International Meeting for Autism Research: Streptococcal Antibodies In Autism Spectrum Disorders with Catatonia

Streptococcal Antibodies In Autism Spectrum Disorders with Catatonia

Friday, May 13, 2011
Elizabeth Ballroom E-F and Lirenta Foyer Level 2 (Manchester Grand Hyatt)
2:00 PM
S. Kile1, M. Chez2, C. Parise3, A. Hankins4, T. Donnel3, R. Low5, S. Caffery6 and C. Lepage6, (1)Sacramento, CA, (2)Sutter Neuroscience Institute, Sacramento; UC Davis Medical Center, Sacramento, CA, United States, (3)Sacramento, CA, United States, (4)Sutter Institute for Medical Research, Sacramento, CA, (5)Sutter Neuroscience Medical Group, Sacramento, CA, United States, (6)Sutter Neuroscience Medical Group, Sacramento, CA
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.  

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