss Brain Institute, University of Calgary, Canada; Department of Clinical Neuroscience (A.S., Z.A.), UCL Institute of Neurology, University College London, UK; Child and Adolescent Psychiatry Department (A.A., N.B.-M., T.S.), Schneider Children's Medical Center of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari "Aldo Moro"; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology, Directorate National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Department of Child and Adolescent Psychiatry (C.H.), De Bascule, Amsterdam UMC, the Netherlands; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (M.M.), Seville; Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville; Department of Child and Adolescent Psychiatry and Psychology (A. Morer), Institute of Neurosciences, Hospital Clínic; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (A. Morer), Barcelona; Centro de Investigación en Red de Salud Mental (CIBERSAM) (A. Morer), Instituto Carlos III, Madrid; Department of Medicine (A. Morer), University of Barcelona, Spain; Child and Adolescent Mental Health Center (N.M.D., K.J.P., L.S.), Mental Health Services, Capital Region of Denmark and University of Copenhagen, Denmark; Institute of Laboratory Medicine (N. Moll, M.S.) and Department of Psychiatry and Psychotherapy (N. Müller, J.S.), University Hospital LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.M.-V.), Hannover Medical School; Institute of Neurogenetics (A. Munchau), University of Lübeck, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (P.N., Z.T.), Budapest, Hungary; Division of Child and Adolescent Psychiatry, Department of Psychiatry (K.J.P.), Lausanne University Hospital, Switzerland; ASL BA, Mental Health Department (C.P.), Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry, Department of Clinical and Experimental Medicine (R.R.), University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Clinic of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and Department of Child and Adolescent Psychiatry (A.D., P.J.H.), University of Groningen, University Medical Center Groningen, the Netherlands
| | - Andrea Dietrich
- From the Department of Clinical Neurosciences (D.M.), Cumming School of Medicine & Hotchkiss Brain Institute, University of Calgary, Canada; Department of Clinical Neuroscience (A.S., Z.A.), UCL Institute of Neurology, University College London, UK; Child and Adolescent Psychiatry Department (A.A., N.B.-M., T.S.), Schneider Children's Medical Center of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari "Aldo Moro"; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology, Directorate National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Department of Child and Adolescent Psychiatry (C.H.), De Bascule, Amsterdam UMC, the Netherlands; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (M.M.), Seville; Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville; Department of Child and Adolescent Psychiatry and Psychology (A. Morer), Institute of Neurosciences, Hospital Clínic; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (A. Morer), Barcelona; Centro de Investigación en Red de Salud Mental (CIBERSAM) (A. Morer), Instituto Carlos III, Madrid; Department of Medicine (A. Morer), University of Barcelona, Spain; Child and Adolescent Mental Health Center (N.M.D., K.J.P., L.S.), Mental Health Services, Capital Region of Denmark and University of Copenhagen, Denmark; Institute of Laboratory Medicine (N. Moll, M.S.) and Department of Psychiatry and Psychotherapy (N. Müller, J.S.), University Hospital LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.M.-V.), Hannover Medical School; Institute of Neurogenetics (A. Munchau), University of Lübeck, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (P.N., Z.T.), Budapest, Hungary; Division of Child and Adolescent Psychiatry, Department of Psychiatry (K.J.P.), Lausanne University Hospital, Switzerland; ASL BA, Mental Health Department (C.P.), Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry, Department of Clinical and Experimental Medicine (R.R.), University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Clinic of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and Department of Child and Adolescent Psychiatry (A.D., P.J.H.), University of Groningen, University Medical Center Groningen, the Netherlands
| | - Pieter J Hoekstra
