Can Strep Bring On an Anxiety Disorder?

[Guest guest]

http://www.nytimes.com/2004/12/14/health/psychology/14ocd.html

December 14, 2004

Can Strep Bring On an Anxiety Disorder?

By ANAHAD O'CONNOR

Looking back, Watkins is convinced a sore throat disabled her son one

year ago. His bizarre obsessions emerged not long after, first the constant

nightmares about snakes and alligators, then the relentless hand washing

that left his skin raw and chapped.

Mrs. Watkins, who lives in Lakeland, Fla., was told that her son, Will, had

obsessive-compulsive disorder. But it seemed odd, Ms. Watkins thought. Will

was only 5 years old, and his illness seemed to burst out of nowhere.

" In a matter of weeks, " she said, " this was a totally different child. "

Then one day, buried on a Web site about mental illness, her husband noticed

a small " blip " on children who develop a sudden, severe form of

obsessive-compulsive disorder after a bout of strep throat.

Mrs. Watkins read the description, decided that Will fit the pattern, and

thus became part of a small but growing number of parents who blame a common

bacterial infection for the psychiatric illness of a son or daughter.

About one child in 1,000 may be afflicted, but some experts say the number

is higher if milder cases that escape notice are included. The condition is

known as Pandas, or pediatric autoimmune neuropsychiatric disorder

associated with streptococcal infection, and scientists know so little about

it that some question whether it even exists.

Frustrated parents, many of whom describe watching helplessly as their

children unravel overnight, are waiting on a handful of studies now under

way to yield some answers. Meanwhile, many have sought out drugs and

complicated medical procedures that may be unnecessary, and in some cases

dangerous.

" With Pandas you get a very desperate situation, " said Dr. ,

director of the child anxiety and tic disorder clinic at the University of

Florida. " It's amazing how quickly the kids go from functioning pretty well

to being devastated with motor tics and symptoms of O.C.D. Then you see

parents wanting to do anything to get their kids back to the way they used

to be. I can understand where they're coming from. "

There are no nationwide statistics on how many children may have the

disorder. But Dr. said that in the last three years, in Florida

alone, she had enrolled in her studies at least 100 children who fit the

pattern.

" I'm also aware of at least three times that many children from phone calls

and parents of clinic patients who do not want their children enrolled in

research, " she added.

First described by scientists at the National Institutes of Health in the

mid-1990's, Pandas is still relatively new. There is no surefire way to

detect it, and few doctors have even heard of it. But the signs are often

unmistakable.

Children, sometimes as young as 2 or 3, develop odd verbal and motor tics.

They feel compelled to engage in repetitive behaviors. They develop

irrational fears of germs, bugs, intruders, almost everything around them.

Separation anxiety is another hallmark. Even getting them to perform routine

activities like going to school becomes a struggle. Many of the symptoms -

ritualistic behaviors and disturbing thoughts, for example - mirror those of

obsessive-compulsive disorder.

But unlike O.C.D., Pandas crops up almost overnight, its onset coinciding

with a streptococcus infection or immediately after it. And the symptoms wax

and wane. They flare up, anecdotal evidence suggests, whenever the child has

contracted a new strep infection, leading some scientists to suspect a

causal link.

" This is not what we're used to seeing, " said Dr. Lombroso, a professor

of child psychiatry at the Yale Child Study Center who is also involved in

studies of the disorder. " Normally, the onset of a tic disorder is a much

more slow, insidious process. "

Dr. Swedo, a researcher at the National Institute of Mental Health who

first described Pandas, believes the disorder is caused by a severe immune

reaction that leads to brain damage. The mechanism may be similar to what is

seen in some other diseases. In rheumatic fever, for example, antibodies

produced against an untreated strep infection mistakenly attack the heart

valves.

Dr. Swedo, after finding that children with Pandas had abnormally high

levels of antibodies, theorized that their immune systems had also gone

haywire. In this case, she suspects, it is the basal ganglia, a clump of

nerve clusters in the brain that helps sequence movements, that is damaged.

