Abstract | BACKGROUND: In children, exacerbations of tics and obsessive symptoms may occur after infection with group A beta-haemolytic streptococci. If post-streptococcal autoimmunity is the cause of the exacerbations, then children might respond to immunomodulatory treatments such as plasma exchange or intravenous immunoglobulin ( IVIG). We studied whether plasma exchange or IVIG would be better than placebo ( sham IVIG) in reducing severity of neuropsychiatric symptoms. METHODS: Children with severe, infection-triggered exacerbations of obsessive-compulsive disorder (OCD) or tic disorders, including Tourette syndrome, were randomly assigned treatment with plasma exchange (five single-volume exchanges over 2 weeks), IVIG (1 g/kg daily on 2 consecutive days), or placebo ( saline solution given in the same manner as IVIG). Symptom severity was rated at baseline, and at 1 month and 12 months after treatment by use of standard assessment scales for OCD, tics, anxiety, depression, and global function. FINDINGS: 30 children entered the study and 29 completed the trial. Ten received plasma exchange, nine IVIG, and ten placebo. At 1 month, the IVIG and plasma exchange groups showed striking improvements in obsessive-compulsive symptoms (mean improvement on children's Yale-Brown obsessive compulsive scale score of 12 [45%] and 13 [58%], respectively), anxiety (2.1 [31%] and 3.0 [47%] improvement on National Institute of Mental Health anxiety scale), and overall functioning (2.9 [33%] and 2.8 [35%] improvement on National Institute of Mental Health global scale). Tic symptoms were also significantly improved by plasma exchange (mean change on Tourette syndrome unified rating scale of 49%). Treatment gains were maintained at 1 year, with 14 (82%) of 17 children "much" or "very much" improved over baseline (seven of eight for plasma exchange, seven of nine for IVIG). INTERPRETATION:
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Authors | S J Perlmutter, S F Leitman, M A Garvey, S Hamburger, E Feldman, H L Leonard, S E Swedo |
Journal | Lancet (London, England)
(Lancet)
Vol. 354
Issue 9185
Pg. 1153-8
(Oct 02 1999)
ISSN: 0140-6736 [Print] England |
PMID | 10513708
(Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial)
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Chemical References |
- Immunoglobulins, Intravenous
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Topics |
- Adolescent
- Analysis of Variance
- Autoimmune Diseases
(etiology, therapy)
- Child
- Child, Preschool
- Female
- Humans
- Immunoglobulins, Intravenous
(therapeutic use)
- Male
- Obsessive-Compulsive Disorder
(classification, etiology, therapy)
- Plasma Exchange
- Severity of Illness Index
- Streptococcal Infections
(complications)
- Tic Disorders
(classification, etiology, therapy)
- Treatment Outcome
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