- From the Department of Clinical Neurosciences (D.M.), Cumming School of Medicine & Hotchkiss Brain Institute, University of Calgary, Canada; Department of Clinical Neuroscience (A.S., Z.A.), UCL Institute of Neurology, University College London, UK; Child and Adolescent Psychiatry Department (A.A., N.B.-M., T.S.), Schneider Children's Medical Center of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari "Aldo Moro"; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology, Directorate National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Department of Child and Adolescent Psychiatry (C.H.), De Bascule, Amsterdam UMC, the Netherlands; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (M.M.), Seville; Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville; Department of Child and Adolescent Psychiatry and Psychology (A. Morer), Institute of Neurosciences, Hospital Clínic; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (A. Morer), Barcelona; Centro de Investigación en Red de Salud Mental (CIBERSAM) (A. Morer), Instituto Carlos III, Madrid; Department of Medicine (A. Morer), University of Barcelona, Spain; Child and Adolescent Mental Health Center (N.M.D., K.J.P., L.S.), Mental Health Services, Capital Region of Denmark and University of Copenhagen, Denmark; Institute of Laboratory Medicine (N. Moll, M.S.) and Department of Psychiatry and Psychotherapy (N. Müller, J.S.), University Hospital LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.M.-V.), Hannover Medical School; Institute of Neurogenetics (A. Munchau), University of Lübeck, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (P.N., Z.T.), Budapest, Hungary; Division of Child and Adolescent Psychiatry, Department of Psychiatry (K.J.P.), Lausanne University Hospital, Switzerland; ASL BA, Mental Health Department (C.P.), Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry, Department of Clinical and Experimental Medicine (R.R.), University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Clinic of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and Department of Child and Adolescent Psychiatry (A.D., P.J.H.), University of Groningen, University Medical Center Groningen, the Netherlands
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Grassi G, Cecchelli C, Mazzocato G, Vignozzi L. Early onset obsessive-compulsive disorder: the biological and clinical phenotype. CNS Spectr 2021:1-7. [PMID: 33517936 DOI: 10.1017/s1092852921000122] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Moving from a behavioral-based to a biological-based classification of mental disorders is a crucial step toward a precision-medicine approach in psychiatry. In the last decade, a big effort has been made in order to stratify genetic, immunological, neurobiological, cognitive, and clinical profiles of patients. Making the case of obsessive-compulsive disorder (OCD), a lot have been made in this direction. Indeed, while the Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnosis of OCD aimed to delineate a homogeneous group of patients, it is now clear that OCD is instead an heterogeneous disorders both in terms of neural networks, immunological, genetic, and clinical profiles. In this view, a convergent amount of literature, in the last years, indicated that OCD patients with an early age at onset seem to have a specific clinical and biological profile, suggesting it as a neurodevelopmental disorder. Also, these patients tend to have a worse outcome respect to adult-onset patients and there is growing evidence that early-interventions could potentially improve their prognosis. Therefore, the aim of the present paper is to review the current available genetic, immunological, neurobiological, cognitive, and clinical data in favor of a more biologically precise subtype of OCD: the early-onset subtype. We also briefly resume current available recommendations for the clinical management of this specific population.
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Prato A, Gulisano M, Scerbo M, Barone R, Vicario CM, Rizzo R. Diagnostic Approach to Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections (PANDAS): A Narrative Review of Literature Data. Front Pediatr 2021; 9:746639. [PMID: 34778136 PMCID: PMC8580040 DOI: 10.3389/fped.2021.746639] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 09/24/2021] [Indexed: 12/12/2022] Open
Abstract
Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) are clinical conditions characterized by the sudden onset of obsessive-compulsive disorder and/or tics, often accompanied by other behavioral symptoms in a group of children with streptococcal infection. PANDAS-related disorders, including pediatric acute-onset neuropsychiatric syndrome (PANS), childhood acute neuropsychiatric symptoms (CANS), and pediatric infection triggered autoimmune neuropsychiatric disorders (PITANDs), have also been described. Since first defined in 1998, PANDAS has been considered a controversial diagnosis. A comprehensive review of the literature was performed on PubMed and Scopus databases, searching for diagnostic criteria and diagnostic procedures of PANDAS and related disorders. We propose a test panel to support clinicians in the workout of PANDAS/PANS patients establishing an appropriate treatment. However, further studies are needed to improve our knowledge on these acute-onset neuropsychiatric conditions.
