Archive for the ‘Psychological Aspects’ Category

How T. Gondii Infection Causes Seizures, and Psychiatric Illness For Some

https://neurosciencenews.com/t-gondii-infection-seizure-mental-health-16063how-t-gondii-infection-causes-seizures-and-psychiatric-illness-for-some/

How T. gondii infection causes seizures, and psychiatric illness for some

iu-51

Summary: Study shows how Toxoplasma parasitic infections promote the loss of inhibitory signaling in the brain by altering the behavior of microglia.

Source: Virginia Tech

Think about traffic flow in a city – there are stop signs, one-way streets, and traffic lights to organize movement across a widespread network. Now, imagine what would happen if you removed some of the traffic signals.

Among your brain’s 86 billion neurons are the brain’s own version of stop signals: inhibitory neurons that emit chemicals to help regulate the flow of ions traveling down one cell’s axon to the next neuron. Just as a city without traffic signals would experience a spike in vehicle accidents, when the brain’s inhibitory signals are weakened, activity can become unchecked, leading to a variety of disorders.

In a new study published in GLIA on March 11, Virginia Tech neuroscientists at the Fralin Biomedical Research Institute at VTC describe how the common Toxoplasma gondii parasite prompts the loss of inhibitory signaling in the brain by altering the behavior of nearby cells called microglia.

The Centers for Disease Control and Prevention estimates that 40 million Americans have varying levels of Toxoplasma infection, although most cases are asymptomatic. Commonly passed to humans via exposure to farm animals, infected cat litter, or undercooked meat, the parasitic infection causes unnoticeable or mild, to flu-like symptoms in most healthy people. But for a small number of patients, these microscopic parasites hunker down inside of neurons, causing signaling errors that can result in seizures, personality and mood disorders, vision changes, and even schizophrenia.

“After the initial infection, humans will enter a phase of chronic infection. We wanted to examine how the brain circuitry changes in these later stages of parasitic cyst infection,” said Michael Fox, a professor at the Fralin Biomedical Research Institute and the study’s lead author.

The parasite forms microscopic cysts tucked inside of individual neurons.

“The theory is that neurons are a great place to hide because they fail to produce some molecules that could attract cells of the immune system,” said Fox, who is also director of the research institute’s Center for Neurobiology Research.

Fox and his collaborator, Ira Blader, recently reported that long-term Toxoplasma infections redistribute levels of a key enzyme needed in inhibitory neurons to generate GABA, a neurotransmitter released at the specialized connection between two neurons, called a synapse.

Building on that discovery, the scientists revealed that persistent parasitic infection causes a loss of inhibitory synapses, and they also observed that cell bodies of neurons became ensheathed by other brain cells, microglia. These microglia appear to prevent inhibitory interneurons from signaling to the ensheathed neurons.

“In neuropsychiatric disorders, similar patterns of inhibitory synapse loss have been reported, therefore these results could explain why some people develop these disorders post-infection,” Fox said.

Fox said the inspiration for this study started years ago when he met Blader, a collaborating author and professor of microbiology and immunology at the University at Buffalo Jacobs School of Medicine and Biomedical Sciences, after he delivered a seminar at Virginia Tech. Blader studied Toxoplasma gondii and wanted to understand how specific strands of the parasite impacted the retina in mouse models.

Working together, the two labs found that while the retina showed no remarkable changes, inhibitory interneurons in the brain were clearly impacted by the infection. Mice – similar to humans – exhibit unusual behavioral changes after Toxoplasma infection. One hallmark symptom in infected mice is their tendency to approach known predators, such as cats, displaying a lack of fear, survival instincts, or situational processing.

“Even though a lot of neuroscientists study Toxoplasma infection as a model for immune response in the brain, we want to understand what this parasite does to rewire the brain, leading to these dramatic shifts in behavior,” Fox said.

This shows a head
The parasite forms microscopic cysts tucked inside of individual neurons. The image is in the public domain.

Future studies will focus on further describing how microglia are involved in the brain’s response to the parasite.

Among the research collaborators is Gabriela Carrillo, the study’s first author and a graduate student in the Translational Biology, Medicine, and Health Program. Previously trained as an architect before pursuing a career in science, Carrillo chose this topic for her doctorate dissertation because it involves an interdisciplinary approach.

“By combining multiple tools to study infectious disease and neuroscience, we’re able to approach this complex mechanistic response from multiple perspectives to ask entirely new questions,” Carrillo said. “This research is fascinating to me because we are exposing activated microglial response and fundamental aspects of brain biology through a microbiological lens.”

