[PANDAS with a chorea-like clinical presentation and associated autoimmune pathology: a case report]. / PANDAS con clínica tipo corea-like y patología autoinmune asociada: presentación de un caso.

INTRODUCTION: The disorder known as 'PANDAS syndrome' (paediatric autoimmune neuro-psychiatric disorders associated with Streptococci) consists in an abrupt onset of obsessive-compulsive symptoms and/or movement disorders, a pre-puberal onset, and an episodic course. Antibiotic therapy has been postulated as a first choice therapeutic option. A summarised review of main literature on this topic is presented. CASE REPORT: A girl, 10 years and 6 months old, with a dramatic clinical onset of a chorea-like and obsessive-compulsive symptomathology with a remarkable improvement after 10 days penicillin p.o. intake. She has a positive family history of autoimmune disorders, with elevated anti-phospholipidic antibodies. CONCLUSION: The implications of the case follow-up with many relapses, the development of a diabetes after corticoid therapy and the elevated anti glutamic dexcarboxilasa (anti-GAD) are discussed regarding a common underlying autoimmune mechanism.

PANDAS con clínica tipo corea-like y patología autoinmune asociada: presentación de un caso / Pandas with a Chorea- Like clincial presentation and associated autoimmune pathology: a case report

Resumen. Introducción. El trastorno conocido como enfermedad neuropsiquiátrica de etiología autoinmune asociada a estreptococo (PANDAS) consiste en una sintomatología de inicio brusco, con presentación clínica de tipo obsesivo-compulsivo y/o trastornos del movimiento tipo tics, de inicio prepuberal, que suele evolucionar de forma episódica y para el que se postula el tratamiento antibiótico como primera elección. Se revisan y resumen los hallazgos más relevantes de la bibliografía publicada hasta el momento sobre esta entidad clínica. Caso clínico. Niña de 10 años y 6 meses de edad con criterios diagnósticos de PANDAS, con presentación clínica de inicio brusco, de características coreicas y sintomatología ansiosa de tipo obsesivo-compulsivo. La mejoría clínica es muy marcada tras la administración de penicilina oral durante 10 días. Hay antecedentes familiares de enfermedad autoinmune con anticuerpos antifosfolípidos a títulos muy altos. Conclusión. El cuadro evoluciona posteriormente con recaídas, aparece una diabetes probablemente secundaria a la administración de corticoides y se detectan títulos elevados de anti-glutámico descarboxilasa (anti-GAD), fenómenos que son revisados según la hipótesis de un mecanismo de tipo autoinmune en función de los diferentes hallazgos clínicos y de laboratorio de esta paciente (AU)

Summary. Introduction. The disorder known as ‘PANDAS syndrome’ (paediatric autoimmune neuro-psychiatric disorders associated with Streptococci) consists in an abrupt onset of obsessive-compulsive symptoms and/or movement disorders, a pre-puberal onset, and an episodic course. Antibiotic therapy has been postulated as a first choice therapeutic option. A summarised review of main literature on this topic is presented. Case report. A girl, 10 years and 6 months old, with a dramatic clinical onset of a chorea-like and obsessive-compulsive symptomathology with a remarkable improvement after 10 days penicillin p.o. intake. She has a positive family history of autoimmune disorders, with elevated anti-phospholipidic antibodies. Conclusion. The implications of the case follow-up with many relapses, the development of a diabetes after corticoid therapy and the elevated anti glutamic dexcarboxilasa (anti-GAD) are discussed regarding a common underlying autoimmune mechanism (AU)

The effects of opioid receptor blockade on experimental panic provocation with CO2.

Several reports have linked, among other aspects, the role of an opioid system in respiratory physiology with underlying mechanisms of panic attacks. The involvement of the opioid system in experimental panic is to be further probed. This study aimed to determine whether opioid blockade would increase panic-related symptomatology on provocation with 35% CO2 inhaled by healthy volunteers. Participants in a double-blind, randomised crossover design orally received either 50 mg of naltrexone or placebo. Most subjects undertook a double inhalation of 35% CO2 one hour after pre-medication, and a separate group did so after five hours. The reactivity to CO2 and the symptoms elicited by naltrexone alone were measured. Among other findings, naltrexone pre-medication alone elicited significant increments in panic-related symptoms. Responses to CO2 were not significantly different between conditions in either group. These preliminary findings suggest that exposure to opioid blockade alone can potentially elicit symptoms that resemble panic, however, without modifying the response to experimental panic provocation with 35% CO2.