Sunday, July 18, 2010

#2 A bear by any other name…..

“ Alex has OCD (Obsessive Compulsive Disorder)! She was fine until a few weeks ago and now she gets stuck on everything. She was fine and so normal. Now she has completely regressed. It is horrifying to watch, “ Mrs. P relayed without pausing to breathe.

I had not heard from Mrs. P for over a year. Alex, who had a history of developmental delays had completely recovered with some miraculous combination of nutrition support, solid therapy and persistent parenting.

“Can you give me some examples of what she is doing now?” I asked.

“She opens and closes doors over and over or she repeats the same thing a half dozen times, “ Mrs. P supplied readily and then lamented, “All of the gains she has made are gone.”

After several more minutes of clarification it appeared that while Alex’s behavior as off, her cognitive development was unaffected. Having honed in on the symptoms, we threaded through the recent history.

Had she been sick around the time of the change?


Had she changed her eating or sleeping patterns?


Had the doctor checker her over?


Her conclusion?

Everything was fine and it was a minor quirk that would pass.

Trips, school changes, life changes?

No, no and no.

Were there indications that the repetitive behavior was diminishing or possibly getting better?

No. Mrs. P thought the symptoms were getting worse.

Has strep been going around the school?

Yes. There was a notice sent home several weeks ago but Alex was fine.

Now we were getting somewhere. Strep can often be asymptomatic that is, without symptoms. A lovely researcher I know from NIMH named Susan Swedo, discovered that strep infections can cause the sudden onset of OCD. She called this condition PANDAS (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Strep).

I explained the emerging link between strep and sudden development of obsessive and/or repetitive (including tics) behaviors to Mrs. P. and suggested she call her pediatrician and request a strep test. The least invasive way to do this is with a throat culture but if the throat culture is negative a blood test is needed to completely rule out PANDAS as a possibility. The basic blood test measures DNAase and ASO titers for strep.

Mrs. P wanted the problem solved yesterday so she hung up and called her doctor immediately demanding a blood test. The doctor balked and suggested a throat culture. Mrs. P refused to budge and I am sure would make an excellent district attorney if she ever put her mind to it. It was a good thing she was stubborn because the blood test was run and came up strongly positive.

It was PANDAS alright so you would think that would be the end of this story…..
(To be continued……)

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