This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (68)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Psychiatry, Other  • Alert me on articles by topic

Bradley S. Peterson, MD; James F. Leckman, MD; Daniel Tucker, MD; Lawrence Scahill, MSN, PhD; Lawrence Staib, PhD; Heping Zhang, PhD; Robert King, MD; Donald J. Cohen, MD; John C. Gore, PhD; Paul Lombroso, MD

Arch Gen Psychiatry. 2000;57:364-372.

Background  Previous studies have provided preliminary serological evidence supporting the theory that symptoms of tic disorders or obsessive-compulsive disorder (OCD) may be sequelae of prior streptococcal infection. It is unclear, however, whether previously reported associations with streptococcal infection were obscured by the presence of diagnostic comorbidities. It is also unknown whether streptococcal infection is associated in vivo with anatomical alterations of the brain structures that have been implicated in the pathophysiology of these disorders.

Methods  Antistreptococcal antibody titers were measured in 105 people diagnosed as having CTD, OCD, or attention-deficit/hyperactivity disorder (ADHD) and in 37 community controls without a disorder. Subjects were unselected with regard to their history of streptococcal exposure. Basal ganglia volumes were measured in 113 of these subjects (79 patients and 34 controls).

Results  A DSM-IV diagnosis of ADHD was associated significantly with titers of 2 distinct antistreptococcal antibodies, antistreptolysin O and anti–deoxyribonuclease B. These associations remained significant after controlling for the effects of CTD and OCD comorbidity. No significant association was seen between antibody titers and a diagnosis of either CTD or OCD. When basal ganglia volumes were included in these analyses, the relationships between antibody titers and basal ganglia volumes were significantly different in OCD and ADHD subjects compared with other diagnostic groups. Higher antibody titers in these subjects were associated with larger volumes of the putamen and globus pallidus nuclei.

Conclusions  These findings suggest that the prior reports of an association between antistreptococcal antibodies and either CTD or OCD may have been confounded by the presence of ADHD. They also support the hypothesis that in susceptible persons who have ADHD or OCD, chronic or recurrent streptococcal infections are associated with structural alterations in basal ganglia nuclei.

From the Yale Child Study Center (Drs Peterson, Leckman, Tucker, Scahill, King, and Cohen), and the Departments of Diagnostic Radiology (Drs Peterson, Staib, and Gore) and Epidemiology and Public Health (Dr Zhang), Yale School of Medicine, New Haven, Conn.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Anti-basal ganglia antibodies and Tourette's syndrome: a voxel-based morphometry and diffusion tensor imaging study in an adult population
Martino et al.
J. Neurol. Neurosurg. Psychiatry 2008;79:820-822.
ABSTRACT | FULL TEXT  

Magnetic Resonance Imaging Volumetric Analysis of the Putamen in Children With ADHD: Combined Type Versus Control.
Wellington et al.
J Atten Disord 2006;10:171-180.
ABSTRACT  

Increased Antistreptococcal Antibody Titers and Anti--Basal Ganglia Antibodies in Patients With Tourette Syndrome: Controlled Cross-Sectional Study
Rizzo et al.
J Child Neurol 2006;21:747-753.
 

Tic Disorders: Neural Circuits, Neurochemistry, and Neuroimmunology
Harris and Singer
J Child Neurol 2006;21:678-689.
ABSTRACT  

Increased Number of Subcortical Hyperintensities on MRI in Children and Adolescents With Tourette's Syndrome, Obsessive-Compulsive Disorder, and Attention Deficit Hyperactivity Disorder
Amat et al.
Am. J. Psychiatry 2006;163:1106-1108.
ABSTRACT | FULL TEXT  

Attention-Deficit Hyperactivity Disorder (ADHD)
Voeller
J Child Neurol 2004;19:798-814.
ABSTRACT  

Does Group A {beta}-Hemolytic Streptococcal Infection Increase Risk for Behavioral and Neuropsychiatric Symptoms in Children?
Perrin et al.
Arch Pediatr Adolesc Med 2004;158:848-856.
ABSTRACT | FULL TEXT  

A Possible Association of Recurrent Streptococcal Infections and Acute Onset of Obsessive-Compulsive Disorder
Kim et al.
J. Neuropsychiatry Clin. Neurosi. 2004;16:252-260.
ABSTRACT | FULL TEXT  

Brain Structural Abnormalities in Psychotropic Drug-Naive Pediatric Patients With Obsessive-Compulsive Disorder
Szeszko et al.
Am. J. Psychiatry 2004;161:1049-1056.
ABSTRACT | FULL TEXT  

The Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infection (PANDAS) Subgroup: Separating Fact From Fiction
Swedo et al.
Pediatrics 2004;113:907-911.
FULL TEXT  

A Murine Model for Neuropsychiatric Disorders Associated with Group A {beta}-Hemolytic Streptococcal Infection
Hoffman et al.
J. Neurosci. 2004;24:1780-1791.
ABSTRACT | FULL TEXT  

Frontostriatal Abnormalities in Adolescents With Bipolar Disorder: Preliminary Observations From Functional MRI
Blumberg et al.
Am. J. Psychiatry 2003;160:1345-1347.
ABSTRACT | FULL TEXT  

Basal Ganglia Volumes in Patients With Gilles de la Tourette Syndrome
Peterson et al.
Arch Gen Psychiatry 2003;60:415-424.
ABSTRACT | FULL TEXT  

Autoimmunity and the basal ganglia: new insights into old diseases
Dale
QJM 2003;96:183-191.
ABSTRACT | FULL TEXT  

A Functional Magnetic Resonance Imaging Study of Language Processing and Its Cognitive Correlates in Prematurely Born Children
Peterson et al.
Pediatrics 2002;110:1153-1162.
ABSTRACT | FULL TEXT  

Post-streptococcal autoimmune psychiatric and movement disorders in children
DALE and HEYMAN
Br. J. Psychiatry 2002;181:188-190.
FULL TEXT  

Is obsessive-compulsive disorder an autoimmune disease?
Arnold and Richter
CMAJ 2001;165:1353-1358.
ABSTRACT | FULL TEXT  

Regional Brain and Ventricular Volumes in Tourette Syndrome
Peterson et al.
Arch Gen Psychiatry 2001;58:427-440.
ABSTRACT | FULL TEXT  

Regional Brain Volume Abnormalities and Long-term Cognitive Outcome in Preterm Infants
Peterson et al.
JAMA 2000;284:1939-1947.
ABSTRACT | FULL TEXT  

More on Strep Infections, ADHD, and OCD
JWatch Neurology 2000;2000:15-15.
FULL TEXT  

More on Strep Infections, ADHD, and OCD
JWatch Psychiatry 2000;2000:9-9.
FULL TEXT