Abstract
Objective: To examine prospectively the association between group A Streptococcus (GAS) pharyngeal exposures and exacerbations of tics in a large multicenter population of youth with chronic tic disorders (CTD) across Europe. Methods: We followed up 715 children with CTD (age 10.7 ± 2.8 years, 76.8% boys,), recruited by 16 specialist clinics from 9 countries, and followed up for 16 months on average. Tic, obsessive-compulsive symptom (OCS,), and attention-deficit/hyperactivity disorder (ADHD) severity was assessed during 4-monthly study visits and telephone interviews. GAS exposures were analyzed using 4 possible combinations of measures based on pharyngeal swab and serologic testing. The associations between GAS exposures and tic exacerbations or changes of tic, OC, and ADHD symptom severity were measured, respectively, using multivariate logistic regression plus multiple failure time analyses and mixed effects linear regression. Results: A total of 405 exacerbations occurred in 308 of 715 (43%) participants. The proportion of exacerbations temporally associated with GAS exposure ranged from 5.5% to 12.9%, depending on GAS exposure definition. We did not detect any significant association of any of the 4 GAS exposure definitions with tic exacerbations (odds ratios ranging between 1.006 and 1.235, all p values >0.3). GAS exposures were associated with longitudinal changes of hyperactivity-impulsivity symptom severity ranging from 17% to 21%, depending on GAS exposure definition. Conclusion: sThis study does not support GAS exposures as contributing factors for tic exacerbations in children with CTD. Specific workup or active management of GAS infections is unlikely to help modify the course of tics in CTD and is therefore not recommended.
Original language | English |
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Pages (from-to) | E1680-E1693 |
Journal | Neurology |
Volume | 96 |
Issue number | 12 |
DOIs | |
State | Published - 23 Mar 2021 |
Externally published | Yes |
Bibliographical note
Publisher Copyright:© 2020 American Academy of Neurology.
Funding
D. Martino has received honoraria for lecturing from the Movement Disorders Society, Tourette Syndrome Association of America, and Dystonia Medical Research Foundation Canada; research funding support from Dystonia Medical Research Foundation Canada, the University of Calgary, the Michael P. Smith Family, the Owerko Foundation, Ipsen Corporate, the Parkinson Association of Alberta, and the Canadian Institutes for Health Research; and royalties from Springer-Verlag. A. Münchau is supported by the Deutsche Forschungsgemeinschaft (DFG; FOR 2698). A. Schrag is supported by the UCL/H NIHR Biomedical Research Centre. V. Roessner has received payment for consulting and writing activities from Lilly, Novartis, and Shire Pharmaceuticals; lecture honoraria from Lilly, Novartis, Shire Pharmaceuticals, and Medice Pharma; and support for research from Shire and Novartis. He has carried out (and is currently carrying out) clinical trials in cooperation with Novartis, Shire, and Otsuka. S. Walitza has received in the last 5 years royalties from Thieme Hogrefe, Kohlhammer, Springer, and Beltz. Her work was supported in the last 5 years by the Swiss National Science Foundation (SNF), diff. EU FP7s, HSM Hochspezialisierte Medizin of the Kanton Zurich, Switzerland, Bfarm Germany, ZInEP, Hartmann Müller Stiftung, Olga Mayenfisch, and Gertrud Thalmann Fonds. Outside professional activities and interests are declared under the link of the University of Zurich ( uzh.ch/prof/ssl-dir/interessenbindungen/client/web/ ). A. Schrag, Z. Anastasiou, A. Apter, N. Benaroya-Milstein, M. Buttiglione, F. Cardona, R. Creti, A. Efstratiou, T. Hedderly, I. Heyman, C. Huyser, M. Madruga, P. Mir, A. Morer, N. Mol Debes, N. Moll, N. Müller, K. Müller-Vahl, P. Nagy, K.J. Plessen, C. Porcelli, R. Rizzo, J. Schnell, M. Schwarz, L. Skov, T. Steinberg, Z. Tarnok, A. Dietrich, and P.J. Hoekstra do not have financial disclosures. Go to Neurology.org/N for full disclosures. This project has received funding from the European Union's Seventh Framework Program for research, technological development and demonstration under grant agreement 278367. This project has received funding from the European Union’s Seventh Framework Program for research, technological development and demonstration under grant agreement 278367.
Funders | Funder number |
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European Union's Seventh Framework Program for research, technological development and demonstration | |
European Union’s Seventh Framework Program for research, technological development and demonstration | 278367 |
Ipsen Corporate | |
Michael P. Smith Family | |
Owerko Foundation | |
Tourette Syndrome Association of America | |
International Parkinson and Movement Disorder Society | |
University of Calgary | |
Canadian Institutes of Health Research | |
University College London | |
Deutsche Forschungsgemeinschaft | FOR 2698 |
Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung | |
Dystonia Medical Research Foundation Canada | |
NIHR Great Ormond Street Hospital Biomedical Research Centre | |
Parkinson Association of Alberta |