Vol. 4, No. 3, 1998 Page 5

'Strep throat' bacteria linked to hyperactivity

The researchers have identified a syndrome they have dubbed PANDAS, short for "pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections." The PANDAS symptoms seen in their group of patients, Swedo et al. say, begin shortly following strep infections in childhood, usually before adolescence. The onset of the disorder, which occurs more frequently in boys than in girls, is sudden, with some children literally developing symptoms overnight. After the first attack of PANDAS, symptoms often abate, only to grow worse during later bouts of strep or other illnesses.

Symptoms seen in children with PANDAS include Tourette-like tics, obsessive-compulsive behaviors, hyperactivity, impulsivity, distractibility, mood swings, separation anxiety, bedtime rituals, cognitive deficits, and oppositional behaviors. "The children with PANDAS exhibited a peculiar `squirminess' in which the children tried very hard to sit still but constantly wriggled and fidgeted in their chairs," the researchers say.

The link between PANDAS and hyperactivity is of interest to researchers in the field of criminology because hyperactivity is a well-known risk factor for criminal and delinquent behavior. Other PANDAS symptoms, including oppositional behavior, impulsivity, and cognitive deficits, also are linked to criminality.

To date, Swedo and colleagues have identified 50 children with PANDAS symptoms. The researchers currently are studying the effects of treating PANDAS with immune system therapies, and in an article in the Medical Post, Swedo commented that some treatment responses have been "miraculous."

Noting that strep can cause a movement disorder called Syd- enham's chorea, also associated with behavioral changes Swedo et al. hypothesize that PANDAS symptoms may be a mild form of this chorea.

"Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: clinical description of the first 50 cases," Susan E. Swedo, Henrietta L. Leonard, Marjorie Garvey, Barbara Mittleman, Albert J. Allen, Susan Perlmutter, Sara Dow, Jason Zamkoff, Billinda K. Dubbert, and Lorraine Lougee; American Journal of Psychiatry, Vol. 155, No. 2, February 1998, pp. 264- 271. Address: Susan Swedo, Child Psychiatry Branch, NIMH, Bldg. 10, Room 4N224, 9000 Rockville Pike, Bethesda, MD 20892-1381.

"Researchers find link between tic disorders and strep," Edward Susman, Brown University Child and Adolescent Behavior Letter, Vol. 11, No. 12,