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Incidence of anti-brain antibodies in children with obsessive–compulsive disorder

Neurosciences Unit, Unit of Child Health and Great Ormond Street Hospital, and Neuroinflammation Unit, Institute of Neurology, London

ISOBEL HEYMAN, MBBS, PhD, MRCPsych

Neurosciences Unit, Unit of Child Health and Great Ormond Street Hospital, and Department of Child and Adolescent Psychiatry, Institute of Psychiatry, London

GAVIN GIOVANNONI, PhD, MRCP and ANDRE W J. CHURCH, BSc

Neuroinflammation Unit, Institute of Neurology, London, UK

Correspondence: Dr Isobel Heyman, Department of Child and Adolescent Psychiatry, PO Box 085, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. E-mail: I.Heyman{at}iop.kcl.ac.uk

Declaration of interest None. Funding detailed in Acknowledgements.

Background Obsessions and compulsions may occur in the post-streptococcal disorders Sydenham’s chorea and paediatric autoimmune neuropsychiatric disorders associated with streptococcus (PANDAS). The proposed mediators are anti-basal ganglia antibodies (ABGA).

Aims We tested the hypothesis that post-streptococcal autoimmunity may have a role in‘idiopathic’obsessive–compulsive disorder (OCD).

Method We examined 50 children with OCD for ABGA using enzyme-linked immunosorbent assay (ELISA) and western immunoblotting. The findings were compared with paediatric autoimmune (n=50), neurological (n=100) and streptococcal (n=40) controls.

Results The mean ABGA binding on ABGA binding on ELISA was elevated in the patient cohort compared with all control groups (P<0.005 in all comparisons). Western immunoblotting revealed positive antibody binding (as seen in Sydenham’s chorea) in 42% of the patient cohort compared with 2–10% of control groups (P<0.001 in all comparisons).

Conclusions Our findings support the hypothesis that central nervous system autoimmunity may have a role in a significant subgroup of cases of OCD. Further studyis required to examine whether the antibodies concerned are pathogenic.

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