The study’s other contributing authors include Valerie Ballard, a Roanoke Valley Governor’s School high school student; Taylor Glausen, a graduate student working in Blader’s laboratory at the University at Buffalo; Zack Boone, a Virginia Tech undergraduate student; Cyrus Hinkson, a fourth-year Virginia Tech Carilion School of Medicine student; and Elizabeth Wohlfert, an assistant professor of microbiology and immunology at the University at Buffalo.

Source:
Virginia Tech
Media Contacts:
Whitney Slightham – Virginia Tech
Image Source:
The image is in the public domain.

Original Research: Closed access
“Toxoplasma infection induces microglia‐neuron contact and the loss of perisomatic inhibitory synapses”. Gabriela L. Carrillo, Valerie A. Ballard, Taylor Glausen, Zack Boone, Joseph Teamer, Cyrus L. Hinkson, Elizabeth A. Wohlfert, Ira J. Blader, Michael A. Fox.
GLIA doi:10.1002/glia.23816.

Abstract

Toxoplasma infection induces microglia‐neuron contact and the loss of perisomatic inhibitory synapses

Infection and inflammation within the brain induces changes in neuronal connectivity and function. The intracellular protozoan parasite, Toxoplasma gondii, is one pathogen that infects the brain and can cause encephalitis and seizures. Persistent infection by this parasite is also associated with behavioral alterations and an increased risk for developing psychiatric illness, including schizophrenia. Current evidence from studies in humans and mouse models suggest that both seizures and schizophrenia result from a loss or dysfunction of inhibitory synapses. In line with this, we recently reported that persistent T. gondii infection alters the distribution of glutamic acid decarboxylase 67 (GAD67), an enzyme that catalyzes GABA synthesis in inhibitory synapses. These changes could reflect a redistribution of presynaptic machinery in inhibitory neurons or a loss of inhibitory nerve terminals. To directly assess the latter possibility, we employed serial block face scanning electron microscopy (SBFSEM) and quantified inhibitory perisomatic synapses in neocortex and hippocampus following parasitic infection. Not only did persistent infection lead to a significant loss of perisomatic synapses, it induced the ensheathment of neuronal somata by myeloid‐derived cells. Immunohistochemical, genetic, and ultrastructural analyses revealed that these myeloid‐derived cells included activated microglia. Finally, ultrastructural analysis identified myeloid‐derived cells enveloping perisomatic nerve terminals, suggesting they may actively displace or phagocytose synaptic elements. Thus, these results suggest that activated microglia contribute to perisomatic inhibitory synapse loss following parasitic infection and offer a novel mechanism as to how persistent T. gondii infection may contribute to both seizures and psychiatric illness.

Feel Free To Share This Neuroscience News.

________________

For more:  https://madisonarealymesupportgroup.com/2016/05/21/toxoplasmosis/ T. gondii is responsible for about 1/5 of schizophrenia cases.  

https://madisonarealymesupportgroup.com/2019/04/06/toxoplasmosis-outbreak-due-to-undercooked-deer-meat-from-illinois/

https://madisonarealymesupportgroup.com/2018/06/20/brazil-569-confirmed-cases-of-toxoplasmosis-of-which-50-are-pregnant-women

https://madisonarealymesupportgroup.com/2018/08/01/risky-business-linking-t-gondii-entrepreneurship-behaviors/

https://madisonarealymesupportgroup.com/2020/02/27/global-prevalence-of-toxoplasmosis-in-cats-a-systematic-review-meta-analysis/

https://madisonarealymesupportgroup.com/2019/12/31/psychiatric-disorders-are-infectious-agents-to-blame/

BTW: t. gondii has been found in ticks (Ixodes ricinus), and these ticks also transmit Lyme and tick-borne encephalitis virus:  https://www.researchgate.net/publication/40846277_The_occurrence_of_Toxoplasma_gondii_and_Borrelia_burgdorferi_sensu_lato_in_Ixodes_ricinus_ticks_from_Eastern_Poland_with_the_use_of_PCR, and https://ecdc.europa.eu/en/disease-vectors/facts/tick-factsheets/ixodes-ricinus

Toxoplasmosis causes many mental issues and psychiatrist E. Fuller Torry believes that 75% of schizophrenia is associated with infections, with Toxo a significant portion.

 

Category:

Psychological Aspects, research, Toxoplasmosis

Marsy’s Law in Light of Lyme Disease

A federal judge did not delay Wisconsin’s presidential primary but he stated those voting absentee be given an extra six days.  Deadline for absentee ballots is now 4 p.m. on April 13. Deadline for voters to request absentee ballots is today at 5 p.m.  Voting in person is Tuesday, April 7.  https://apnews.com/e36c3adc0c7474014f3e7ab566071303

On the ballot is a referendum called Marsy’s Law.  