" The hypothesis is that there is a similarity between proteins found in

strep bacteria and proteins in the brain, " said Dr. Leckman, a

professor of child psychiatry at the Yale Child Study Center.

At least two recent studies have shown that antibiotics can reduce symptoms.

Only small samples of children were involved, however, and the studies were

not long term. For some researchers, that is not enough evidence to conclude

that a strep infection can set off brain damage or that children thought to

have Pandas should be given antibiotics. Strep infections are so widespread,

they argue, that a child who develops tics and obsessive-compulsive

behaviors might also test positive for the bacteria purely by chance.

Dr. Kurlan, a neurologist at the University of Rochester School of

Medicine and Dentistry, said in some parts of the country up to half the

students in any given grade school will test positive for strep, depending

on the time of the year. He believes that in most children with a tic

disorder, like Tourette's syndrome, strep infections may be just one of

thousands of things that can provoke symptoms without actually causing the

underlying illness.

" It's been known forever that almost anything can act as a trigger - a viral

infection, a death in the family, allergies, anything that causes anxiety, "

he said. " The question now is whether an infection with strep is just

another one of these nonspecific triggers. "

The answer may have far -reaching effects. Studies show that antibiotics are

widely overused, and some experts worry that doctors are prescribing the

drugs for children with tics or obsessive-compulsive disorder who do not

need them.

Other doctors and parents may be going to greater lengths. Dr. Kurlan said

some children had been treated with costly medical procedures that could

have serious side effects. One is plasma exchange, a modern form of

bloodletting. The technique involves removing a patient's blood and purging

it of antibodies. In some cases it can lead to infection and blood clots.

" It's expensive and potentially dangerous, " he said. " I know some parents

have asked for it. Most doctors who know the facts will not use plasma

exchange, but there are places in the country that have made it available to

parents. "

Experts say that cognitive behavioral therapy may be one helpful option.

There is no solid evidence backing any drug treatments, but several

large-scale studies could soon change that. Dr. and scientists at the

National Institutes of Health are following dozens of children thought to

have Pandas to determine whether antibiotics can prevent symptoms from

flaring. One group will receive penicillin, the other a placebo. Dr.

expects to have the answer early next year.

Other studies, at multiple sites, are following children month by month with

tests for antibodies and strep to determine how tightly infections and

symptoms are linked, if at all. Dr. Kurlan, who is leading one of the

studies, said results might be ready by next summer.

In the meantime, parents like Mrs. Watkins wait. Mrs. Watkins said her son's

most destructive symptoms - the hand washing, separation anxiety and night

terrors - slowly disappeared when he began taking antibiotics for his sore

throat a year ago. He often repeats his sentences now and displays tics and

quirky behaviors. Mrs. Watkins enrolled him in the penicillin study at

Florida, which he is scheduled to begin this month.

" I really hope he's not in the placebo group, " she said.

Copyright 2004 The New York Times Company | Home | Privacy Policy | Search |

Corrections | RSS | Help | Back to Top

[Guest guest]

http://www.nytimes.com/2004/12/14/health/psychology/14ocd.html

December 14, 2004

Can Strep Bring On an Anxiety Disorder?

By ANAHAD O'CONNOR

Looking back, Watkins is convinced a sore throat disabled her son one

year ago. His bizarre obsessions emerged not long after, first the constant

nightmares about snakes and alligators, then the relentless hand washing

that left his skin raw and chapped.

Mrs. Watkins, who lives in Lakeland, Fla., was told that her son, Will, had

obsessive-compulsive disorder. But it seemed odd, Ms. Watkins thought. Will

was only 5 years old, and his illness seemed to burst out of nowhere.

" In a matter of weeks, " she said, " this was a totally different child. "

Then one day, buried on a Web site about mental illness, her husband noticed

a small " blip " on children who develop a sudden, severe form of

obsessive-compulsive disorder after a bout of strep throat.

