tag:blogger.com,1999:blog-2186593343917545414.post2227882398890706596..comments2024-03-10T12:29:30.004-07:00Comments on pediatric neurology: A PANDAS (or PANS) storyGalen Breningstall, MDhttp://www.blogger.com/profile/07170864203251456228noreply@blogger.comBlogger6125tag:blogger.com,1999:blog-2186593343917545414.post-14598202324097702612016-11-09T13:48:51.659-08:002016-11-09T13:48:51.659-08:00(continued)Despite him having always been a health...(continued)Despite him having always been a healthy child, doctors believe his condition stemmed from his bout of scarlet fever. <br /><br />He has been in and out of hospital for the last three years in a bid to try and control his symptoms. <br /><br />Doctors removed his tonsils - where the bacteria is rife - in order to prevent violent rages. <br /><br />He has also had four rounds of intravenous immunoglobulin - which involves pumping antibodies directly into his bloodstream.<br /><br />But still his symptoms continue and any time he catches any sort of bug, the condition flares up and causes him to suffer more violent rages.<br /><br />When at home, he still has to be restrained by his parents as he tries to grab knives from the kitchen drawer to harm himself or his family. <br /> <br />He also suffers from severe pain in his head, obsessive compulsive disorder and his short term memory is deteriorating similar to that seen in dementia.<br /><br />While Mrs Lindsay has acquired a brain injury from one of her son's attacks. <br /><br />Cameron is only able to attend school for six to nine hours a week and needs full time support. <br /><br />His violent rages have become so bad that his little sister Annie, now 12, often has to leave the family home and stay with family friends for her own safety...<br /><br />There were just no signs and then it was like there was an earthquake in his brain. <br /><br />'I find it very hard to find the words to convey what that felt like to watch.<br /><br />'When he asks me what has happened to him, I use the earthquake analogy - there are aftershocks and it takes a long time to rebuild a city after that. <br /><br />'While that happens, the city runs on reduced power, alternative routes have to be taken and normal life is not possible.' <br /><br />Mrs Lindsay has also had to take a three-year career break from her job as a box office and marketing manager for a local theatre company to help care for her son.<br /><br />Read more: http://www.dailymail.co.uk/health/article-3846830/Teenager-started-threatening-family-knives-common-throat-infection-triggered-exorcist-syndrome.html#ixzz4PY8TwCX3 Galen Breningstall, MDhttps://www.blogger.com/profile/07170864203251456228noreply@blogger.comtag:blogger.com,1999:blog-2186593343917545414.post-70921841750185476362016-11-09T13:47:12.079-08:002016-11-09T13:47:12.079-08:00A mother says her teenage son is 'possessed by...A mother says her teenage son is 'possessed by the devil' after an infection triggered a rare neurological condition.<br /><br />Cameron Lindsay, 14, from Ballyclare, Northern Ireland, often has violent rages which cause him to grab knives from the kitchen to harm himself or his family.<br /><br />He went from a normal, healthy boy to wishing his parents dead - and doctors believe it was triggered by the Streptococcal A bacteria, a common cause of sore throats.<br /><br />His condition has even caused him to hallucinate that Adolf Hitler was at his window, his family say.<br /><br />It is thought Cameron developed what some experts refer to as 'exorcist syndrome' after suffering scarlet fever - caused by the bacteria.<br /><br />While he has inflicted pain onto his mother, Natasha, 40, by giving her a black eye, bruised ribs and broken fingers as a result of his vicious attacks. <br /><br />Mrs Lindsay said: 'At first I was worried about taking him to the doctor because I thought they would lock him up for being psychotic. <br /><br />'It may manifest itself like a mental illness but this is caused by his body fighting strep.<br /><br />'It was an incredible shock to the system to have a healthy normal, functioning 11-and-a-half-year old to then suddenly watch that child completely disappear before your eyes.<br /><br />'It's like someone kidnapped him but he never left the house. It was very very, very frightening because it really felt like the devil had taken possession of my child.<br /><br />'He does things like throw himself down the stairs or puts his hands on the grill and when I try to stop him, he'll say things like "I hope you die in a firey car crash and come back to the house in a coffin". It's just heartbreaking.'<br /><br />Cameron became very anxious and started to have some nervous tics in 2013 but his parents thought he was just worried about school.<br /><br />But just after the February half-term break, he started to suffer from body contortions, very violent tics and severe anxiety.<br /><br />His family rushed him to their local hospital in a desperate attempt to find out what was wrong.<br /><br />He was then transferred to the Royal Victoria Children's Hospital in Belfast and initially told he had rapid onset Tourette's syndrome.<br /><br />But when they noticed a raised streptococcal levels in his blood, he was diagnosed with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS).<br /><br />It's caused by the body trying to fight a infection but it also destroys some of the cells in the brain that are of a similar make up. (continued)Galen Breningstall, MDhttps://www.blogger.com/profile/07170864203251456228noreply@blogger.comtag:blogger.com,1999:blog-2186593343917545414.post-66847834196664629072016-11-09T13:45:31.971-08:002016-11-09T13:45:31.971-08:00A mother says her teenage son is 'possessed by...A mother says her teenage son is 'possessed by the devil' after an infection triggered a rare neurological condition.<br /><br />Cameron Lindsay, 14, from Ballyclare, Northern Ireland, often has violent rages which cause him to grab knives from the kitchen to harm himself or his family.<br /><br />He went from a normal, healthy boy to wishing his parents dead - and doctors believe it was triggered by the Streptococcal A bacteria, a common cause of sore throats.