Please study this for yourself:  https://ballotpedia.org/Wisconsin_Marsy%27s_Law_Crime_Victims_Rights_Amendment_(April_2020)

Marsy’s Law, meant with good intentions, would present grave risks to the constitutional protections for citizens of Wisconsin accused of crimes.

Here’s some information that should be taken into consideration.

  • Voters are asked to make a substantial constitutional change without text of the proposed amendment.
  • The Montana Supreme Court struck it down as unconstitutional as it contains multiple amendments, each of which should require a separate vote.
  • Section 9m, article I of the Wisconsin Constitution already provides victims with many of the same constitutional rights, making Marsy’s Law redundant.
  • South Dakota reportedly spent a half-million dollars in the first year alone responding to the constitutional mandates created by Marsy’s Law.
  • Wisconsin judges, prosecutors, law enforcement agencies and victim rights coordinators would have to interpret unclear mandates, creating additional burdens on justice officials and taxpayers.

Lastly, the one that really trumps all others:

Because Lyme/MSIDS is a systemic infection that can and often affects the brain and cognitive behavior of patients, they can unfortunately have run-ins with the law due to erratic behavior.

A few cases:

  1. https://www.foxnews.com/story/can-lyme-disease-lead-to-insanity-violent-tendencies
  2. https://madisonarealymesupportgroup.com/2019/03/21/bartonella-sudden-onset-adolescent-schizophrenia-a-case-study/
  3. https://madisonarealymesupportgroup.com/2017/08/24/dutch-lyme-patients-accused-of-child-abuse/
  4. https://madisonarealymesupportgroup.com/2018/07/28/stories-of-pandas/  Children with PANS often have an underlying tick-borne illness.
  5. Dr. Bransfield states that YES, Lyme disease CAN cause violent behavior & substance abuse:  https://madisonarealymesupportgroup.com/2019/09/17/ignoring-psychiatric-lyme-disease-at-our-peril/

To this day authorities won’t recognize the connection between tick-borne illness and mental issues:  https://madisonarealymesupportgroup.com/2018/06/04/ld-diagnosis-took-forever-because-of-mental-health-stigma/

So, back to Marsy’s Law….hopefully it’s clear that tick-borne illness can cause violent and erratic behavior which could lead to being accused of crimes. Accusers wouldn’t have to present any evidence.  

Patients would be guilty until proven innocent.
For patients struggling cognitively, accusers would have unfair advantage.

Lastly, please read this:

The U.S. Constitution and all 50 state constitutions guarantee defendants’ rights because they are rights against the state, not because they are valued more by society than victims’ rights. Defendants’ rights only apply when the state is attempting to deprive the accused – not the victim – of life, liberty, or property. They serve as essential checks against government abuse, preventing the government from arresting and imprisoning anyone, for any reason, at any time.

Victims’ rights are not rights against the state. Instead, they are rights against another individual. The Marsy’s Law formula includes the rights to restitution, to reasonable protection, and to refuse depositions and discovery requests, all of which are enforced against the defendant. Such rights do nothing to check the power of the government. In fact, many of the provisions in Marsy’s Law could actually strengthen the state’s hand against a defendant, undermining a bedrock principle of our legal system — the presumption of innocence.  https://www.aclu.org/blog/criminal-law-reform/victims-rights-proposals-marsys-law-undermine-due-process

Category:

Activism, Lyme, Psychological Aspects

How To Stay Sane in Uncertain Times

https://www.linkedin.com/pulse/how-stay-sane-uncertain-times-lori-dennis-ma-rp/?

How to stay sane in uncertain times

Lori Dennis, MA,RP

Lori Dennis, MA,RP

Registered Psychotherapist, Speaker, Author of Lyme Madness

These are times of great uncertainty. Uncharted, unprecedented times that require a sense of calm, creativity and connection.

I wish it weren’t so but the truth is that my family, along with tens of millions worldwide, have been living a similar medical nightmare for years. While chronic Lyme disease and the Coronavirus have many distinctions, the experience is parallel in many ways.

For both, there is an inability to get properly tested, a lack of access to proper care for far too many, frustration with the CDC for their lack of transparency, not enough support or resources to manage this pandemic, no viable treatment or cure, the fear of how this will impact all of us financially.

The Coronavirus, like chronic Lyme, is an experience unlike the world has ever seen and, for the most part, we are being asked to navigate this in the dark.