Mrs. Watkins read the description, decided that Will fit the pattern, and

thus became part of a small but growing number of parents who blame a common

bacterial infection for the psychiatric illness of a son or daughter.

About one child in 1,000 may be afflicted, but some experts say the number

is higher if milder cases that escape notice are included. The condition is

known as Pandas, or pediatric autoimmune neuropsychiatric disorder

associated with streptococcal infection, and scientists know so little about

it that some question whether it even exists.

Frustrated parents, many of whom describe watching helplessly as their

children unravel overnight, are waiting on a handful of studies now under

way to yield some answers. Meanwhile, many have sought out drugs and

complicated medical procedures that may be unnecessary, and in some cases

dangerous.

" With Pandas you get a very desperate situation, " said Dr. ,

director of the child anxiety and tic disorder clinic at the University of

Florida. " It's amazing how quickly the kids go from functioning pretty well

to being devastated with motor tics and symptoms of O.C.D. Then you see

parents wanting to do anything to get their kids back to the way they used

to be. I can understand where they're coming from. "

There are no nationwide statistics on how many children may have the

disorder. But Dr. said that in the last three years, in Florida

alone, she had enrolled in her studies at least 100 children who fit the

pattern.

" I'm also aware of at least three times that many children from phone calls

and parents of clinic patients who do not want their children enrolled in

research, " she added.

First described by scientists at the National Institutes of Health in the

mid-1990's, Pandas is still relatively new. There is no surefire way to

detect it, and few doctors have even heard of it. But the signs are often

unmistakable.

Children, sometimes as young as 2 or 3, develop odd verbal and motor tics.

They feel compelled to engage in repetitive behaviors. They develop

irrational fears of germs, bugs, intruders, almost everything around them.

Separation anxiety is another hallmark. Even getting them to perform routine

activities like going to school becomes a struggle. Many of the symptoms -

ritualistic behaviors and disturbing thoughts, for example - mirror those of

obsessive-compulsive disorder.

But unlike O.C.D., Pandas crops up almost overnight, its onset coinciding

with a streptococcus infection or immediately after it. And the symptoms wax

and wane. They flare up, anecdotal evidence suggests, whenever the child has

contracted a new strep infection, leading some scientists to suspect a

causal link.

" This is not what we're used to seeing, " said Dr. Lombroso, a professor

of child psychiatry at the Yale Child Study Center who is also involved in

studies of the disorder. " Normally, the onset of a tic disorder is a much

more slow, insidious process. "

Dr. Swedo, a researcher at the National Institute of Mental Health who

first described Pandas, believes the disorder is caused by a severe immune

reaction that leads to brain damage. The mechanism may be similar to what is

seen in some other diseases. In rheumatic fever, for example, antibodies

produced against an untreated strep infection mistakenly attack the heart

valves.

Dr. Swedo, after finding that children with Pandas had abnormally high

levels of antibodies, theorized that their immune systems had also gone

haywire. In this case, she suspects, it is the basal ganglia, a clump of

nerve clusters in the brain that helps sequence movements, that is damaged.

" The hypothesis is that there is a similarity between proteins found in

strep bacteria and proteins in the brain, " said Dr. Leckman, a

professor of child psychiatry at the Yale Child Study Center.

At least two recent studies have shown that antibiotics can reduce symptoms.

Only small samples of children were involved, however, and the studies were

not long term. For some researchers, that is not enough evidence to conclude

that a strep infection can set off brain damage or that children thought to

have Pandas should be given antibiotics. Strep infections are so widespread,

they argue, that a child who develops tics and obsessive-compulsive

behaviors might also test positive for the bacteria purely by chance.

Dr. Kurlan, a neurologist at the University of Rochester School of

Medicine and Dentistry, said in some parts of the country up to half the

students in any given grade school will test positive for strep, depending

on the time of the year. He believes that in most children with a tic

disorder, like Tourette's syndrome, strep infections may be just one of

thousands of things that can provoke symptoms without actually causing the

underlying illness.

