In a recent NIMH Director's Blog, Dr. Thomas Insel gave yet another update on PANDAS and PANS. Both of those are names describing two similar medical conditions that can evolve from either Streptococcus bacteria for the former, and for the latter- Lyme bacteria, Epstein Barr Virus, or Mycoplasma bacteria , plus "cause unspecified." We have been hearing a lot about these two increasing neuropsychiatric disorders but what really caught my eye was the title and comparisons being made by Dr. Insel. His chosen title for the blog, " From Paresis to PANDAS & PANS " is an ironic twist on what we, here on Age of Autism, have been talking about for years -- the evolution of disorders, especially those with neuropsychiatric features and how mercury has been a big player.
"The Age of Autism: Mercury, Medicine, and a Man-Made Epidemic" -
General paresis was a form of psychosis with delusions, hallucinations, and memory problems often of rapid onset and thought to be due to a general constitutional weakness. At least that was the explanation until 1913, when general paresis was shown to be caused by syphilitic infection of the brain. The first treatments were awarded a Nobel Prize in 1917. The advent of antibiotics 30 years later led to the virtual eradication of neuro-syphilis, as the disorder came to be called, in this country. The idea that mental or behavioral disorders could be due to infection is, therefore, not new but it remains surprisingly difficult to accept....We may be looking at a similar reluctance to accept an infectious cause of pediatric sudden onset obsessive compulsive disorder (OCD) – in a debate that has been ongoing for almost two decades... The onset has not always been linked precisely with a strep infection and the critical increase in antibodies to strep has not been evident consistently. Nevertheless, immune-based treatments have proven successful, leading to the growing acceptance of the concept of Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus ( PANDAS ).
What Dr. Insel is not telling us is that Syphilis rarely presented as "psychosis with delusions, hallucinations, and memory problems." It was when you added mercury that these symptoms of GPI developed
"IS GENERAL PARESIS DEPENDENT UPON PREVIOUS TREATMENT WITH MERCURY?"
BY POVL HEIBERG, M.D. 1938
Deputy-City Medical Officer of Health, Copenhagen
The classical studies of Jessen, Kjeldberg and Jespersen established with a high degree of certainty that general paresis was always preceded by infection with syphilis several years before. In particular, the excellent little dissertation by Jespersen
established this fact, but Jespersen refuted decidedly the theory which was at that time advocated by various authors that previous treatment with mercury is a contributory factor in the development of general paresis.The chief argument advanced by Jespersen was that the poisoning of a patient at the age of 20 years could not possibly bring about the appearance of the disease from 20 to 40 years later. Nowadays this argument does not seem particularly weighty. In recent years Aebly (1920) first advanced the view that the paralysis is directly attributable to the antisyphilitic treatment with mercury, and this view has been corroborated later by the findings reported by various investigators. Among these, particular mention is to be made of the experiences reported from the Charite Hospital,' Berlin, that the length of the latent period is dependent upon the amount of mercury employed.
So, a latent period is to be expected with mercury. Infections then, causing behavioral issues, may be only part of the story. More research could be extremely helpful in the area of microbes and their interaction with metals. By using Dr. Insel's MRI PANDAS pictures, we can see where there seems to be an area of the brain, the basal ganglia, and more specifically, the caudate nucleus, which become inflamed due to targeting by "anti-brain antibodies, triggered by a Strep infection." By coincidence, there seems to be a connection also to autism and the caudate nucleus --
"Prevalence of serum antibodies to caudate nucleus in autistic children:"
And how, exactly, did the child recover from what the father believed was a vaccine injury? The letter reports: “In March of 1994, we met with Dr. [name omitted] and his immunological panel of tests indicated an underlying immunodeficiency as you can see by his report. His suspicions of the MMR vaccine in my son's case are mentioned in his letter. He was immediately put on 400 mg/kg of IVIG every four weeks at [clinic name omitted], and he responded quite well to the treatment.”
IVIG is intravenous immunoglobulin, administered to boost antibody levels in immune deficient patients and, at high doses, to regulate autoimmune conditions.
The father took his son to another leading immunologist, who reported that his measles virus titer was above measurable limits. Workups by a third doctor revealed his son “was suffering from indeterminant inflammatory bowel disease.”
This was the apparent new syndrome the Royal Free doctors were treating and that Wakefield was investigating – indeterminate or non-specific inflammatory bowel disease and autistic regression, in most instances associated in time by parents or doctors with the MMR shot. The father learned of the work at the Royal Free from his American doctors and was the first to fly his child across the Atlantic because he believed his son was showing the same pattern. The first case series, on 12 such children including Child 11, was published in The Lancet in 1998.
But this clear sequence – vaccination, illness, regression, chronic bowel inflammation, treatment, recovery – is nowhere to be found in the BMJ account of Child 11, even though Deer met with the father twice, in California and London, and also communicated with him via e-mail.
Absent, too, is the fact that Child 11 is now in college in California after graduating from high school with a 3.75 academic average.
The treatment the father cited, and the rationale for it, has been described in detail by the U.S. doctor who administered it. “A number of immunological abnormalities have been observed in patients with autism,” according to the text of comments he subsequently made at a meeting of an autism group. He said all the children he treated, which included child 11, had regressed after the MMR shot.
“Natural killer cells … that appear to play an important role in defense against virus infected cells and tumor cells are decreased both in numbers and functions in patients with autism. This deficiency may play a role in increased susceptibility to various infections that may in turn play a role in the pathogenesis of autism.”
The sudden onset of a tic disorder in 15 upstate New York teens might be the result of a strep or other microbial contagion, not "conversion disorder"
"Short-term benefit from oral vancomycin treatment of regressive-onset autism".
...11 children with regressive-onset autism were recruited for an intervention trial using a minimally absorbed oral antibiotic. .... Short-term improvement was noted using multiple pre- and post-therapy evaluations. These included coded, paired videotapes scored by a clinical psychologist blinded to treatment status; these noted improvement in 8 of 10 children studied... these results indicate that a possible gut flora-brain connection warrants further investigation, as it might lead to greater pathophysiologic insight and meaningful prevention or treatment in a subset of children with autism.
"Treating Autism With Antibiotics" (France 3 19/20, Feb 17, 2012)
"Scientists shocked to find antibiotics alleviate symptoms of schizophrenia - Chance discovery of link between acne drug and psychosis may unlock secrets of mental illness" - The Independent, Friday 02 March 2012
The National Institute for Health Research is funding a £1.9m trial of minocycline, which will begin recruiting patients in the UK next month. The research follows case reports from Japan in which the drug was prescribed to patients with schizophrenia who had infections and led to dramatic improvements in their psychotic symptoms....The chance observation caused researchers to test the drug in patients with schizophrenia around the world. Trials in Israel, Pakistan and Brazil have shown significant improvement in patients treated with the drug.....The first account of minocycline's effects appeared in 2007 when a 23-year-old Japanese man was admitted to hospital suffering from persecutory delusions and paranoid ideas. He had no previous psychiatric history but became agitated and suffered auditory hallucinations, anxiety and insomnia. Blood tests and brain scans showed no abnormality and he was started on the powerful anti-psychotic drug halperidol. The treatment had no effect and he was still suffering from psychotic symptoms a week later when he developed severe pneumonia.He was prescribed minocycline to treat the pneumonia and within two weeks the infection was cleared and the psychosis resolved.
"Mercury and autoimmunity: implications for occupational and environmental health"