Here are a few simple suggestions to help you find some light in the dark:

Turn anxiety into action – High anxiety can be paralyzing. While we are certainly entitled to feel a sense of angst, unease, and even gloom and doom, it’s not productive to stay stuck in these feelings. The best way to combat these strong, often destructive emotions is to turn your angst into action.

When I was feeling paralyzed about our chronic Lyme crisis, I resolved my ‘stuckness’ by researching daily, writing a book on the subject, giving talks, blogging and creating an online platform where I could connect with and help others.

How you take action is entirely up to you and your own strengths, needs and preferences. But taking action, without a doubt, is the best way I know to take back your power in a very powerless situation.

Practice self care – When we’re experiencing tough times, we tend to forget about our own personal needs, often putting them on the back burner. This is the time to take walks, go for a run, meditate, journal, eat well, sleep well, create daily rituals that feed your body, mind and soul.

Stay connected – Whether introverted or extraverted, we are all social beings. This time of social distancing requires us to discover more creative ways to stay connected. Staying in touch with family, friends, and colleagues is critical to our health and well-being. Make more time to nurture relationships — even from a distance. Help others when possible. We are all in this collective experience together.

Reframe crisis into opportunity – The Chinese character for crisis is opportunity. Get creative. Think of ways to reframe your struggles – emotional, physical, spiritual, financial — by creating healthy new habits, developing new family rituals, designing new business practices that can benefit you and others.

I’ll be writing more about how to navigate these dark waters in the weeks to come.

Until then, stay well and stay safe. ❤️

LORI DENNIS, MA, Registered Psychotherapist. Author LYME MADNESS, Speaker, Activist, For more information, feel free to message me on LinkedIn, or email me at loridennis@talktherapy.ca

 

 

 

 

Category:

Lyme, Psychological Aspects, Uncategorized, Viruses

Lyme Brain: The Science & The Experience

https://globallymealliance.org/lyme-brain-the-science-and-the-experience/

by Jennifer Crystal

At the 2019 International Lyme and Associated Diseases Society (ILADS) conference in Boston, infectious disease specialist Francine Hanberg, M.D. gave a talk about the causes and manifestations of “Lyme brain” called “Neuropathology in Patients With Late Lyme Disease and Post-Treatment Lyme Disease Symptoms: CNS Vasculitis, Hypoperfusion, Inflammation and Neuropathy.”  Since I had suffered from many of the symptoms associated with Lyme brain—such as short-term memory loss, confusion, brain fog, word repetition, and word loss— her talk caught my attention.

Dr. Hanberg focused on documenting the severity of tick-borne diseases through brain imaging and neurodiagnostic studies. I was struck by her study “Watershed Sign As a Marker for Late Lyme Neuroborreliosis.” “Watershed” areas of the brain, it turns out, simultaneously receive blood from different arteries, the way a creek might receive water from different outlets that eventually drain into a river.

In a previous post, I described Lyme-brain as a feeling of  “molasses seeping through your brain, pouring into all the crevices until your brain feels…[as if] it will explode.” Reviewing Dr. Hanberg’s slides, I could imagine exactly where my “molasses” was pouring—or, rather, I could see where the inflammation in those areas once made my own brain feel so heavy with pressure.

Because Lyme tends to affect watershed areas, cognitive impairments from the disease are usually broad-spectrum, rather than localized as with stroke. As described in the book Lyme Brain by Nicola McFadzean Ducharme, N.D., a study done by neuropsychologist Marian Rissenberg, Ph.D. and Susan Chambers, M.D. explains the major cognitive challenges of Lyme as affecting seven cognitive categories.[i]

I’ve outlined these categories below. For each, I will explain what the impairment definition is, what it felt like for me in my worst days, and what improvements I’ve seen with remission.

  1. Attention and mental tracking

What it means: An inability to focus on one task through to completion or to multi-task

What I experienced then: If I was talking with someone and there was noise in the background, I couldn’t follow what was being said. Moreover, if I was writing even something as simple as an email, I could not endure any background noise, whereas, when I was in college I’d written papers with music playing and people talking all around me. I could complete tasks, but everything took longer than before. I sometimes had difficulty concentrating on a single task; it was hard for me to finish watching a TV show or reading an article without wanting to stop and do something else.

What I experience now: It’s still difficult for me to concentrate with background noise, though light instrumental music is okay. I can follow conversations with far greater acuity, and I can watch and process full-length TV shows and read articles and books. I can scroll through social media and process all the different things I’m reading without hindrance, and stay focused on the task at hand.

  1. Memory

What it means: Difficulty processing and retrieving information; forgetfulness

What I experienced then: I often could not remember the answers to questions as basic as “What’s your zip code?” or “Who’s the President?” It would take me several minutes to come up with the answer.

