“PANDAS and Autoimmunity”-Summary of Dr. Cunningham’s AutismOne Presentation

“If autoantibodies are proven to affect behaviors,

it will change the way we think about and treat mental disorders forever.”


On 5/29/2011, Dr. Madeleine Cunningham presented “PANDAS and Autoimmunity” at the Autism One/Generation Rescue Conference.  As of today (5/31), the archived video presentation is still available to watch. We do not know how long it will be archived, so if you would like to do view it, we suggest watching it sooner than later.

We are supplying an outline  for those that are unable watch the hour long presentation as we understand parenting a PANDAS child can be time consuming in itself.  We suggest you watch it in its entirety if you are able. We are unable to supply pictures of slides in our summary. Summaries, as understood by a PANDAS Network volunteer, are in italics.

 

“PANDAS and Autoimmunity”

Dr. Madeleine Cunningham

Group A Strep

This included an overall view of strep and how it may appear through such things as pharigitis, impetigo, scarlet fever, Rheumatic Fever, and PANDAS . It was discussed how strep can come from adults, human, and animals. That there are rashes that can be the result of strep and scarlet fever.


Autoimmune Manifestations of Streptococcal Sequalae:Acute Rheumatic Fever

  • Carditis
  • Sydenham Chorea (CNS manifestation)

Strep Associated Behavior and Movement Disorders

  • Sydenham’s Chorea
  • PANDAS or PANS  (Pediatric Acute Neurologic Syndrome)
  • OCD behaviors
  • Hyperactivity and emotional lability
  • Tic Like Symptoms

PITAND was also mentioned in this section of the presentation and how any infection can cause onset of symptoms.

Despair of Parents (quoted from presentation)

“We watch hopelessly as our dear children lose chunks of their childhood to something so few currently understand.”

A Case of PANDAS

In this section it was discussed how a 14 year old went away to camp where other children were becoming ill. This child appeared to have “cold like” symptoms. Two weeks later, he had an onset of severe obsessions and compulsions.

The criteria for PANDAS was listed and then the clinical manifestation was discussed.

PANDAS- Clinical Manifestation

  • Relapsing, remitting symptom course
  • Young age at onset
    6.5 +/- 3 years for tics and 7.4 +/- 2 years for OCD
  • Boys outnumber girl-2.6:1
  • Comorbid OCD and tics is common (65%)
  • Other co morbid symptom occur frequently

It was stated that even though there is a high chance of tics and OCD both occurring, it is not the case for every child. A child can have one without the other.

Frequency of Comorbid Symptoms in PANDAS

Comorbid Diagnosis
ADHD 40%
ADD 40%
Depression 36%
Dysthymia 12%
Separation Anxiety 20%
Overanxious 28%
Enuresis 20%
Anorexia 17%

It was specifically mentioned that she was surprised by the anorexia numbers.

Symptoms During Exacerbations
Choreiform Movements 95%
Emotional Lability 66%
School Changes 60%
Personality Changes 54%
Bedtime fears 50%
Fidgetness 50%
Separation fears 40%
Sensory Defensiveness 40%
Irritability 40%
Impulsivity/distraction 38%

Symptom Clusters in PANDAS

  • Separation Anxiety with Night time fears and enuresis/daytime  urinary frequency
  • ADHD with emotional lability and emotional changes
  • Motoric Symptoms- Tics, motoric hyperactivity, simple compulsive rituals, and handwriting changes

Etiology and Pathogenesis of PANDAS

Charts were provided for this explanation. It was stated that genes and genetic susceptibility plays a role in this along with an abnormal immune response and the types of exposures.


PANDAS Host Susceptibility

  • Increased family history of OCD and tics
  • Increased family history of Rheumatic fever

It was stated that if this autoimmune reaction is caught and treated with antibiotics, this may lead to a better outcome.

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This following section would be easier to follow when watching the video as many slides are used for the presentation...

Many charts and graphs were used to explain things like the brain antigens, Lysogangliosides and Tubulin. Anti-Lysogangliosides were higher in SC and PANDAS than their controls. Acute PANDAS cases reacted to Lysogangliosides.  Anti-Tubulin antibodies help identify acute PANDAS and SC.

It was also stated that in PANDAS kids, excess dopamine is released.

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Activation of Cam Kinase in PANDAS

 

Activation of Cam Kinase in PANDAS

 


Overall SC is higher, but some PANDAS kids did score as high as the 200’s.

Graph obtained from previously published Antibody-mediated neuronal cell signaling in behavior and
movement disorders
“.

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At this point, the TelAviv study was discussed and some charts were shown. Again, we cannot use charts used in this presentation in this summary. It was discussed how the mice were immunized against strep and those immunized began to show changes in food manipulation, unable to balance, and induced grooming (ie. water being thrown on them and they continue to groom, unphased by the water). IgG deposits were found in brain sections of the rats immunized with strep. Immunization also led to Cam Kinase increase.

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Dopamine Receptors

They think that D1 affects OCD and D2 affects movements. But they are still investigating this.

Acute PANDAS cases had high anti-dopamine receptors.

 

Auto-antibody Effects the Brain

They have not proven beyond doubt where the anti-neuronal antibodies are binding to lysoganglioside and dopamine receptors, but they have studies underway for this. Research takes time. They can say the receptors are being triggered/signaled.

 

How do Antibodies penetrate the Blood Brain Barrier (BBB)?

  • Infections release molecules that open the BBB
  • Stress induces molecules such as epinephrine which may open the BBB

 

Disease is a Two step Process

  • Immune response
  • Opening of the BBB


Acknowledgements were given

 

Q and A with Audience

In the Q and A section, it was said that her study is no longer enrolling new participants. She has reached 1000 subjects to base research on. She reiterated she is a researcher.

Some points she made in the Q and A

  • Can take more than one IVIG
  • Longer into the illness, may take longer to heal
  • IVIG is known to get inflammation down.

 

Dr Madeleine Cunningham