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Streptococcal infection and immune response in children with Tourette’s syndrome

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Abstract

Background

Streptococcal infection and basal ganglia inflammation are hypothesized to be involved in Tourette’s syndrome (TS). There is a need for effective therapies for managing TS. We studied streptococcal infection and immunity in TS following immunomodulator (pidotimod) therapy.

Methods

Blood samples from 58 patients with TS and 128 age-matched healthy controls enabled measurement of antistreptolysin O (ASO), T cells, natural killer (NK) cells, interleukin-6 (IL-6) and interleukin-8 (IL-8), and tumor necrosis factor-α (TNF-α). Forty-four patients with abnormal T cell numbers were divided into two groups and treated with pidotimod granules (pidotimod group, n = 20) or pidotimod plus dopaminergic receptor antagonists (combination group, n = 24). Yale Global Tic Severity Scale (YGTSS) scores and immunologic indices were assessed after treatment.

Results

An ASO >1:200 was found in 22.4 % of children with TS, 7.5 % of controls, and 38.9 % of children with both TS and attention deficit hyperactivity disorder (ADHD) compared to 15.0 % of children with TS alone (P < 0.05). Children with TS showed decreased CD3+ and CD4+ T cells, CD4+/CD8+ ratio, IL-6 and IL-8, increased NKC and TNF-α (P < 0.05) as compared to controls. ASO-positive children with TS had lower CD4+ T cells as compared to ASO-negative children with TS, and lower IL-6 and IL-8 levels as compared to controls (P < 0.05). After 8 weeks of pidotimod treatment, IL-8 was increased compared to either tiapride hydrochloride or haloperidol and pidotimod (P < 0.05).

Conclusions

Streptococcal infection in TS patients is associated with immune and cytokine dysfunction, which can be potentially managed with immunomodulator therapy.

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Acknowledgments

This study was supported by grant from program of the Capital Applied Research with Clinical Characteristics (D101100050010040). We are grateful to all patients in the Capital Institute of Pediatrics neurological department. We would like to acknowledge assistance from all staff of the neurology department of the Capital Institute of Pediatrics. We thank all participants and their family members for their cooperation in providing both clinical information and samples for the study.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Neurology Department, Capital Institute of Pediatrics, Beijing, 100020, China

    Erzhen Li, Qian Chen, Lingyun Lv, Ping Zheng & Liwen Wang

  2. Department of Peadiatrics, Maternal and Child Health Hospital, Children’s Hospital of Guangxi, Nanning, 530003, China

    Yiyan Ruan

  3. Clinical Centrol Labrary, Capital Institute of Pediatrics, Beijing, 100020, China

    Xiaodai Cui

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  1. Erzhen Li
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  2. Yiyan Ruan
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Correspondence to Erzhen Li.

Additional information

Erzhen Li and Yiyan Ruan contributed equally to this work.

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Li, E., Ruan, Y., Chen, Q. et al. Streptococcal infection and immune response in children with Tourette’s syndrome. Childs Nerv Syst 31, 1157–1163 (2015). https://doi.org/10.1007/s00381-015-2692-8

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