What I experience now: Sometimes it still takes me a moment to remember what I had for breakfast, but only when I’m overtired. The same is true for repeating conversations (telling a friend the same thing twice); I also have to remember that I’m getting older, too!). On the whole, I can process and retrieve information fast enough to navigate a busy city, give a lecture or facilitate conversation in my classroom. My long-term memory thankfully remains razor-sharp.

  1. Receptive language

What it means: Difficulty understanding written and spoken language; losing track of conversations, not being able to process ideas quickly enough to comprehend or respond in a timely fashion; difficulty reading

What I experienced then: There was a point when I could only process short emails and couldn’t even read a full magazine article. The words would blur in front of my eyes and I would read sentences over and over, trying to understand them. I’d lose track of what I was saying mid-conversation or even mid-sentence.

What I experience now: I can read full magazines and books, but pace myself in order not to get overwhelmed. I read and respond to many student essays. I read and easily process news articles. Once in a while, I’ll lose track of what I was saying, but that’s only when I’m tired or overwhelmed, and then I quickly self-correct.

  1. Expressive language

What it means: Difficulty communicating through written and spoken words

What I experienced then: When my grandfather was struggling with dementia, I’d watch him know what he wanted to say, but be unable to find the words. So he’d get frustrated and give up, and stop participating in conversation altogether. Sometimes, when I was very sick with tick-borne illnesses, that would happen to me. At other times my words would come out in a jumble. My doctor would ask for an overview of how I’d been feeling recently and I couldn’t summarize anything for him (I started keeping a written log of daily symptoms, so that I could put together a report for appointments).

What I experience now: I still keep that written log, but my ability to express myself has improved tremendously. I write weekly columns, have written two books, give lectures, and lead conversations all without issue. Occasionally I can’t come up with a specific word, but can usually get it when prompted.

  1. Visuospatial processing

What it means: Poor spatial relationships; vision difficulties

What I experienced then: My spatial relations have never been great, because I do not have binocular vision (I only see out of one eye at a time, which means I don’t possess depth perception). With Lyme, my capacity to experience spatial relations worsened. Sometimes I’d miss my mouth with the fork, or knock a glass before getting it into the dishwasher, or bump into furniture. Other Lyme patients find themselves getting lost or forgetting where they were going entirely.

What I experience now: My spatial relationships are still not very good, but I attribute these difficulties mostly to my previous vision issues.

  1. Abstract reasoning

What it means: The inability to grasp issues and reach conclusions, or the inability to understand the consequences of one’s actions.

What I experienced then: Sometimes conversations, which previously I would have been able to follow with ease, just seemed too high-level for me. It was as if my brain would “turn off” when people were discussing intellectual issues. This was frightening because I thought I had lost my intelligence and didn’t have anything worthwhile to say. Many Lyme patients thus afflicted might say or do things they would not have otherwise, which can take a toll on relationships.

What I experience now: I can process and synthesize information from multiple sources, recall it and contribute to a conversation. I’m a reflective person—over-analytical— so I overthink potential consequences too much, but that’s not always a bad thing.

  1. Speed of mental and motor processing

What it means: Inability to keep up with a lively conversation

What I experienced then: Returning to the feeling of one’s brain clogged with molasses, I processed everything very slowly. As mentioned earlier, it took too long for me to comprehend information and respond to it.

What I experience now: On most days, my head feels clear and I can process and express thoughts cogently. I’m best in the mornings, so I’ve learned to do creative work then, rather than in the late afternoons or evenings, and I always take an early afternoon nap. When I’m overtired, the brain fog can return, but it lifts much quicker than it used to, and I experience more sunny days.

Of course, this list begs the question, how did I get better? While there is no single protocol for everyone, my neurological symptoms improved through a combination of antibiotic and antimalarial medication, nutritional and homeopathic supplements, adjunct therapies like integrative manual therapy and neurofeedback, and an anti-inflammatory diet. For more ideas on addressing Lyme brain, check out the aforementioned book, or talk with your Lyme Literate Medical Doctor (LLMD).

Note: for patients with difficulty reading, my “Living With Lyme Brain” post is now available as an audio blog.

________________________

[i] Ducharme, Nicola McFadzean. Lyme Brain. California: BioMed Publishing Group, LLC, 2016 (9-12).

Related Posts: 
Feed Your Body to Fight Lyme
Living with Lyme Brain
Dealing With Brain Fog

jennifer crystal_2

Opinions expressed by contributors are their own.

Jennifer Crystal is a writer and educator in Boston. Her memoir about her medical journey is forthcoming. Contact her at lymewarriorjennifercrystal@gmail.com.