" It's been known forever that almost anything can act as a trigger - a viral

infection, a death in the family, allergies, anything that causes anxiety, "

he said. " The question now is whether an infection with strep is just

another one of these nonspecific triggers. "

The answer may have far -reaching effects. Studies show that antibiotics are

widely overused, and some experts worry that doctors are prescribing the

drugs for children with tics or obsessive-compulsive disorder who do not

need them.

Other doctors and parents may be going to greater lengths. Dr. Kurlan said

some children had been treated with costly medical procedures that could

have serious side effects. One is plasma exchange, a modern form of

bloodletting. The technique involves removing a patient's blood and purging

it of antibodies. In some cases it can lead to infection and blood clots.

" It's expensive and potentially dangerous, " he said. " I know some parents

have asked for it. Most doctors who know the facts will not use plasma

exchange, but there are places in the country that have made it available to

parents. "

Experts say that cognitive behavioral therapy may be one helpful option.

There is no solid evidence backing any drug treatments, but several

large-scale studies could soon change that. Dr. and scientists at the

National Institutes of Health are following dozens of children thought to

have Pandas to determine whether antibiotics can prevent symptoms from

flaring. One group will receive penicillin, the other a placebo. Dr.

expects to have the answer early next year.

Other studies, at multiple sites, are following children month by month with

tests for antibodies and strep to determine how tightly infections and

symptoms are linked, if at all. Dr. Kurlan, who is leading one of the

studies, said results might be ready by next summer.

In the meantime, parents like Mrs. Watkins wait. Mrs. Watkins said her son's

most destructive symptoms - the hand washing, separation anxiety and night

terrors - slowly disappeared when he began taking antibiotics for his sore

throat a year ago. He often repeats his sentences now and displays tics and

quirky behaviors. Mrs. Watkins enrolled him in the penicillin study at

Florida, which he is scheduled to begin this month.

" I really hope he's not in the placebo group, " she said.

Copyright 2004 The New York Times Company | Home | Privacy Policy | Search |

Corrections | RSS | Help | Back to Top

[Guest guest]

http://www.nytimes.com/2004/12/14/health/psychology/14ocd.html

December 14, 2004

Can Strep Bring On an Anxiety Disorder?

By ANAHAD O'CONNOR

Looking back, Watkins is convinced a sore throat disabled her son one

year ago. His bizarre obsessions emerged not long after, first the constant

nightmares about snakes and alligators, then the relentless hand washing

that left his skin raw and chapped.

Mrs. Watkins, who lives in Lakeland, Fla., was told that her son, Will, had

obsessive-compulsive disorder. But it seemed odd, Ms. Watkins thought. Will

was only 5 years old, and his illness seemed to burst out of nowhere.

" In a matter of weeks, " she said, " this was a totally different child. "

Then one day, buried on a Web site about mental illness, her husband noticed

a small " blip " on children who develop a sudden, severe form of

obsessive-compulsive disorder after a bout of strep throat.

Mrs. Watkins read the description, decided that Will fit the pattern, and

thus became part of a small but growing number of parents who blame a common

bacterial infection for the psychiatric illness of a son or daughter.

About one child in 1,000 may be afflicted, but some experts say the number

is higher if milder cases that escape notice are included. The condition is

known as Pandas, or pediatric autoimmune neuropsychiatric disorder

associated with streptococcal infection, and scientists know so little about

it that some question whether it even exists.

Frustrated parents, many of whom describe watching helplessly as their

children unravel overnight, are waiting on a handful of studies now under

way to yield some answers. Meanwhile, many have sought out drugs and

complicated medical procedures that may be unnecessary, and in some cases

dangerous.

" With Pandas you get a very desperate situation, " said Dr. ,

director of the child anxiety and tic disorder clinic at the University of

Florida. " It's amazing how quickly the kids go from functioning pretty well

to being devastated with motor tics and symptoms of O.C.D. Then you see

parents wanting to do anything to get their kids back to the way they used

to be. I can understand where they're coming from. "

There are no nationwide statistics on how many children may have the

disorder. But Dr. said that in the last three years, in Florida

alone, she had enrolled in her studies at least 100 children who fit the

pattern.

