Possible breakthrough in OCD, Tourette’s, and PANDAS, PANS, tic disorders?

By: Dr. M. Kyu Chung

Up until now OCD, Tourette’s, and tic disorders have been treated either with medication or behavioral therapy.  Both types of therapies usually fail to resolve or reverse the condition and only relieve some of the severity of the symptoms.

We have recently developed a therapy that has surprisingly reversed these conditions in several of our patients without the use of chronic medications.  Our report is preliminary as we have so far only treated a few patients. Please see the video testimonials from a few of our clients for more personal reflections on this discussion.

Discussion:

Most psychiatrists generally believe OCD to be a psychiatric condition that spontaneously begins early in life and that rarely resolves and continues lifelong.  Anti-depressants are prescribed but usually result in only a partial reduction of symptoms and usually have to be taken for long periods at a time.

An acute form of OCD was identified and described in 1998 by Susan Swedo et al that was associated with Strep infections and was labeled: Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections (PANDAS).[1]

Subsequently a broader syndrome called Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) has become increasingly used to describe acute onset OCD in children. This broader term includes children who have a dramatic – sometimes overnight – onset of neuropsychiatric symptoms including obsessions/compulsions and/or motor tics who do not necessarily have evidence of a current or previous strep infection. Hence PANDAS is considered a subset of PANS.

The cause of PANS is thought to be unknown in most cases but is thought to be triggered by infections, metabolic disturbances, and other inflammatory reactions.

Over fifteen years ago, we began seeing patients with PANDAS who responded to low dose immunotherapy (LDI’s) against strep infections. However, we began encountering patients who fit the clinical symptom criteria for PANDAS who showed no evidence of strep who failed therapy with strep LDI’s. At the time PANS was not fully coined as an entity.  However, some of our patients showed evidence of abnormal reactions on Autonomic Response Testing (ART) to swabs taken from their throat (but strep negative).   Some of these patients responded to low dose immunotherapy made from samples from their throat swabs. In homeopathy, remedies that are made from the very same substance that cause the problem are called isode’s.

Recently, due to the COVID pandemic we happen to obtain thin nasal swabs to obtain samples from the nasopharynx.  We then began sampling the nasopharynx in our OCD patients. We found there were a significant subset of patients who had normal throat swabs but abnormal nasopharyngeal swabs. Just as different regions of the earth favor different types of organisms, the nasopharynx appeared to have its own unique environment that favored its own unique set of microbes.

When we employed Low Dose Immunotherapy LDI remedies from these samples, we began seeing astounding effects on chronic cases of OCD as well as body/facial tics including Tourette’s Syndrome. We now see more cases that are associated with swabs taken from the nasopharynx than that obtained from the throat.

Given the small number of patients that we have treated we cannot say what per cent of OCD patients will ultimately respond to this type of therapy. However, we have seen a variety of other psychiatric and neurologic conditions improve using isode’s from the nasopharynx. Given the close proximity of the nasopharynx to the brain we believe that a large group of patients with neuropsychiatric symptoms may be affected by inflammation arising from the nasopharyngeal region.  

Currently there are only scattered papers that suggest that organisms in the oropharynx affect the brain. Mahoney et al reported a review of 150 patients who fit the criteria for PANS.[2]

“10/150 (6.6%) patients had isolated sinusitis at the time of their neuropsychiatric deterioration. Eight patients received antibiotics to treat sinusitis, three of whom also received sinus surgery. Neuropsychiatric symptoms improved in all eight patients concurrent with resolution of sinusitis per parent report and clinician.”

We believe that many of the other 140 patients who were not treated with antibiotics would have had abnormal nasopharyngeal swabs on autonomic response testing. It is important to note these patients fit the criteria for PANS which is considered an acute possibly acquired condition. Our three case examples are patients who fit the criteria for the usual chronic OCD of long duration and would not fit the criteria for PANS.

Therefore, employing LDI’s from the nasopharynx may turn out to

potentially be a great solution to OCD, Tourette’s, Tics, and a variety of neuropsychiatric conditions. We are also looking into the connection between gum bacteria and neuropsychiatric conditions and find isode’s from the gum (floss) to be beneficial.

The positive response of our patients who had longstanding OCD symptoms calls into question whether OCD and Tourette’s have similar etiologies to the acute form of OCD described in PANS. There is an ever-increasing number of research papers supporting the possibility that neuropsychiatric conditions have an inflammatory component.[3]

Someday basic science research may verify the different types of organisms that are associated with different neuropsychiatric conditions. We are finding that LDI isode therapy obtained from the nasopharyngeal region to be a very promising therapy for these otherwise difficult to treat conditions.

[1] Swedo SE, Leonard HL, Garvey M, Mittleman B, Allen AJ, Perlmutter S, Lougee L, Dow S, Zamkoff J, Dubbert BK: Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: Clinical description of the first 50 cases. Am J Psychiatry 155:264–271, 1998. Erratum in Am J Psychiatry 155:578, 1998

[2] Talia Mahony 1, Douglas Sidell 2, Hayley Gans 3, Kayla Brown 4, Bahare Farhadian 5, Melissa Gustafson 6, Janell Sherr 7, Margo Thienemann 8, Jennifer Frankovich 9 , Improvement of psychiatric symptoms in youth following resolution of sinusitis. Int J Pediatr Otorhinolaryngol . 2017 Jan:92:38-44. doi: 10.1016/j.ijporl.2016.10.034. Epub 2016 Oct 31.

[3] Han,KyuMan, Ham,Byung-Joo How Inflammation Affects the Brain in Depression: A Review of Functional and Structural MRI Studies,  J Clin Neurol. 2021 Oct; 17(4): 503–515., Published online 2021 Sep 17. doi: 10.3988/jcn.2021.17.4.503