Autoimmune Neurological Disorders

Today's most exciting frontier of OCD research stems from a remarkable finding reported in 1997 by psychiatrists Susan Swedo, Judith Rapoport and colleagues at the National Institutes of Mental Health. What the NIMH researchers have discovered is that childhood OCD is frequently associated with group A beta hemolytic streptococcal infections — strep throat!

This research had its start a decade ago with the study of OCD's link to Sydenham's chorea, a now rare disease of childhood that was seen frequently before the age of antibiotics. Once known as Saint Vitus' dance, Sydenham's is characterized by the sudden onset of neurological symptoms ranging from mild clumsiness and a tendency to drop objects to unrestrained flailing of the arms and delirium. Sydenham's, it has been discovered, is an autoimmune disease.

As with rheumatic fever, infections with streptococcal bacteria lead to the production of antibodies that double-cross the body: They kill not only streptococci but normal cells as well. In rheumatic fever, the heart is attacked; in Sydenham's chorea, the brain. Brain-imaging studies of people suffering Sydenham's chorea demonstrate inflamed, bulging basal ganglias.

OCD has long been known to bear a relationship to Sydenham's, which is characterized by obsessions and compulsions in over half of all cases. Exploring this relationship, Swedo and colleagues asked this question: Could some routine cases of childhood OCD be caused, like Sydenham's, by autoimmune damage to the basal ganglia? They were astounded by the finding. It now appears possible that up to 25 percent of childhood OCD may, indeed, have this origin.

On the horizon is the remarkable possibility that large numbers of children with OCD may be effectively treated with penicillin. University centers are already screening childhood OCDers for antistreptococcal antibodies and treating some cases with antibiotics. The NIMH researchers, whose offices are located not far from the National Zoo, have given a name to these immune system disorders that attack the basal ganglia: pediatric autoimmune neurobiological disorders associated with streptococci, or PANDAS.

It is interesting to note that Saint Therese of Lisieux, the Christian luminary who was discussed in Chapter 3, may well have had PANDAS. Therese suffered severe bouts of sore throat all of her life and finally died at twenty-four of a respiratory illness. As a child, just prior to developing obsessive-compulsive disorder, Therese was confined to bed for a period of two months with a disorder of intermittent delirium she later referred to as "my strange sickness."

The saint's aunt remembered, "the little girl was seized with a nervous trembling, followed by seizures of fright and hallucinations that were repeated several times a day." The family maid recalled that Therese had "propulsive seizures during which she made wheel-like movements that she would have been absolutely incapable of making in a state of health." The doctor called on to treat the disorder diagnosed St. Vitus' dance.

Source: Ian Osborn, "Tormenting Thoughts and Secret Rituals," 1999, pp. 183-185. More about this book...