" I'm also aware of at least three times that many children from phone calls

and parents of clinic patients who do not want their children enrolled in

research, " she added.

First described by scientists at the National Institutes of Health in the

mid-1990's, Pandas is still relatively new. There is no surefire way to

detect it, and few doctors have even heard of it. But the signs are often

unmistakable.

Children, sometimes as young as 2 or 3, develop odd verbal and motor tics.

They feel compelled to engage in repetitive behaviors. They develop

irrational fears of germs, bugs, intruders, almost everything around them.

Separation anxiety is another hallmark. Even getting them to perform routine

activities like going to school becomes a struggle. Many of the symptoms -

ritualistic behaviors and disturbing thoughts, for example - mirror those of

obsessive-compulsive disorder.

But unlike O.C.D., Pandas crops up almost overnight, its onset coinciding

with a streptococcus infection or immediately after it. And the symptoms wax

and wane. They flare up, anecdotal evidence suggests, whenever the child has

contracted a new strep infection, leading some scientists to suspect a

causal link.

" This is not what we're used to seeing, " said Dr. Lombroso, a professor

of child psychiatry at the Yale Child Study Center who is also involved in

studies of the disorder. " Normally, the onset of a tic disorder is a much

more slow, insidious process. "

Dr. Swedo, a researcher at the National Institute of Mental Health who

first described Pandas, believes the disorder is caused by a severe immune

reaction that leads to brain damage. The mechanism may be similar to what is

seen in some other diseases. In rheumatic fever, for example, antibodies

produced against an untreated strep infection mistakenly attack the heart

valves.

Dr. Swedo, after finding that children with Pandas had abnormally high

levels of antibodies, theorized that their immune systems had also gone

haywire. In this case, she suspects, it is the basal ganglia, a clump of

nerve clusters in the brain that helps sequence movements, that is damaged.

" The hypothesis is that there is a similarity between proteins found in

strep bacteria and proteins in the brain, " said Dr. Leckman, a

professor of child psychiatry at the Yale Child Study Center.

At least two recent studies have shown that antibiotics can reduce symptoms.

Only small samples of children were involved, however, and the studies were

not long term. For some researchers, that is not enough evidence to conclude

that a strep infection can set off brain damage or that children thought to

have Pandas should be given antibiotics. Strep infections are so widespread,

they argue, that a child who develops tics and obsessive-compulsive

behaviors might also test positive for the bacteria purely by chance.

Dr. Kurlan, a neurologist at the University of Rochester School of

Medicine and Dentistry, said in some parts of the country up to half the

students in any given grade school will test positive for strep, depending

on the time of the year. He believes that in most children with a tic

disorder, like Tourette's syndrome, strep infections may be just one of

thousands of things that can provoke symptoms without actually causing the

underlying illness.

" It's been known forever that almost anything can act as a trigger - a viral

infection, a death in the family, allergies, anything that causes anxiety, "

he said. " The question now is whether an infection with strep is just

another one of these nonspecific triggers. "

The answer may have far -reaching effects. Studies show that antibiotics are

widely overused, and some experts worry that doctors are prescribing the

drugs for children with tics or obsessive-compulsive disorder who do not

need them.

Other doctors and parents may be going to greater lengths. Dr. Kurlan said

some children had been treated with costly medical procedures that could

have serious side effects. One is plasma exchange, a modern form of

bloodletting. The technique involves removing a patient's blood and purging

it of antibodies. In some cases it can lead to infection and blood clots.

" It's expensive and potentially dangerous, " he said. " I know some parents

have asked for it. Most doctors who know the facts will not use plasma

exchange, but there are places in the country that have made it available to

parents. "

Experts say that cognitive behavioral therapy may be one helpful option.