 

 

____________________

For more:  https://madisonarealymesupportgroup.com/2020/03/02/overcome-lyme-brain-causes-solutions/

https://madisonarealymesupportgroup.com/2019/12/28/what-is-brain-fog-what-can-a-patient-do-to-get-rid-of-it/

https://madisonarealymesupportgroup.com/2015/10/18/psychiatric-lymemsids/

Category:

Lyme, Psychological Aspects, research

Is Your Child Crazy, or Sick? Mental Illness vs. Medical Disorder

https://www.lymedisease.org/kinderlehrer-crazy-sick/

Is your child crazy, or sick? Mental illness vs. medical disorder

Kinderlehrer

By Daniel A. Kinderlehrer, MD

Brad’s parents brought him to see me when he was eleven years old. He was scratched by a cat at age two and developed enlarged lymph nodes in his neck. As a toddler, he began experiencing episodes of inconsolable crying and rocking. By age five, he clearly had problems focusing and was not interested in reading.

His symptoms worsened around age eight. The boy became agitated and easily overwhelmed, with outbursts of anger and rage. His father often had to hold Brad, so that he didn’t destroy the house.

Brad described dark episodes when he had obsessive, intrusive thoughts, such as hurting himself and others. He had severe anxiety and refused to go to school. He had pseudo-seizures, when he would suddenly flop to the ground but be totally conscious.

Brad had other symptoms including sharp chest pains with shortness of breath; abdominal pain with nausea, constipation and flatulence; knee, neck, and spine pain; lightheadedness, sound sensitivity, fatigue, and sugar cravings.

His mood issues were so severe that he underwent two psychiatric hospitalizations. His psychiatrist tried several medications. There was some improvement on Prozac and Trileptal, an anti-epileptic drug that is also prescribed as a mood stabilizer.

We’ll get back to Brad. But first, I want to describe one way that microbes can cause psychiatric symptoms.

Dr. Susan Swedo is a researcher in the field of pediatrics and neuropsychiatry. Since 1998, she has been Chief of the Pediatrics & Developmental Neuroscience Branch at the US National Institute of Mental Health.

PANDAS and PANS

In 1994, Swedo was the lead author on a paper characterizing PANDAS—Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus. Swedo described children who experienced the sudden onset of OCD, tics and other mood and behavior problems following a strep infection.1

Since then, it has become clear that strep is not the only microbe that can trigger psychiatric symptoms. Accordingly, this syndrome is now referred to as PANS—Pediatric Acute-onset Neuropsychiatric Syndrome.

Herpes simplex virus, influenza A virus, varicella zoster virus, Epstein-Barr virus, HIV, recurrent sinusitis, mold, and the common cold have been identified as triggers.2-4 Tick-borne infections including Mycoplasma pneumonia, Bartonella heneslae, and probably Borrelia burgdorferi, the Lyme pathogen, have also been identified as triggers.2,5,6

PANDAS, caused by strep, is now considered a subset of PANS.

PANS may be a lot more common than we realize. In 2018, Dr. Nancy Brown and I did a pilot study in which we tested 10 adolescents at a residential treatment center in Colorado.7 None of the teens had a known organic illness. All 10 were diagnosed with Major Depressive Disorder and seven with Generalized Anxiety Disorder. They were too symptomatic to stay at home or go to public school.

On testing, six of the 10 kids had antibodies to tick-borne infections—Lyme, bartonellosis and Tick Borne Relapsing Fever. Three had antibodies to Streptococcus. What was most surprising was that nine of the 10 teens had elevated antineuronal antibodies.

Antineuronal antibodies

Elevation of these antibodies, along with activation of a specific enzyme (calcium calmodulin-dependent protein kinase II—CaMKII) is the laboratory hallmark of PANS.8 In the 1990s, Dr. Madeleine Cunningham performed groundbreaking research to demonstrate the association of these lab abnormalities in kids with this disorder.9

It turns out that antibodies that target some microbes attack neuronal tissue and activate CaMKII, which disrupts dopamine transmission.10 The result is ‘Brain on Fire,’ neuroinflammation that triggers a host of neuropsych symptoms.

Children with PANS display a wide array of mood and behavior issues, especially anxiety, OCD, depression, and irritability/oppositional/anger issues that can reach epic proportions like Brad’s. Interestingly, many outbursts are followed by remorse.

Children with PANS often fall behind developmentally and academically. Other common symptoms include involuntary movements, tics, and eating disorders. While the case definition of PANS limits the diagnosis to symptoms that have a sudden onset,11 most of my patients’ symptoms have come on gradually.

