Streptococcal Antibodies In Autism Spectrum Disorders with Catatonia

Background: Catatonia has been described for centuries yet the etiology of this disabling illness has remained elusive and it is often regarded as an idiopathic psycho-motor complication of psychiatric illness. Recently, catatonia has become recognized as having an increased prevalence (12-17%) in young adults with autism spectrum disorders (Wing and Shah, 2000; Billstedt et al., 2005). Laboratory abnormalities have been reported in some cases of catatonia (eg, elevated CPK, low iron, elevated CSF HVA); however, to our knowledge, this is the first report of abnormal streptococcal antibodies in catatonia.

Objectives: To evaluate clinical features and diagnostic studies in catatonia in young adults with autism spectrum disorders.

Methods: A record review of 78 patients who presented to the Sutter Transition for Autism and Neurodevelopmental Disorders (S.T.A.N.D.) Clinic, a transition clinic for young adults with neurodevelopmental disorders, over 18-months since inception.

Results: Five cases (age range 16-29) out of 78 of teens and adults (age range 16-60) with autism spectrum disorders presented with catatonia. Laboratory screening revealed an elevated anti-DNase Ab (avg. 544 [340-1360]; nl <85) in all five subjects with catatonia and an elevated ASOT (avg 437.8 [105-1210]; nl <200) in three of the five with catatonia. No clear recent streptococcal infections were identified in these five subjects. Three subjects demonstrated a positive clinical response to immunotherapy (the other two patients are still being assessed and are likely going to start immunotherapy soon).

Conclusions: We hypothesize that the streptococcal antibodies may point to a neuro-autoimmunologic etiology of catatonia in autism spectrum disorders. Similar neuro-immunologic mechanisms have been proposed in other neurological disorders associated with streptococcal antibodies (PANDAS, Sydenham’s chorea, and post-streptococcal dystonia). Further investigation is important as this could represent a biomarker for catatonic patients who may respond to immunological treatment strategies.