There is no solid evidence backing any drug treatments, but several

large-scale studies could soon change that. Dr. and scientists at the

National Institutes of Health are following dozens of children thought to

have Pandas to determine whether antibiotics can prevent symptoms from

flaring. One group will receive penicillin, the other a placebo. Dr.

expects to have the answer early next year.

Other studies, at multiple sites, are following children month by month with

tests for antibodies and strep to determine how tightly infections and

symptoms are linked, if at all. Dr. Kurlan, who is leading one of the

studies, said results might be ready by next summer.

In the meantime, parents like Mrs. Watkins wait. Mrs. Watkins said her son's

most destructive symptoms - the hand washing, separation anxiety and night

terrors - slowly disappeared when he began taking antibiotics for his sore

throat a year ago. He often repeats his sentences now and displays tics and

quirky behaviors. Mrs. Watkins enrolled him in the penicillin study at

Florida, which he is scheduled to begin this month.

" I really hope he's not in the placebo group, " she said.

Copyright 2004 The New York Times Company | Home | Privacy Policy | Search |

Corrections | RSS | Help | Back to Top

[Guest guest]

http://www.nytimes.com/2004/12/14/health/psychology/14ocd.html

December 14, 2004

Can Strep Bring On an Anxiety Disorder?

By ANAHAD O'CONNOR

Looking back, Watkins is convinced a sore throat disabled her son one

year ago. His bizarre obsessions emerged not long after, first the constant

nightmares about snakes and alligators, then the relentless hand washing

that left his skin raw and chapped.

Mrs. Watkins, who lives in Lakeland, Fla., was told that her son, Will, had

obsessive-compulsive disorder. But it seemed odd, Ms. Watkins thought. Will

was only 5 years old, and his illness seemed to burst out of nowhere.

" In a matter of weeks, " she said, " this was a totally different child. "

Then one day, buried on a Web site about mental illness, her husband noticed

a small " blip " on children who develop a sudden, severe form of

obsessive-compulsive disorder after a bout of strep throat.

Mrs. Watkins read the description, decided that Will fit the pattern, and

thus became part of a small but growing number of parents who blame a common

bacterial infection for the psychiatric illness of a son or daughter.

About one child in 1,000 may be afflicted, but some experts say the number

is higher if milder cases that escape notice are included. The condition is

known as Pandas, or pediatric autoimmune neuropsychiatric disorder

associated with streptococcal infection, and scientists know so little about

it that some question whether it even exists.

Frustrated parents, many of whom describe watching helplessly as their

children unravel overnight, are waiting on a handful of studies now under

way to yield some answers. Meanwhile, many have sought out drugs and

complicated medical procedures that may be unnecessary, and in some cases

dangerous.

" With Pandas you get a very desperate situation, " said Dr. ,

director of the child anxiety and tic disorder clinic at the University of

Florida. " It's amazing how quickly the kids go from functioning pretty well

to being devastated with motor tics and symptoms of O.C.D. Then you see

parents wanting to do anything to get their kids back to the way they used

to be. I can understand where they're coming from. "

There are no nationwide statistics on how many children may have the

disorder. But Dr. said that in the last three years, in Florida

alone, she had enrolled in her studies at least 100 children who fit the

pattern.

" I'm also aware of at least three times that many children from phone calls

and parents of clinic patients who do not want their children enrolled in

research, " she added.

First described by scientists at the National Institutes of Health in the

mid-1990's, Pandas is still relatively new. There is no surefire way to

detect it, and few doctors have even heard of it. But the signs are often

unmistakable.

Children, sometimes as young as 2 or 3, develop odd verbal and motor tics.

They feel compelled to engage in repetitive behaviors. They develop

irrational fears of germs, bugs, intruders, almost everything around them.

Separation anxiety is another hallmark. Even getting them to perform routine

activities like going to school becomes a struggle. Many of the symptoms -

ritualistic behaviors and disturbing thoughts, for example - mirror those of

obsessive-compulsive disorder.

