Autoimmune factors

Recently, a strong association has been demonstrated between OCD and Sydenham's chorea, a childhood movement disorder associated with rheumatic fever which is thought to be a result of an antineuronal antibody-mediated response to group A b-haemolytic streptococcus ( GABHS), directed at portions of the basal ganglia.(41) OCD or some of its symptoms are seen in 70 per cent of Sydenham's chorea cases. Swedo et al.(42) have also documented post-streptococcal cases of OCD and/or tics in children and adolescents, without the neurological symptoms of Sydenham's chorea, giving them the acronym of PANDAS (paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections). Therapeutically, this finding of a probable autoimmune-caused OCD raises the clinical possibility that immunosuppressant and even antibiotic treatments will be effective in treating or preventing some cases of OCD. An antigen labelled D8/17, on the surface of peripheral blood mononuclear cells has been shown to be a marker for the genetic tendency to generate abnormal antibodies to GABHS. Two independent groups of researchers have found a greater expression of the D8/17 antigen in the B lymphocytes of patients with childhood-onset OCD or Tourette's disorder compared with healthy controls, indicating that the presence of the D8/17 antigen may serve as a marker of susceptibility for OCD. (39)

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