From: hounddog23x@gmail.com   
      
   W5 investigates possible links between common infection and psychiatric and   
   neurological disorders in children   
      
    W5: The Strep Connection   
   W5: The Strep Connection airs this Saturday at 7 p.m.   
      
   Chad Derrick , W5    
   Published Friday, February 13, 2015 10:28AM EST    
   Last Updated Friday, February 13, 2015 10:29AM EST   
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   Two years ago, Noah Castellani was a calm, well-adjusted seven year-old boy.   
   His life in Surrey, British Columbia was much like any other kid his age -   
   attending school and playing hockey on the weekends.   
   But one winter's day, all of that changed. Noah's mother, Leslie, distinctly   
   recollects the moment she realized something was wrong with her son. It   
   happened while Noah was playing hockey at a local rink.   
   "I started to see him hopping on the ice, hopping like a bunny rabbit. He had   
   a two minute shift and he would hop 30 times," she said.   
   Leslie had never seen Noah do anything like this. When she asked him why he   
   was acting this way he answered that his body "told" him to do it.   
   Within a week, Noah started acquiring strange new behaviours - vocal tics   
   which evolved to grunting, and motor tics like eye rolling. Soon he began   
   having frequent angry outbursts and worst of all - smashing his head against   
   hard objects like tables and    
   walls.   
   It was as if he'd become a different child.   
   "It was really tough watching our previously happy go lucky son, fun loving   
   son, funny son, become something that you didn't even know," Leslie told W5.   
   When Leslie consulted with doctors, she was advised that he might have   
   Tourette syndrome - an often inherited tic disorder. But Tourette syndrome   
   didn't run in the family and doctors said they needed to observe a year of   
   sustained tics to make a    
   diagnosis. With a follow-up appointment scheduled four months later, Leslie   
   looked for more information online.   
   PANDAS   
   That's where she learned about a little known medical disorder affecting   
   children called PANDAS - an acronym for Pediatric Autoimmune Neuropsychiatric   
   Disorders Associated with Streptococcal Infections. The testimonials Leslie   
   read on the internet    
   matched Noah's behaviours, including the sudden and dramatic onset of his   
   symptoms.   
   Researchers from the U.S National Institute of Mental Health (NIMH), who   
   proposed PANDAS in 1998, defined several diagnostic criteria but the most   
   important characteristic of the disorder was that Obsessive Compulsive   
   Disorder (OCD) and tic disorders    
   like Tourette syndrome are triggered by Group A strep infection. The   
   hypothesis that a bacterial infection like strep throat - a common bug that   
   affects many school aged children - could be linked to mental or neurological   
   symptoms was ground breaking    
   and controversial.   
   The NIMH researchers suggested that in some cases of strep infection, a   
   child's immune system goes awry. Instead of attacking the strep, a child's   
   antibodies mistakenly attack a part of the brain - the basal ganglia -   
   believed to be responsible for    
   movement and behaviour.   
   But almost twenty years after PANDAS was proposed, many Canadian doctors still   
   remain unaware of it. And a scientific debate amongst neurologists,   
   psychiatrists, pediatricians and infectious disease specialists about the   
   evidence linking strep infection    
   to OCD and tics has led some doctors to question whether PANDAS even exists.   
   For Leslie Castellani, even getting a doctor to test her son, Noah, for strep   
   with a throat swab or a blood test to measure antibodies was no easy feat.   
   When Leslie took Noah to a medical clinic and asked for him to be tested the   
   doctor resisted. Noah didn't seem to exhibit symptoms of strep throat.   
   However, some children can have strep without exhibiting classical signs of   
   the infection.   
   Only after Leslie broke down in desperation, did the doctor relent and agree   
   to test Noah for strep. And days later, the test came back positive. The   
   doctor prescribed a seven day dose of antibiotics and amazingly, Noah's   
   symptoms subsided almost    
   immediately.   
   "Two days into the antibiotics the tics went down by 90%," said Leslie.   
   Controversy over the strep connection   
   Leslie and Noah were relieved - but when the antibiotics ran out Noah's tics   
   came back with intensity. PANDAS symptoms are sometimes characterized by a   
   waxing and waning pattern - depending on the persistence or recurrence of   
   infection.   
   But controversy around PANDAS and the strep connection have impacted the way   
   doctors treat children who exhibit symptoms of OCD or tics.   
   "Controversy exists around PANDAS, there's no question about it. And I think   
   the main reason for that is we just don't understand the condition well," said   
   Dr. Ran Goldman, a pediatrician at BC Children's Hospital in Vancouver.   
   While antibiotics are almost universally prescribed for strep infection, most   
   doctors are generally reluctant to prescribe antibiotics long-term - fearful   
   of dangerous bacteria that build resistance to those drugs or of destroying   
   gut flora essential to    
   overall health.   
   Doctors reluctant to prescribe long-term antibiotics - as well as those who   
   are skeptical or unaware of PANDAS often primarily treat symptoms with therapy   
   and psychiatric medications like Zoloft or Prozac for OCD.   
   As a result, children who suddenly present with OCD and tics, and their   
   parents, are often caught in the middle of the controversy around PANDAS and   
   the discrepancies in treatment.   
   Many families of children with PANDAS symptoms go from doctor to doctor,   
   looking for answers and direction.   
   "I wanted someone to help lead me through this. Nobody wants to watch their   
   child deteriorate so quickly and feel like they can't get anywhere in the   
   medical system to get the help that the child needs," said Leslie Castellani.   
   After being frustrated by a series of pediatricians and specialists, Leslie   
   and Noah finally turned to a naturopathic doctor, Ayla Wilson. In British   
   Columbia, naturopathic doctors are allowed to prescribe antibiotics. After   
   initially treating Noah with    
   antibiotics and other medications, Wilson added natural supplements to boost   
   his immunity and recommended dietary restrictions.   
   And now, two years after his symptoms first appeared, Noah's tics and rages   
   are all but gone. Still, Leslie Castellani believes that his behaviours could   
   resurface.   
   "I am well aware that I have several years more of this. But I know we're   
   heading in the right direction and that's pretty exciting. I have my son   
   again."   
      
      
      
      
      
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