In my medical practice, which is limited to patients with tick-borne infections, I see many children and teens. I have been surprised by how many suffer from PANS. While they all have Lyme disease, it appears that Bartonella and Mycoplasma may be the worst offenders in triggering PANS.

What are the best treatments?

It is important that these kids be treated with antibiotics,12 although careful titration is necessary because Herxheimer reactions can be severe.

Dr. Amiram Katz, a neurologist in Connecticut, has found that low-dose penicillin injections have been very effective.13 I have had the same experience. Katz recommends long-acting penicillin injections (LA Bicillin), 1.2 million units once weekly if less than 100 lbs. and 2.4 million units once weekly if over 100 lbs. If there is no significant improvement after ten doses. then there is no reason to continue.

Intravenous Gammaglobulin (IVIG) has helped many kids with PANS.14 IVIG is composed of human antibodies and has the paradoxical function of stimulating the immune system while decreasing inflammation. It is administered intravenously or subcutaneously, often every three weeks. However, it is quite expensive and insurance coverage is difficult to procure, except for residents of Illinois.

Other interventions are often helpful. Many kids with PANS have mast cell activation syndrome (MCAS), which contributes to inflammation.15 In these cases, interventions such as antihistamines can be helpful. Cromolyn, which inhibits the release of histamine and other inflammatory mediators from mast cells, is particularly beneficial.

Problem foods

Food sensitivities can also contribute to inflammation,16 so parents should consider specialized testing or an elimination/challenge diet. Be particularly suspicious of food cravings—the foods people crave are often the worst offenders.17

In my practice, sugar, yeast, gluten and dairy products are the most common culprits. Mold can trigger inflammation as well. Even though I live in Colorado, a low humidity state, I am amazed at how many of my patients suffer from mold issues.

Other interventions are occasionally beneficial. Anti-inflammatory agents, whether ibuprofen or natural products such as curcumin, may help. Some people find that low-dose naltrexone decreases symptoms. Family counseling and support groups are also a good idea. Occasionally, antidepressants can lessen symptoms, particularly sertraline.

Other modalities that sometimes prove helpful include biofeedback and plasmapheresis, a procedure in which blood is removed and antibodies filtered out before the blood is replaced.12

Back to Brad

Brad suffered from several tick-borne infections: Lyme disease, babesiosis and bartonellosis. He likely acquired Bartonella from the cat scratch at age two, which then activated a congenital infection with Borrelia burgdorferi and Babesia.

He is sensitive to gluten, dairy, and yeast, which I suspected from the pattern of his food cravings. He had a positive Cunningham Panel consistent with PANS. After major improvement on antimicrobials and intestinal support, he suffered a relapse triggered by a mold exposure. Now on disulfiram, he is doing much better.

I think that once the immune system gets triggered by one or more microbes, the systemic inflammation leads to multiple other sensitivities that contribute to even more inflammation. Brad likely did not acquire food sensitivities until after the infections flared. Then he also became more sensitive to mold.

These kids are suffering a great deal; some of them are suicidal. If we do careful detective work and treat the sources of their inflammation as well as the inflammation itself, we can help them get their lives back. Moleculera Labs, which performs the Cunningham Panel, offers a host of information on PANS.

Daniel A. Kinderlehrer, MD, is an internist in Denver, Colorado. His medical practice is dedicated to treating people with tick-borne illness. He is the author of the forthcoming book “Recovery From Lyme: The Integrative Medicine Guide to Diagnosing and Treating Tick-Borne Illness.”