But unlike O.C.D., Pandas crops up almost overnight, its onset coinciding

with a streptococcus infection or immediately after it. And the symptoms wax

and wane. They flare up, anecdotal evidence suggests, whenever the child has

contracted a new strep infection, leading some scientists to suspect a

causal link.

" This is not what we're used to seeing, " said Dr. Lombroso, a professor

of child psychiatry at the Yale Child Study Center who is also involved in

studies of the disorder. " Normally, the onset of a tic disorder is a much

more slow, insidious process. "

Dr. Swedo, a researcher at the National Institute of Mental Health who

first described Pandas, believes the disorder is caused by a severe immune

reaction that leads to brain damage. The mechanism may be similar to what is

seen in some other diseases. In rheumatic fever, for example, antibodies

produced against an untreated strep infection mistakenly attack the heart

valves.

Dr. Swedo, after finding that children with Pandas had abnormally high

levels of antibodies, theorized that their immune systems had also gone

haywire. In this case, she suspects, it is the basal ganglia, a clump of

nerve clusters in the brain that helps sequence movements, that is damaged.

" The hypothesis is that there is a similarity between proteins found in

strep bacteria and proteins in the brain, " said Dr. Leckman, a

professor of child psychiatry at the Yale Child Study Center.

At least two recent studies have shown that antibiotics can reduce symptoms.

Only small samples of children were involved, however, and the studies were

not long term. For some researchers, that is not enough evidence to conclude

that a strep infection can set off brain damage or that children thought to

have Pandas should be given antibiotics. Strep infections are so widespread,

they argue, that a child who develops tics and obsessive-compulsive

behaviors might also test positive for the bacteria purely by chance.

Dr. Kurlan, a neurologist at the University of Rochester School of

Medicine and Dentistry, said in some parts of the country up to half the

students in any given grade school will test positive for strep, depending

on the time of the year. He believes that in most children with a tic

disorder, like Tourette's syndrome, strep infections may be just one of

thousands of things that can provoke symptoms without actually causing the

underlying illness.

" It's been known forever that almost anything can act as a trigger - a viral

infection, a death in the family, allergies, anything that causes anxiety, "

he said. " The question now is whether an infection with strep is just

another one of these nonspecific triggers. "

The answer may have far -reaching effects. Studies show that antibiotics are

widely overused, and some experts worry that doctors are prescribing the

drugs for children with tics or obsessive-compulsive disorder who do not

need them.

Other doctors and parents may be going to greater lengths. Dr. Kurlan said

some children had been treated with costly medical procedures that could

have serious side effects. One is plasma exchange, a modern form of

bloodletting. The technique involves removing a patient's blood and purging

it of antibodies. In some cases it can lead to infection and blood clots.

" It's expensive and potentially dangerous, " he said. " I know some parents

have asked for it. Most doctors who know the facts will not use plasma

exchange, but there are places in the country that have made it available to

parents. "

Experts say that cognitive behavioral therapy may be one helpful option.

There is no solid evidence backing any drug treatments, but several

large-scale studies could soon change that. Dr. and scientists at the

National Institutes of Health are following dozens of children thought to

have Pandas to determine whether antibiotics can prevent symptoms from

flaring. One group will receive penicillin, the other a placebo. Dr.

expects to have the answer early next year.

Other studies, at multiple sites, are following children month by month with

tests for antibodies and strep to determine how tightly infections and

symptoms are linked, if at all. Dr. Kurlan, who is leading one of the

studies, said results might be ready by next summer.

In the meantime, parents like Mrs. Watkins wait. Mrs. Watkins said her son's

most destructive symptoms - the hand washing, separation anxiety and night

terrors - slowly disappeared when he began taking antibiotics for his sore

throat a year ago. He often repeats his sentences now and displays tics and

quirky behaviors. Mrs. Watkins enrolled him in the penicillin study at

Florida, which he is scheduled to begin this month.

" I really hope he's not in the placebo group, " she said.

Copyright 2004 The New York Times Company | Home | Privacy Policy | Search |

Corrections | RSS | Help | Back to Top