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Neuropsychological manifestations in children with Sydenham’s chorea after adjunct intravenous immunoglobulin and standard treatment

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Abstract

This was an exploratory study comparing neuropsychological manifestations of Sydenham’s chorea (SC), 6 months after initiation of treatment, in children who had received intravenous immunoglobulins as an adjunct to standard treatment, with those who had received standard treatment. We included a non-SC control group for comparison. We hypothesized that compared to controls, children with SC who had received prior intravenous immunoglobulins would demonstrate less pronounced impairments compared to those who had received standard care. We conducted a cross-sectional analysis of 17 children with −SC who had received treatment 6 months previously (9 treated with standard of care and 8 augmented with intravenous immunoglobulins) and 17 non-SC, medically well controls. The standard treatment group (n = 9) exhibited significant behavioral difficulties, including significantly poorer co-operation (p = 0.009) compared with the other augmented immunoglobulins and non-SC control groups, and increased impulsivity (p = 0.016) compared with non-SC controls. The standard treatment group scored significantly lower than the other two groups on a measure of executive functioning (p = 0.03). Children with SC may be more at risk for neuropsychological difficulties than non-SC, medically well children. Intravenous immunoglobulins may mitigate some of these impairments.

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Acknowledgments

The authors would like to acknowledge Renee de Wit for her contribution to assessments and data collection.

Author contributions

CL is a clinical psychologist who assessed participants’ significant others with a psychiatric assessment battery. KW was the principal investigator in the medical treatment trial comparing the use of IVIG plus standard treatment to standard treatment alone in the treatment of Sydenham chorea. She contributed to the development of the Walker, Wilmshurst, Wendy SC clinical rating scale. The other authors contributed in the following ways. CG assisted with the neuropsychological assessments. LM assisted with administrative and funding matters, and entered all data that were collected. MK advised the researchers on the data analyses. CS contributed to the writing and proof reading of the manuscript. SS provided supervision. JW contributed to the writing of the proposal of the study and to the development and validation of the WWW clinical rating scale for SC and the proof reading of the manuscript. All authors contributed significantly to writing of the manuscript.

Declaration of conflicting interests

The authors declared a potential conflict of interest (e.g., a financial relationship with the commercial organizations or products discussed in this article) as follows: The National Bioproducts Institute donated the intravenous immunoglobulin (polygamy) used in this study.

Funding

We would like to acknowledge the Crossley Foundation for funding.

Ethical approval

The study was approved by the Research Ethics Committee of the University of Cape Town (REF049/2002; Clinical Trial Registration number NCT 00615797) and the Health Research Ethics Committee of Stellenbosch University (N04/09/156).

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Authors and Affiliations

  1. Department of Psychiatry, University of Stellenbosch, P.O. Box 19063, Tygerberg, 7505, South Africa

    Claire Gregorowski, Lindi Martin, Candice Simmons & Soraya Seedat

  2. US/UCT MRC Unit on Anxiety & Stress Disorders, Department of Psychiatry, University of Stellenbosch, Tygerberg, South Africa

    Christine Lochner & Soraya Seedat

  3. Centre for Statistical Consultation, Department of Statistics & Actuarial science, University of Stellenbosch, Tygerberg, South Africa

    Martin Kidd

  4. Department of Paediatric Neurology, Red Cross War Memorial Children’s Hospital, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa

    Kathleen Walker & Jo M. Wilmshurst

Authors
  1. Claire Gregorowski
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  2. Christine Lochner
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  3. Lindi Martin
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  4. Candice Simmons
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  5. Martin Kidd
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  6. Kathleen Walker
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  7. Jo M. Wilmshurst
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  8. Soraya Seedat
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Corresponding author

Correspondence to Candice Simmons.

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Gregorowski, C., Lochner, C., Martin, L. et al. Neuropsychological manifestations in children with Sydenham’s chorea after adjunct intravenous immunoglobulin and standard treatment. Metab Brain Dis 31, 205–212 (2016). https://doi.org/10.1007/s11011-015-9681-1

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  • DOI: https://doi.org/10.1007/s11011-015-9681-1

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