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Affiliation(s)
- Adriana Prato
- Department of Cognitive Sciences, Psychology, Education and Cultural Studies, University of Messina, Messina, Italy.,Child and Adolescent Neurology and Psychiatric Section, Department of Clinical and Experimental Medicine, Catania University, Catania, Italy
| | - Mariangela Gulisano
- Child and Adolescent Neurology and Psychiatric Section, Department of Clinical and Experimental Medicine, Catania University, Catania, Italy
| | - Miriam Scerbo
- Child and Adolescent Neurology and Psychiatric Section, Department of Clinical and Experimental Medicine, Catania University, Catania, Italy
| | - Rita Barone
- Child and Adolescent Neurology and Psychiatric Section, Department of Clinical and Experimental Medicine, Catania University, Catania, Italy
| | - Carmelo M Vicario
- Department of Cognitive Sciences, Psychology, Education and Cultural Studies, University of Messina, Messina, Italy
| | - Renata Rizzo
- Child and Adolescent Neurology and Psychiatric Section, Department of Clinical and Experimental Medicine, Catania University, Catania, Italy
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Murciano M, Biancone DM, De Luca F, Piras Marafon D, Guido CA, Spalice A. Breastfeeding in Pediatric Acute-Onset Neuropsychiatric Syndrome: An Italian Observational Study. Front Pediatr 2021; 9:682108. [PMID: 34307255 PMCID: PMC8295522 DOI: 10.3389/fped.2021.682108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/12/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Pediatric acute-onset neuropsychiatric syndrome (PANS) is a condition defined by sudden onset of obsessive-compulsive symptoms and/or severe eating restrictions, along with at least two other cognitive, behavioral, or neurological symptoms. Its pathogenesis is unknown but it seems triggered by infections, metabolic disturbances, and other inflammatory reactions. PANS represents a neurodevelopmental problem and infant feeding can play a role. Breast milk is the ideal food for infants and influences children's brain, cognitive, and socio-emotional development. Methods: We enrolled 52 children diagnosed with PANS. We interviewed their parents in order to investigate perinatal history, infant feeding, neurologic development, and confounding factors like socio-economic status and region of origin. We subgrouped PANS patients into three subsets: those who only received human milk (HMO), those who only received infant formula, and those who received mixed feeding. Results: The cohort is composed of 78.9% males, with a median age of 11 years (range 7-17). We found some neurodevelopmental problems (13.5%): walking disorders, ASD, ADHD, oppositional attitude, and delayed psychomotor development. We found scholar performance deficits (25%), including language problems like dysgraphia, dyslexia, and dyscalculia. The achievement of some milestones in the development of the infant is affected in 73.1% of cases. Breastfeeding is not homogeneously practiced in Italy because of social, economic, and cultural phenomena. The richest and the poorest families (100%) in the sample choose breastfeeding, probably with a different approach and for different reasons (awareness or need). In the group of PANS patients fed with HMO, compared to the rest of the patients, we registered fewer cases of growth problems (0 vs. 12.9%; p = 0.14), school performance problems or the need for school support (19.1% vs. 29%; p = 0.42), and a delay in the age of babbling/speaking (range 4-20 vs. 7-36 months; p = 0.066). Conclusion: This is the first study that investigates the role of breastfeeding in the development of PANS. Promoting breastfeeding is important in the general population and also in PANS patients because it has an important social and global health impact, also during adult life. Further studies with a bigger population are needed to investigate the mechanisms underlying PANS and the role that breastfeeding may play in their short- and long-term neurodevelopment.
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Affiliation(s)
- Manuel Murciano
- Emergency Paediatric Department, Bambino Gesù Children's Hospital, Rome, Italy
| | - Davide Maria Biancone
- Child Neurology Division, Department of Pediatrics, "Sapienza" University of Rome, Rome, Italy
| | - Francesca De Luca
- Child Neurology Division, Department of Pediatrics, "Sapienza" University of Rome, Rome, Italy
| | | | - Cristiana Alessia Guido
- Child Neurology Division, Department of Pediatrics, "Sapienza" University of Rome, Rome, Italy.,Department of Developmental and Social Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Alberto Spalice
- Child Neurology Division, Department of Pediatrics, "Sapienza" University of Rome, Rome, Italy
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Gagliano A, Puligheddu M, Ronzano N, Congiu P, Tanca MG, Cursio I, Carucci S, Sotgiu S, Grossi E, Zuddas A. Artificial Neural Networks Analysis of polysomnographic and clinical features in Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS): from sleep alteration to "Brain Fog". Nat Sci Sleep 2021; 13:1209-1224. [PMID: 34326674 PMCID: PMC8315772 DOI: 10.2147/nss.s300818] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 05/17/2021] [Indexed: 02/05/2023] Open
Abstract
STUDY OBJECTIVES PANS (pediatric acute onset neuropsychiatric syndrome) is thought to be the result of several mechanisms and multiple etiologies, ranging from endocrine/metabolic causes to postinfectious autoimmune and neuroinflammatory disorders. Sleep disorders represent one of the most frequent manifestations of PANS, involving around 80% of patients. The present study describes the clinical and polysomnographic features in a group of PANS children identifying the relationships between sleep disorders and other PANS symptoms. METHODS All participants underwent a clinical evaluation including comprehensive sleep history, polysomnography, cognitive assessment and blood chemistry examination. A data mining approach with fourth-generation artificial neural networks has been used in order to discover subtle trends and associations among variables. RESULTS Polysomnography showed abnormality in 17 out of 23 recruited subjects (73.9%). In particular, 8/17 children (47%) had ineffective sleep, 10/17 (58.8%) fragmented sleep, 8/17 (47.1%) periodic limb movement disorder (PLMD) and 11/17 (64.7%) REM-sleep without atonia (RSWA). Most subjects presented more than one sleep disturbances. Notably, among the 19/23 patients diagnosed with Tic/Tourette disorder, 8/19 (42.1%) show PLMD and 10/19 (52.6%) RSWA. Artificial neural network methodology and the auto-contractive map exploited the links among the full spectrum of variables revealing the simultaneous connections among them, facing the complexity of PANS phenotype. CONCLUSION Disordered sleep represents, for prevalence and impact on quality of life, a cardinal symptom in patients with PANS. Thus, considering the weight of sleep disturbances on diagnosis and prognosis of PANS, we could consider the possibility of including them among the major diagnostic criteria.