<br /><br />His condition has even caused him to hallucinate that Adolf Hitler was at his window, his family say.<br /><br />It is thought Cameron developed what some experts refer to as 'exorcist syndrome' after suffering scarlet fever - caused by the bacteria.<br /><br />While he has inflicted pain onto his mother, Natasha, 40, by giving her a black eye, bruised ribs and broken fingers as a result of his vicious attacks. <br /><br />Mrs Lindsay said: 'At first I was worried about taking him to the doctor because I thought they would lock him up for being psychotic. <br /><br />'It may manifest itself like a mental illness but this is caused by his body fighting strep.<br /><br />'It was an incredible shock to the system to have a healthy normal, functioning 11-and-a-half-year old to then suddenly watch that child completely disappear before your eyes.<br /><br />'It's like someone kidnapped him but he never left the house. It was very very, very frightening because it really felt like the devil had taken possession of my child.<br /><br />'He does things like throw himself down the stairs or puts his hands on the grill and when I try to stop him, he'll say things like "I hope you die in a firey car crash and come back to the house in a coffin". It's just heartbreaking.'<br /><br />Cameron became very anxious and started to have some nervous tics in 2013 but his parents thought he was just worried about school.<br />But just after the February half-term break, he started to suffer from body contortions, very violent tics and severe anxiety.<br />His family rushed him to their local hospital in a desperate attempt to find out what was wrong.<br /><br />He was then transferred to the Royal Victoria Children's Hospital in Belfast and initially told he had rapid onset Tourette's syndrome.<br /><br />But when they noticed a raised streptococcal levels in his blood, he was diagnosed with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS).<br />It's caused by the body trying to fight a infection but it also destroys some of the cells in the brain that are of a similar make up. (continued)Galen Breningstall, MDhttps://www.blogger.com/profile/07170864203251456228noreply@blogger.comtag:blogger.com,1999:blog-2186593343917545414.post-88166058194446393312016-10-28T09:04:30.966-07:002016-10-28T09:04:30.966-07:00The patient mentioned in the 10/27 9:36 am entry I...The patient mentioned in the 10/27 9:36 am entry I last saw 4 1/2 years ago. In a newspaper article published 1 1/2 years after our last encounter, the patient's mother is described as having three children with PANDAS.Galen Breningstall, MDhttps://www.blogger.com/profile/07170864203251456228noreply@blogger.comtag:blogger.com,1999:blog-2186593343917545414.post-47038351375240642632016-10-27T16:23:13.858-07:002016-10-27T16:23:13.858-07:00I queried a colleague: In your neuroimmunology exp...I queried a colleague: In your neuroimmunology experience, how many patients have you seen with a diagnosis of PANDAS or PANS?<br /><br />The reply: Whose parents are convinced have PANDAS or PANS? Or that I am convinced have an autoimmune or post infectious psychiatric disorder, movement disorder or encephalitis? <br /><br />I think these disorders probably exist, but are relatively uncommon. Majority of patients I've seen with these diagnoses have tics, OCD or other neuropsychiatric diagnoses that I don't think are autoimmune but probably genetic. As they are often predicted by family history and traits. Often it seems that these families are unwilling to accept these "psych" diagnoses and are searching for an alternative "scapegoat" and treatment options. <br /><br />In summary -- I'm not a big believer. But infection related/post infectious autoimmune encephalitis is very real and recognizable (NMDA etc) but very different and district then those showing up to my clinic for evaluation/second opinion/treatment for PANDAS/PANS. Galen Breningstall, MDhttps://www.blogger.com/profile/07170864203251456228noreply@blogger.comtag:blogger.com,1999:blog-2186593343917545414.post-17400418348488443862016-10-27T09:36:38.643-07:002016-10-27T09:36:38.643-07:00I did see in the past a patient described by her i...I did see in the past a patient described by her immunologist as having a “diagnosis of PANDAS manifested as Sydenham chorea elevated antinuclear antibodies (U1RNP) and streptococcal infections.” The immunologist said at an earlier point in time, “While it is compelling to think this could be a neuropsychiatric problem that is immune mediated such as ‘PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infection),’ it just as likely could be a genetic or congenital defect in neurodevelopment. Favoring an immune mechanism is the family history and the positive FANA. Favoring a neurodevelopmental defect is family history and young age at presentation." Another neurologist said, “I am having a hard time diagnosing her with PANDAS with the lack of diagnosed strep infections when she is symptomatic. Having said that, she improves with episodic single dose steroids. There is little research data but some good anecdotal data supporting this.”<br /><br />She was never symptomatic at the time I saw her. I was able to view a video, which showed her having chorea. Another neurologist opined, “The video, however, does not show classic chorea, with large amplitude movements.” I had indicated that I desired to see her at a time when she was symptomatic. Her father indicated that this would be “logistically difficult to accomplish”. She had received treatment with high dose intravenous steroids, intravenous gamma globulin and antibiotics intermittently or chronically. She was described as having obsessive compulsive features, anxiety and attention deficit. At 8 years of age, she was a nationally competitive 400 meter runner. I do not recollect hearing that her ability to participate in track competitions was ever impaired by her chronic illness.Galen Breningstall, MDhttps://www.blogger.com/profile/07170864203251456228noreply@blogger.com