Too Soon to Link Strep, Psychiatric Disorders

Doctors who prescribe antibiotics based on research that has suggested there is a link between a strep infection and the development of tics and obsessive behavior in children may be jumping the gun, according to a new report.

Doctors who prescribe antibiotics based on research that has suggested there is a link between a strep infection and the development of tics and obsessive behavior in children may be jumping the gun, according to a new report. While strep may turn out to be involved in some cases of tics and obsessive behavior, “there is not enough scientific evidence” to prove or disprove any such connection, according to co-author Dr. Roger Kurlan at the University of Rochester School of Medicine in New York. For the time being, the notion that an autoimmune reaction to strep or any other organism causes or worsens tics and obsessive-compulsive symptoms in children remains a hypothesis, not a fact, Kurlan told Reuters Health. “In the absence of sufficient evidence, physicians should not necessarily perform tests for strep infection in children presenting with obsessive-compulsive symptoms or tics,” Kurlan said. Doctors also should not direct any treatment toward a possible infection or abnormal immune response, he said. “Based on currently available evidence, such testing or treatment is premature and certainly unproven for having any benefit,” Kurlan said. Much more research is needed before the hypothesis can be approved or rejected, according to Kurlan. “These studies are in progress,” he said. Kurlan and a colleague, Dr. Edward L. Kaplan at the University of Minnesota School of Medicine in Minneapolis, address the controversy surrounding a proposed condition called PANDAS, or pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections. Their report is published in the April issue of the journal Pediatrics. Several reports have suggested that some children have developed tics and obsessive-compulsive behavior after being infected with group A streptococcus bacteria. According to this hypothesis, antibodies produced in reaction to strep infection may cross-react with certain areas of the brain to cause psychiatric or behavioral problems. The problem with this hypothesis is just that–it is still a hypothesis and remains unproven, according to Kurlan and Kaplan. Almost all children have been infected with strep at one time or another, but that does not mean that strep causes behavioral and psychiatric symptoms, Kurlan notes in a press release. Until more studies are conducted, routine testing for strep in children who develop tics or obsessive-compulsive behavior would be premature, the authors conclude in the report. Similarly, the researchers advise against using antibiotics or immune-modifying therapies to treat these symptoms in children. Kurlan is now involved in a study of 80 children with tics or obsessive-compulsive disorder. The researchers are following the children for 2 years, keeping track of strep infections and behavioral problems. The study, which is funded by the National Institute of Neurological Disorders, should be completed next year. (Source: Pediatrics, Reuters Health, April 2004.)