Correct Diagnosis

[Lil T's Mom]

Our 8 year old daughter had 3 bouts with strep throat late last year, early Jan.2002. After, she started a sniffing tic that went into a blinking, then when school started in Sept. the neck thrust, now an eye rolling.  Heard about PANDAS versus Touretts.  We live in Ohio and looking for specialist in the field.  Do children out grow this?  How can a healthy child suddenly develop this condition?

[CCF-Neuro-M.D.-JT]

PANDAS is a controversial diagnosis that has emerged from the medical literature in the last few years. Some physicians do not believe there is really an association between strep throat infections and neurobehavioral disorders such as obsessive compulsive disorder or tics, while others have collected several case studies of pediatric patients who appeared to have the disease. According to one study from NY, the patients with PANDAS responded well to antibiotic therapy for the infection and had complete resolution of the behavioral symptoms when the infection cleared.  Recurrence of the behavioral symptoms was present in half of the patients, but this was associated with recurrent infection. As for the possibility of Tourette's syndrome, the diagnosis requires both verbal and motor tics for one whole year. It's more common in boys, starts about age 7 (most before age 11), can certainly occur in previously healthy children and has a genetic component (meaning it's inherited in a number of cases). Some reports state that the majority of patients with tourette's have a peak in their tics during adolescence and then the disease slowly peters out as they get older. A small percentage have complete remission after the end of puberty.

Dr. Gerald Erenberg is an outstanding ped neurologist here at the Cleveland CLinic who specializes in tic disorders. If you are interested in making an appointment, I'm sure he would be happy to see your daughter. Good luck.