Group A streptococcal infections and childhood neuropsychiatric disorders - Relationships and therapeutic implications

Recently, a hypothesis concerning the pathophysiology of some cases of paediatric-onset obsessive-compulsive disorder (OCD) and/or tic disorders has been proposed. Infections with group A beta-haemolytic streptococci, and perhaps other agents, are believed to trigger an immune response that crossreacts with neurons in the basal ganglia, disrupting their function and resulting in neuropsychiatric symptoms. Therapeutic possibilities derived from this model have been proposed in terms of 4 sequential events that are hypothesised to occur: (i) infection; (ii) generation of an immune response; (iii) reversible injury to the basal ganglia; and (iv) irreversible injury to the basal ganglia. However, at the present time, research supporting any specific therapeutic approach is extremely limited or nonexistent.