Journal of Neuroimmune Pharmacology

, Volume 9, Issue 5, pp 606–614 | Cite as

On the Connection Between Autoimmunity, tic Disorders and Obsessive-Compulsive Disorders: A Meta-Analysis on Anti-Streptolysin O Titres

  • Marco Pozzi
  • Paolo Pellegrino
  • Carla Carnovale
  • Valentina Perrone
  • Stefania Antoniazzi
  • Cristiana Perrotta
  • Sonia Radice
  • Emilio Clementi


Anti-streptolysin O (ASO) titration is useful in the context of autoimmune pathologies, including specific cases of tic and obsessive-compulsive disorders occurring after streptococcal infections. There is currently a lack of consensus on the use of ASO titres; therefore we performed a meta-analysis to systematise available data and clarify the role of ASO titres in the context of neuropsychiatric disorders. A meta-analysis was performed on ASO titration in neuropsychiatric patients, including tic disorders and obsessive-compulsive disorders. Included studies reported numbers of positive subjects, depending on a chosen threshold, or detailed ASO titrations. Three hundred and twenty nine studies were identified, of which 13 were eligible for meta-analysis. Due to limited available data, only tic disorders were evaluated. The odds ratio of finding an abnormal ASO titre in patients was 3.22 (95 % C.I. 1.51–6.88) as compared to healthy controls and 16.14 (95 % C.I. 8.11–32.11) as compared to non-psychiatric patients. Studies using different thresholds were generally concordant. ASO titres were also compared quantitatively, finding an overall difference of the means of 70.50 U/ml (95 % C.I. 25.21–115.80) in favour of patients with tic disorders. Based on current evidence, tic disorders are associated with a significant increase in ASO titres, evident both in a threshold-level perspective and on a quantitative level. These results encourage the systematisation of ASO titration in the context of tic disorders.


Anti-streptolysin O titre tic disorders Tourette’s syndrome Obsessive-compulsive disorders PANDAS Group A β–haemolytic streptococci 



The financial support by Agenzia Italiana del Farmaco (AIFA) and by the Italian Ministry of Health (Ricerca Corrente 2014, to EC) is gratefully acknowledged. The authors report no conflict of interests. The funding public institutions had no role in any part of the work.


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Marco Pozzi
    • 1
  • Paolo Pellegrino
    • 2
  • Carla Carnovale
    • 2
  • Valentina Perrone
    • 2
  • Stefania Antoniazzi
    • 3
  • Cristiana Perrotta
    • 4
  • Sonia Radice
    • 2
  • Emilio Clementi
    • 1
    • 4
  1. 1.Scientific Institute IRCCS Eugenio MedeaBosisio PariniItaly
  2. 2.Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, “Luigi Sacco”University Hospital, Università di MilanoMilanItaly
  3. 3.IRCCS Foundation Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
  4. 4.Unit of Clinical Pharmacology, CNR Institute of Neuroscience, Department of Biomedical and Clinical Sciences L. Sacco, “Luigi Sacco”University Hospital, Università di MilanoMilanItaly

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