Developmental Medicine & Child Neurology



Review

Post-streptococcal autoimmune disorders of the central nervous system


Russell C Dale  a1 c1
a1 Neurosciences Unit, Great Ormond Street Hospital NHS Trust, London, UK.

Abstract

Group A Streptococcus can induce autoimmune disease in humans with particular involvement of the heart, joints, and brain. The spectrum of post-streptococcal disease of the central nervous system (CNS) has been widened recently and includes movement disorders (chorea, tics, dystonia, and Parkinsonism), psychiatric disorders (particularly emotional disorders), and associated sleep disorders. Neuroimaging and pathological studies indicate that the most vulnerable brain region is the basal ganglia. The immunopathogenesis of the disease is incompletely defined, and although there is some support for autoantibody-mediated disease, several conflicting studies cast doubt on the autoantibody hypothesis. It has been speculated that post-streptococcal autoimmunity has a role in common neuropsychiatric disease but the evidence is conflicting and routine screening of patients with Tourette syndrome and obsessive–compulsive disorder for post-streptococcal autoimmune abnormalities is not be recommended at present. However, post-streptococcal disorders of the CNS remain a useful model of neuropsychiatric disease, which may improve our understanding of abnormal movements and behaviours in children.

(Published Online October 17 2005)
(Accepted July 18 2005)


Correspondence:
c1 Neurosciences Unit, Great Ormond Street Hospital NHS Trust and Institute of Child Health, London WC1N 3JJ, UK. E-mail: rdale@ion.ucl.ac.uk