정서적불안정을동반한 PANDAS 1 예
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1 KISEP Case Report J Korean Neuropsychiatr Assoc Vol 43, No 3 1 예 전남대학교병원정신과 양종철 A Case of PANDAS with Emotional Lability Jong-Chul Yang, MD, PhD Department of Psychiatry, Cheonnam National University Hospital, Gwangju, Korea The authors report a case of pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (PANDAS) and emotional lability. This is a 12-year-old girl who developed normally until the age of 11, when she had a high fever with headache followed by abnormal tic movement, emotional lability, ands high antistreptolysin-o (ASO) titer. The case illustrates difficulties in diagnosing and treating the PANDAS. (J Korean Neuropsychiatr Assoc 2004;43(3): ) KEY WORDS:PANDAS Streptococcal infection Emotional lability. 서 - - 론 357 증 례
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3 고찰 359
4 - 중심단어 REFERENCES 1) Swedo SE, Leonardo HL, Gravey M, Mittleman B, Allen AJ, Perlmutter SJ. et al. Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: Clinical description of the first 50 cases. Am J Psychiatry 1998;155: ) Kaplan EL. Group A Streptococcal infections. In: feigen R, Cherry JD. Textbook of Pediatric Infectious Diseases. 3rd ed. Philadelphia, Pa: WB Sauders Co;1992. p ) Perlmutter SJ, Leitman SF, Garvey MA, Hamburger S, Feldman E, Leonard HL, et al. Therapeutic plasma exchange and intravenous immunoglobulin for obsessive-compulsive disorders and tic disorders in childhood. Lancet 1999;354: ) Mathew SJ. PANDAS variant and body dysmorphic disorder. Am J Psychiatry 2001;158:963. 5) 정유숙. A군연구균감염이후 Antistreptolysin-O 혈중농도증가가뚜렛씨장애의증상악화에미치는영향에대한임상연구. 소아 청소년정신의학 1998;9: ) 정유숙, 양윤선, 이문향, 고효정, 정영기, 이호영. 감염이후자가면역장애가뚜렛장애군의증상악화에미치는영향과치료효과의비교에대한임상연구. 신경정신의학 2001;40: ) 성덕규, 조수철. 소아기붕괴성장애의양상을보이는 PANDAS 1예. 소아 청소년정신의학 2001;12: ) Kleinsasser BJ, Misra LK, Bhatara VS, Sanchez JD. Risperidone in the treatment of choreiform movements and aggressiveness in a child with PANDAS. S D J Med 1999;52: ) Lombroso PJ, Scahill L, King RA, Lynch KA, Chappell PB, Peterson BS, et al. Risperidone treatment of children and adolescents with chronic tic disorders: a preliminary report. J Am Acad Child Adolesc Psychiatry 1995;34: ) Schreier HA. Risperidone for young children with mood disorders and aggressive behavior. J Child Adolesc Psychopharmacol 1998;8: ) Leonard HL, Swedo SE. Pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (PANDAS). Int J Neuropsychopharmacol 2001;4: ) Sinder LA, Swedo SE. Post-streptococcal autoimmune disorders of the central nervous system. Current Opinion in Neurology 2003;16: ) Hall M, Costa DC, Shields J, Heavens J, Robertson M, Ell PJ. Brain perfusion patterns with Tc-99m HMPAO/SPECT in patients will Gilles de la Tourett s syndrome. Eur J Nucl Med 1990;16:56, Riddle MA, Rasmusson AM, Woods SW, Hoffer PB. SPECT imaging of regional cerebral blood flow in Tourette s syndrome. Psychiatry Res; ) Cunningham MW. Pathogenesis of group A streptococcal infection. Clin Microbiol Rev 2000;13: ) Peterson BS, Riddle MA, Cohen DJ, Smith JC, Hardin MT, Leckman JF. Reduced basal ganglia volumes in Tourette s syndrome using 3- dimensional reconstruction technique from magnetic resonance im- 360
5 ages. Neurology 1993;43: ) Giedd JN, Rapoport JL, Garvey MA, Perlmutter S, Swedo SE. MRI assessment of children with obsessive-compulsive disorder or tics associated with streptococcal infection. Am J Psychiatry 2000;157: ) Husby G, van de Rijin, Zabriskie JB, Abdin ZH, Williams RC. Antibodies reacting with cytoplasm of subthalamic and caudate nuclei neurons in chorea and rheumatic fever. J Exp Med 1976;144: ) Singer Hs, Walkup JT. Tourette s syndrome and other tic disorder. Medicine 1991;70: ) Kiessling LS. Tic disorder associated with evidence of invasive group A β-hemolytic streptococcal disease. Dev Med Child Neurol 1989; 48:59 suppl. 361
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