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Affiliation(s)
- Antonella Gagliano
- Child & Adolescent Neuropsychiatry Unit, “Azienda Ospedaliera Brotzu” Hospital Trust, Cagliari, Italy
| | - Monica Puligheddu
- Sleep Disorder Centre, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
- Correspondence: Monica Puligheddu Sleep Disorder Research Center, Department of Medical Science and Public Health, University of Cagliari, asse didattico E. SS 554 bivio Sestu, Monserrato, Cagliari, 09042, ItalyTel +0706754952 Email
| | - Nadia Ronzano
- Section of Neuroscience & Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Patrizia Congiu
- Sleep Disorder Centre, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Marcello Giuseppe Tanca
- Section of Neuroscience & Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Ida Cursio
- Section of Neuroscience & Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Sara Carucci
- Child & Adolescent Neuropsychiatry Unit, “Azienda Ospedaliera Brotzu” Hospital Trust, Cagliari, Italy
| | - Stefano Sotgiu
- Child Neuropsychiatry Unit, Department of Medical, Surgical and Experimental Sciences, University Hospital of Sassari, Sassari, Italy
| | - Enzo Grossi
- Autism Research Unit, Villa Santa Maria Foundation, Como, Italy
| | - Alessandro Zuddas
- Child & Adolescent Neuropsychiatry Unit, “Azienda Ospedaliera Brotzu” Hospital Trust, Cagliari, Italy
- Section of Neuroscience & Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
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Foiadelli T, Rossi V, Paolucci S, Rovida F, Novazzi F, Orsini A, Brambilla I, Marseglia GL, Baldanti F, Savasta S. Human Herpes Virus 7-related encephalopathy in children. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021415. [PMID: 35441609 PMCID: PMC9179060 DOI: 10.23750/abm.v92is4.12664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/27/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Primary HHV7 infection is almost ubiquitous, and it can present as exanthema subitem. Little is known on the clinical relevance of HHV7 neuroinvasion in immunocompetent children. METHODS We describe 12 patients (median age 9.45 years, 50% males) with acute encephalopathy and active HHV7 infection. In all patients, HHV7-DNA was detected on cerebrospinal fluid (CSF) by RT-PCR. RESULTS 7/12 patients had meningoencephalitis (two with ADEM and one with MOG antibody-associated CIS); 5/12 showed acute neuropsychiatric symptoms. EEG showed anomalies exclusively in patients with meningoencephalitis. Six patients had RMN anomalies. CSF HHV7 copies ranged between 20 and 3,500 copies/mL (median 66 copies/mL) and mean HHV7 CSF/blood ratio was 0.75. Outcome was favorable in all children, although 3/12 had minor neurobehavioral sequelae. Mean follow-up period of 5.2 months. CONCLUSIONS HHV7 can determine neuroinvasion in immunocompetent children, leading to acute encephalopathy. Blood-brain barrier damage and high CSF/blood viral copies ratio correlated with a more severe presentation. We speculate on the importance of immune-mediated mechanisms in provoking clinical features.
