PANDAS eş tanısı olan ve olmayan kekemelik olgularının retrospektif olarak değerlendirilmesi

Year 2024, Volume: 49 Issue: 3, 535 - 546, 30.09.2024

Perihan Çam Ray , Merve Doğan , Adnan Barutçu , Necmiye İrem Sehlikoğlu , Ayşegül Yolga Tahiroğlu , Gonca Çelik

https://doi.org/10.17826/cumj.1429653

Abstract

Amaç: Bu çalışmanın amacı, Streptokok Enfeksiyonu İle İlişkili Pediatrik Otoimmün Nöropsikiyatrik Hastalık (PANDAS) eş tanısı olan ve olmayan kekemelik tanılı olguların, klinik, demografik ve otoimmun özelliklerini değerlendirmektir.
Gereç ve Yöntem: Çalışmaya, polikliniğimize 2012-2022 yılları arasında başvuran ve kekemelik tanısı alan 2-17 yaş arası 271 çocuk ve ergen alınmıştır. Hastaların demografik bilgileri ve hastaların ve ailelerinin enfeksiyon, alerji, romatizmal hastalık, tonsillektomi ve penisilin profilaksisi gibi tıbbi geçmişleri retrospektif olarak değerlendirildi. Rutin laboratuvar testleri de kaydedilmiştir.
Bulgular: Yaş ortalaması 7,6±3,6 yıl olan 55 kız (%20,3) ve 216 (%79,7) erkek çocuk çalışmaya dahil edilmiştir. PANDAS grubunda 48 (%17) ve PANDAS olmayan grupta 223 (%82,3) vaka vardı. PANDAS tanı alt grupları karşılaştırıldığında, PANDAS grubunda tonsillektomi, adenoidektomi, adenoid, sık enfeksiyon ve tonsillektomi öyküsü oranlarının anlamlı olarak daha yüksek olduğu görüldü. Aile öyküsü incelendiğinde, PANDAS grubunda psikiyatrik bozukluklar, otoimmün hastalıklar ve alerjik hastalıkların oranlarında anlamlı bir artış vardı. PANDAS grubunda obsesif kompulsif bozukluk, tikler, dikkat eksikliği hiperaktivite bozukluğu ve anksiyete gibi komorbid hastalıkların görülme sıklığı ve en az bir tane mevcut olan ortalama komorbid tanı sayısı diğer gruba kıyasla anlamlı derecede daha yüksekti. Ayrıca, psikiyatrik semptomların başlangıç yaşı ve vakaların ortalama yaşı PANDAS grubunda daha yüksekti. PANDAS grubunun ilk ortalama Anti-streptolizin O düzeyleri 326,5±335,3 IU/mL iken, diğer grupta 155,6±215,1 IU/mL idi.
Sonuç: PANDAS grubunda hem bireylerde hem de ailelerde inflamatuar ve otoimmün bozuklukların yanı sıra yüksek oranda komorbiditeye sahip olduğu bulunmuştur. Kekemelik vakalarında, bu özelliklerin değerlendirilmesi ve gerekli metodolojilerin belirlenmesi ve patofizyolojik mekanizmaların açıklanmasına ihtiyaç vardır.

Keywords

PANDAS, PANS, kekemelik, otoimmünite.

Retrospective evaluation of stuttering cases with and without PANDAS comorbidity

Abstract

Purpose: The aim of this study is to evaluate the clinical, demographic, and autoimmune characteristics of stuttering cases with and without Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) comorbidity.
Materials and Methods: The study included 271 children and adolescents aged 2-17 years who were brought to our outpatient clinic between 2012 and 2022 and diagnosed with stuttering. The demographic information and medical characteristics of the patients and their families, such as infections, allergies, rheumatic diseases, and tonsillectomy or penicillin prophylaxis, were evaluated retrospectively. Their routine laboratory test results were also documented.
Results: In total, 55 girls (20.3%) and 216 (79.7%) boys at a mean age of 7.6±3.6 years were included. Forty-eight cases (17%) were in the PANDAS group, and 223 (82.3%) were in the non-PANDAS group. The comparison of the PANDAS and non-PANDAS groups showed that the PANDAS group had significantly higher rates of history of tonsillectomy, history of adenoidectomy, and history of frequent infections. The rates of psychiatric, autoimmune, and allergic diseases in the families of the cases in the PANDAS group were significantly higher. The PANDAS group had a significantly greater frequency of comorbid conditions such as obsessive-compulsive disorder, tics, attention-deficit/hyperactivity disorder, and anxiety, as well as a greater mean number of comorbid conditions with at least one diagnosis. Additionally, the age at onset of psychiatric symptoms and the mean age of cases were higher in the PANDAS group. The mean initial anti-streptolysin O level of the PANDAS group was 326.5±335.3 IU/mL, while the mean level in the non-PANDAS group was 155.6±215.1 IU/mL.
Conclusion: Both the individuals in the PANDAS group and their families had high rates of comorbidities and inflammatory and autoimmune disorders. In cases of stuttering, there is a need to evaluate these conditions, determine the required methodologies, and explain the relevant pathophysiological mechanisms.

Keywords

PANDAS, PANS, stuttering, autoimmunity

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