References

  1. Swedo SE, Leonard HL, Kiessling LS. Speculations on Antineuronal Antibody-Mediated Neuropsychiatric Disorders of Childhood. Pediatrics. 1994Feb1;93(2):323–6.
  2. Frankovich J, Thienemann M, Rana S, Chang K. Five Youth with Pediatric Acute-Onset Neuropsychiatric Syndrome of Differing Etiologies. J Child Adolesc Psychopharmacol. 2015;25(1):31–7. DOI: 10.1089/cap.2014.0056.
  3. Tisi G, Marzolini M, Biffi G. Pediatric acute onset neuropsychiatric syndrome associated with Epstein–Barr infection in child with Noonan syndrome. Europ Psychiatry. 2017;41(Supplement):S456. DOI: 10.1016/j.eurpsy.2017.01.492.
  4. Breitschwerdt EB, Greenberg R, Maggi RG, Mozayeni BR, Lewis A, Bradley JM. Bartonella henselae Bloodstream Infection in a Boy With Pediatric Acute-Onset Neuropsychiatric Syndrome. J Cent Nerv Syst Dis. 2019Mar18;11. DOI: 10.1177/1179573519832014.
  5. Breitschwerdt EB, Greenberg R, Maggi RG, Mozayeni BR, Lewis A, Bradley JM. Bartonella henselae Bloodstream Infection in a Boy With Pediatric Acute-Onset Neuropsychiatric Syndrome. J Cent Nerv Syst Dis. 2019Mar18;11. DOI: 10.1177/1179573519832014.
  6. Rhee H, Cameron D. Lyme disease and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS): an overview. Int J Gen Med. 2012;5:163–74. DOI: 10.2147/ijgm.s24212.
  7. Kinderlehrer DA, Brown N. Microbial Induced Autoimmune Inflammation as a Cause of Mental Illness in Adolescents: A Pilot Study. Submitted for publication Feb 25, 2020.
  8. Shimasaki C, Frye RE, Trifiletti R, Cooperstock M, Kaplan G, Melamed I, et al. Evaluation of the Cunningham Panel™ in pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (PANDAS) and pediatric acute-onset neuropsychiatric syndrome (PANS): Changes in antineuronal antibody titers parallel changes in patient symptoms. J Neuroimmunol. 2020 Feb15;339:577138. DOI: 10.1016/j.jneuroim.2019.577138.
  9. Cunningham MW, Cox CJ. Autoimmunity against dopamine receptors in neuropsychiatric and movement disorders: a review of Sydenham chorea and beyond. Acta Physiol. 2016Jan;216(1):90–100. DOI: 10.1111/apha.12614
  10. Cox CJ, Zuccolo AJ, Edwards EV, Mascaro-Blanco A, Alvarez K, Stoner J, et al. Antineuronal Antibodies in a Heterogeneous Group of Youth and Young Adults with Tics and Obsessive-Compulsive Disorder. J Child Adolesc Psychopharmacol. 2015Feb;25(1):76–85. DOI: 10.1089/cap.2014.0048.
  11. Chang K, Frankovich J, Cooperstock M, Cunningham MW, Latimer ME, Murphy TK, et al. Clinical Evaluation of Youth with Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS): Recommendations from the 2013 PANS Consensus Conference. J Child Adolesc Psychopharmacol. 2015;25(1):3–13. DOI: 10.1089/cap.2014.0084.
  12. Calaprice D et al. Treatment of Pediatric Acute-Onset Neuropsychiatric Disorder in a Large Survey Population. J Child Adolesc Psychopharmacol. 2018;28(2):92-103.
  13. Katz A. (2018, November). NADAL—Neuropsychiatric Autoimmune Disorder Associated With Lyme Disease –A PANDAS/PANS Equivalent: Diagnosis and Treatment. Presented at the 19th annual conference of The International Lyme and Associated Diseases conference, Chicago, IL.
  14. Kovacevic M, Grant P, Swedo SE. Use of intravenous immunoglobulin in the treatment of twelve youths with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections. J Child Adolesc Psychopharmacol. 2015;25(1):65–69.
  15. Walker ME, Hatfield JK, Brown MA. New insights into the role of mast cells in autoimmunity: evidence for a common mechanism of action? Biochim Biophys Acta. 2012;1822(1):57–65.
  16. Rosa JS et al. Allergic Diseases and Immune-Mediated Food Disorders in Pediatric Acute-Onset Neuropsychiatric Syndrome. Pediatr Allergy Immunol Pulmonol. 2018 Sep 1;31(3):158-165.
  17. Randolph TG, Moss RW. An Alternative Approach to Allergies. Harper & Row, New York, ©1979.

___________________

**Comment**

Fantastic article and clear reminder that many children are losing their childhoods to infections that trigger mental illness. The lack of education and action in the medical community on this issue is astounding.  Again, medical professionals who have taken the Hippocratic Oath to “do no harm,” are telling children they are imagining their illness or making it all up:  https://madisonarealymesupportgroup.com/2017/06/30/child-with-lymemsidspans-told-by-doctors-she-made-it-all-up/

https://madisonarealymesupportgroup.com/2020/02/12/complex-multisystemic-illnesses-lead-to-psychiatric-diagnosis/

https://madisonarealymesupportgroup.com/2019/11/29/its-all-in-your-head-medicines-silent-epidemic/

https://madisonarealymesupportgroup.com/2019/05/27/have-you-been-told-its-all-in-your-head-the-new-biology-of-mental-illness/

For more:  https://madisonarealymesupportgroup.com/2015/10/18/psychiatric-lymemsids/

 

 

 

Category:

Bartonella, Lyme, Mycoplasma, Psychological Aspects, research, Uncategorized