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Affiliation(s)
- Thomas Foiadelli
- Pediatric Clinic, IRCCS Policlinico San Matteo Foundation, Pavia, Italy, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Virginia Rossi
- Pediatric Clinic, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Stefania Paolucci
- Molecular Virology Unit, Department of Diagnostic Medicine, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Francesca Rovida
- Molecular Virology Unit, Department of Diagnostic Medicine, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Federica Novazzi
- Molecular Virology Unit, Department of Diagnostic Medicine, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Alessandro Orsini
- Pediatric Neurology, Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy
| | - Ilaria Brambilla
- Pediatric Clinic, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Gian Luigi Marseglia
- Pediatric Clinic, IRCCS Policlinico San Matteo Foundation, Pavia, Italy, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Fausto Baldanti
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy, Molecular Virology Unit, Department of Diagnostic Medicine, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Salvatore Savasta
- Pediatric Clinic, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
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Pavone P, Parano E, Battaglia C, Marino S, Trifiletti RR, Marino SD, Falsaperla R. Severe Psychotic Symptoms in Youth with PANS/PANDAS: Case-Series. J Child Adolesc Psychopharmacol 2020; 30:567-571. [PMID: 32700992 DOI: 10.1089/cap.2020.0050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Objectives: To report a case series of children presenting with episodes of abrupt onset psychotic symptoms presumably linked to pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) and pediatric acute-onset neuropsychiatric syndrome (PANS). Methods: Children/adolescents were selected among the group of individuals affected by clinical diagnosis of PANDAS/PANS. One group was selected by affected individuals coming from the Center UMDNJ-New Jersey Medical School, New Jersey, USA and the other from the Department of Pediatrics Catania University, Italy. Child health Questionnaire Parent form 50 was given to parents to describe children's quality of life. Results: Among the group of individuals with PANDAS/PANS disorders, eight children/adolescents were selected, six coming from the UMDNJ-New Jersey and two from Catania, University centers showing among the other typical manifestations severe episodes of abrupt onset of psychotic symptoms. Conclusions: Severe psychotic symptoms may be considered one among the other neuropsychiatric clinical manifestations presenting in individuals with PANDAS/PANS syndromes.
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Affiliation(s)
- Piero Pavone
- Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Sciences, University of Catania, Catania, Italy
| | - Enrico Parano
- National Council of Research, Institute for Biomedical Research and Innovation (IRIB), Unit of Catania, Catania, Italy
| | - Chiara Battaglia
- Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Sciences, University of Catania, Catania, Italy
| | - Silvia Marino
- U.O. of Pediatric and Pediatric Emergency, University-Hospital "Policlinico-Vittorio Emanuele," University of Catania, Catania, Italy
| | | | - Simona D Marino
- U.O. of Pediatric and Pediatric Emergency, University-Hospital "Policlinico-Vittorio Emanuele," University of Catania, Catania, Italy
| | - Raffaele Falsaperla
- U.O. of Pediatric and Pediatric Emergency, University-Hospital "Policlinico-Vittorio Emanuele," University of Catania, Catania, Italy
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34
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Fineberg NA, Hollander E, Pallanti S, Walitza S, Grünblatt E, Dell’Osso BM, Albert U, Geller DA, Brakoulias V, Janardhan Reddy Y, Arumugham SS, Shavitt RG, Drummond L, Grancini B, De Carlo V, Cinosi E, Chamberlain SR, Ioannidis K, Rodriguez CI, Garg K, Castle D, Van Ameringen M, Stein DJ, Carmi L, Zohar J, Menchon JM. Clinical advances in obsessive-compulsive disorder: a position statement by the International College of Obsessive-Compulsive Spectrum Disorders. Int Clin Psychopharmacol 2020; 35:173-193. [PMID: 32433254 PMCID: PMC7255490 DOI: 10.1097/yic.0000000000000314] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 03/16/2020] [Indexed: 11/25/2022]
Abstract
In this position statement, developed by The International College of Obsessive-Compulsive Spectrum Disorders, a group of international experts responds to recent developments in the evidence-based management of obsessive-compulsive disorder (OCD). The article presents those selected therapeutic advances judged to be of utmost relevance to the treatment of OCD, based on new and emerging evidence from clinical and translational science. Areas covered include refinement in the methods of clinical assessment, the importance of early intervention based on new staging models and the need to provide sustained well-being involving effective relapse prevention. The relative benefits of psychological, pharmacological and somatic treatments are reviewed and novel treatment strategies for difficult to treat OCD, including neurostimulation, as well as new areas for research such as problematic internet use, novel digital interventions, immunological therapies, pharmacogenetics and novel forms of psychotherapy are discussed.
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Affiliation(s)
- Naomi A. Fineberg
- University of Hertfordshire, Hatfield
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, Hertfordshire
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Eric Hollander
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Stefano Pallanti
- Istituto di Neuroscienze, University of Florence, Firenze, Italy
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich
- Neuroscience Center Zurich, University of Zurich and ETH Zurich
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Edna Grünblatt
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich
- Neuroscience Center Zurich, University of Zurich and ETH Zurich
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Bernardo Maria Dell’Osso
- University of Milan, Department of Biomedical and Clinical Sciences Luigi Sacco, Ospedale Sacco-Polo Universitario, ASST Fatebenefratelli-Sacco, Milan, Italy
- Department of Psychiatry and Behavioural Sciences, Stanford University, California, USA
- CRC ‘Aldo Ravelli’ for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Milan
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford
| | - Umberto Albert
- Department of Medicine, Surgery and Health Sciences, UCO Clinica Psichiatrica, University of Trieste, Trieste, Italy
| | - Daniel A. Geller
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Vlasios Brakoulias
- Western Sydney Obsessive-Compulsive and Related Disorders Service, Western Sydney Local Health District, Blacktown Hospital, Blacktown, New South Wales
- Translational Research Health Institute (THRI), Clinical and Health Psychology Research Initiative (CaHPRI) and School of Medicine, Western Sydney University, Sydney, Australia
| | - Y.C. Janardhan Reddy
- OCD Clinic, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Shyam Sundar Arumugham
- OCD Clinic, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Roseli G. Shavitt
- OCD Spectrum Disorders Program, Institute and Department of Psychiatry, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo-SP, Brazil
| | - Lynne Drummond
- Consultant Psychiatrist, SW London and St George’s NHS Trust and St George’s, University of London, London
| | - Benedetta Grancini
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, Hertfordshire
- University of Milan, Department of Biomedical and Clinical Sciences Luigi Sacco, Ospedale Sacco-Polo Universitario, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Vera De Carlo
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, Hertfordshire
- University of Milan, Department of Biomedical and Clinical Sciences Luigi Sacco, Ospedale Sacco-Polo Universitario, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Eduardo Cinosi
- University of Hertfordshire, Hatfield
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, Hertfordshire
| | - Samuel R. Chamberlain
- Department of Psychiatry, University of Cambridge, Cambridge
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Konstantinos Ioannidis
- Department of Psychiatry, University of Cambridge, Cambridge
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Carolyn I. Rodriguez
- Department of Psychiatry and Behavioural Sciences, Stanford University, California, USA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Kabir Garg
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, Hertfordshire
| | - David Castle
- St. Vincent’s Hospital Melbourne and The University of Melbourne, Melbourne, Australia
| | - Michael Van Ameringen
- Department of Psychiatry and Behavioural Neurosciences, McMaster University
- Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Dan J. Stein
- SA MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Lior Carmi
- The Post Trauma Center, Chaim Sheba Medical Center, Ramat Gan
- The Data Science Institution, The Interdisciplinary Center, Herzliya
| | - Joseph Zohar
- The Post Trauma Center, Chaim Sheba Medical Center, Ramat Gan
- Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Jose M. Menchon
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, University of Barcelona, Cibersam, Barcelona, Spain
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Abstract
In recent years, mold has been blamed for many symptoms or a constellation of symptoms. These symptoms are usually vague and subjective and difficult or impossible to measure or quantify. Moreover, there is no scientific evidence that mold has anything to do with these symptoms. In particular, the concept of toxic mold syndrome has permeated the public consciousness, and mycotoxins have falsely been associated with autoimmune diseases and a variety of other conditions. In fact, there is no evidence that the presence of mycotoxins in the air is enough to cause any disease known to man. Molds legitimately can cause allergies and can be a trigger for asthma. Certain specific molds such as Aspergillus can be a cause of hypersensitivity pneumonitis. In immunocompromised hosts, both dermatologic and systemic infections can result from various fungi and can be associated with significant morbidity or even mortality. However, the existence of toxic mold syndrome has been disproven, despite the numerous disreputable practices such as testing homes for mold spores, measuring "mycotoxins" in the urine, and testing patients for IgG to mold. In truth, none of these techniques have been validated, nor do they have any relevance to any clinical disease. All that these tests that are being performed by laboratories of disrepute does is to further propagate misinformation and inflict unnecessary and often exorbitant costs on patients desperate for a clinical diagnosis, right or wrong, for their constellation of maladies.
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Affiliation(s)
- Christopher Chang
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis, Davis, CA, 95616, USA. .,Division of Pediatric Immunology and Allergy, Joe DiMaggio Children's Hospital, Hollywood, FL, 33021, USA.
| | - M Eric Gershwin
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis, Davis, CA, 95616, USA.
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36
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Conrad K, Shoenfeld Y, Fritzler MJ. Precision health: A pragmatic approach to understanding and addressing key factors in autoimmune diseases. Autoimmun Rev 2020; 19:102508. [PMID: 32173518 DOI: 10.1016/j.autrev.2020.102508] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 11/06/2019] [Indexed: 02/07/2023]
Abstract
The past decade has witnessed a significant paradigm shift in the clinical approach to autoimmune diseases, lead primarily by initiatives in precision medicine, precision health and precision public health initiatives. An understanding and pragmatic implementation of these approaches require an understanding of the drivers, gaps and limitations of precision medicine. Gaining the trust of the public and patients is paramount but understanding that technologies such as artificial intelligences and machine learning still require context that can only be provided by human input or what is called augmented machine learning. The role of genomics, the microbiome and proteomics, such as autoantibody testing, requires continuing refinement through research and pragmatic approaches to their use in applied precision medicine.
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Affiliation(s)
- Karsten Conrad
- Institute of Immunology, Medical Faculty "Carl Gustav Carus", Technical University of Dresden, Dresden, Germany
| | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel; Department of Medicine, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Marvin J Fritzler
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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37
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Baj J, Sitarz E, Forma A, Wróblewska K, Karakuła-Juchnowicz H. Alterations in the Nervous System and Gut Microbiota after β-Hemolytic Streptococcus Group A Infection-Characteristics and Diagnostic Criteria of PANDAS Recognition. Int J Mol Sci 2020; 21:E1476. [PMID: 32098238 PMCID: PMC7073132 DOI: 10.3390/ijms21041476] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 02/16/2020] [Accepted: 02/18/2020] [Indexed: 02/07/2023] Open
Abstract
The objective of this paper is to review and summarize conclusions from the available literature regarding Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS). The authors have independently reviewed articles from 1977 onwards, primarily focusing on the etiopathology, symptoms, differentiation between similar psychiatric conditions, immunological reactions, alterations in the nervous system and gut microbiota, genetics, and the available treatment for PANDAS. Recent research indicates that PANDAS patients show noticeable alterations within the structures of the central nervous system, including caudate, putamen, globus pallidus, and striatum, as well as bilateral and lentiform nuclei. Likewise, the presence of autoantibodies that interact with basal ganglia was observed in PANDAS patients. Several studies also suggest a relationship between the presence of obsessive-compulsive disorders like PANDAS and alterations to the gut microbiota. Further, genetic predispositions-including variations in the MBL gene and TNF-α-seem to be relevant regarding PANDAS syndrome. Even though the literature is still scarce, the authors have attempted to provide a thorough insight into the PANDAS syndrome, bearing in mind the diagnostic difficulties of this condition.
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Affiliation(s)
- Jacek Baj
- Chair and Department of Anatomy, Medical University of Lublin, 20-090 Lublin, Poland
| | - Elżbieta Sitarz
- Department of Forensic Medicine, Medical University of Lublin, 20-090 Lublin, Poland; (E.S.); (A.F.)
| | - Alicja Forma
- Department of Forensic Medicine, Medical University of Lublin, 20-090 Lublin, Poland; (E.S.); (A.F.)
| | - Katarzyna Wróblewska
- North London Forensic Service, Chase Farm Hospital, 127 The Ridgeway, Enfield, Middlesex EN2 8JL, UK;
| | - Hanna Karakuła-Juchnowicz
- Chair and 1st Department of Psychiatry, Psychotherapy and Early Intervention, Medical University of Lublin, Gluska Street 1, 20-439 Lublin, Poland;
- Department of Clinical Neuropsychiatry, Medical University of Lublin, Gluska Street 1, 20-439 Lublin, Poland
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Nazeer A, Latif F, Mondal A, Azeem MW, Greydanus DE. Obsessive-compulsive disorder in children and adolescents: epidemiology, diagnosis and management. Transl Pediatr 2020; 9:S76-S93. [PMID: 32206586 PMCID: PMC7082239 DOI: 10.21037/tp.2019.10.02] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Obsessive-compulsive disorder (OCD) can be found in about 4% of the general population and is characterized by various compulsions and obsessions that interfere with the person's quality of life from a mild to severe degree. The following discussion reflects on current concepts in this condition, including its epidemiology and etiologic underpinnings (behavioral, neurological, immunological, gastroenterological, as well as genetic). The interplay of PANS and PANDAS are included in this review. In addition, the core concepts of OCD diagnosis, differential diagnosis, and co-morbidities are considered. It is stressed that the quality of life for persons with pediatric OCD as well as for family members can be quite limited and challenged. Thus, principles of management are presented as a guide to improve the quality of life for these persons as much as possible.
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Affiliation(s)
- Ahsan Nazeer
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, Sidra Medicine, Doha, Qatar
| | - Finza Latif
- Division of Psychiatry and Behavioral Sciences, George Washington University, Children's National Medical Center, Washington, DC, USA
| | - Aisha Mondal
- Division of Psychiatry and Behavioral Sciences, George Washington University, Children's National Medical Center, Washington, DC, USA
| | | | - Donald E Greydanus
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
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Cabrera-Mendoza B, Genis-Mendoza AD, Nicolini H. Diagnosis in PANDAS: An Update. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2020. [DOI: 10.2174/2666082215666190917161514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:The last twenty years have seen major advancements in unraveling the etiology and the identification of biological markers of Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococci (PANDAS). However, this body of evidence has not yet been translated into a clinical setting.Objective:We will review the most important studies to date on PANDAS, emphasizing those whose advances could improve the diagnosis of these disorders. We also suggest the need for updated diagnosis criteria integrating the recent findings from the hereby included studies.Methods:Consulting the PubMed database, a literature review of the last twenty-one years (between 1998 and 2019) was carried out using the terms “PANDAS” and “pediatric autoimmune neuropsychiatric disorders” in combination with “diagnosis” and “markers”. The search resulted in 175 hits from which we selected clinical cases, original investigations, and clinical reviews.Results:This review offers a compilation of the most important studies performed to date regarding the clinical presentation and potential biological markers of PANDAS. Moreover, we suggest the refinement of some aspects in the current diagnosis criteria, such as focusing on specific symptoms and the inclusion of neuroimaging and peripheral markers.Conclusion:The identification of specific biological markers in PANDAS is crucial for its diagnosis and opportune treatment. Future research will determine whether PANDAS require separated diagnostic and therapeutic measures or if it should be included in recently proposed categories such as Pediatric Acute Neuropsychiatric Syndrome (PANS) or Childhood Acute Neuropsychiatric Syndrome (CANS).
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Affiliation(s)
- Brenda Cabrera-Mendoza
- Genomics of Psychiatric and Neurodegenerative Diseases Laboratory, National Institute of Genomic Medicine (INMEGEN), CDMX, Mexico
| | - Alma Delia Genis-Mendoza
- Genomics of Psychiatric and Neurodegenerative Diseases Laboratory, National Institute of Genomic Medicine (INMEGEN), CDMX, Mexico
| | - Humberto Nicolini
- Genomics of Psychiatric and Neurodegenerative Diseases Laboratory, National Institute of Genomic Medicine (INMEGEN), CDMX, Mexico
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40
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Piras C, Pintus R, Pruna D, Dessì A, Atzori L, Fanos V. Pediatric Acute-onset Neuropsychiatric Syndrome and Mycoplasma Pneumoniae Infection: A Case Report Analysis with a Metabolomics Approach. Curr Pediatr Rev 2020; 16:183-193. [PMID: 31642785 PMCID: PMC8193809 DOI: 10.2174/1573396315666191022102925] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 09/26/2019] [Accepted: 10/02/2019] [Indexed: 01/27/2023]
Abstract
Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) is a clinical condition characterized by a sudden and dramatic obsessive-compulsive disorder with a suggested post-infectious immune-mediated etiology. This condition is accompanied by an extensive series of relatively serious neuropsychiatric symptoms. The diagnosis of PANS is made by "exclusion", as the individual PANS symptoms overlap with a multiplicity of psychiatric disorders with the onset in childhood. A number of researchers accumulated evidence to support the hypothesis that PANS was closely associated with a number of infections. In the last decade, metabolomics played an essential role in improving the knowledge of complex biological systems and identifying potential new biomarkers as indicators of pathological progressions or pharmacologic responses to therapy. The metabolome is considered the most predictive phenotype, capable of recognizing epigenetic differences, reflecting more closely the clinical reality at any given moment and thus providing extremely dynamic data. In the present work, the most recent hypothesis and suggested mechanisms of this condition are reviewed and the case of a 10 - year-old girl with PANS is described, before and after clarithromycin treatment. The main results of this case report are discussed from a metabolomics point of view. The alteration of several metabolic pathways concerning the microbial activity highlights the possible role of the microbiome in the development of PANS. Furthermore, different metabolic perturbations at the level of protein biosynthesis, energy and amino acid metabolisms are observed and discussed. Based on our observations, it is believed that metabolomics is a promising technology to unravel the mysteries of PANS in the near future.
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Affiliation(s)
- Cristina Piras
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Roberta Pintus
- Department of Surgical Sciences, Neonatal Intensive Care Unit, Puericulture Institute and Neonatal Section, Azienda Ospedaliera Universitaria, Cagliari, Italy
| | - Dario Pruna
- Pediatric Neurology and Epileptology Unit, Brotzu Hospital Trust, Cagliari, Italy
| | - Angelica Dessì
- Department of Surgical Sciences, Neonatal Intensive Care Unit, Puericulture Institute and Neonatal Section, Azienda Ospedaliera Universitaria, Cagliari, Italy
| | - Luigi Atzori
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Vassilios Fanos
- Department of Surgical Sciences, Neonatal Intensive Care Unit, Puericulture Institute and Neonatal Section, Azienda Ospedaliera Universitaria, Cagliari, Italy
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