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MRI/EEG

 

MRI

A Pediatric Neurologist may run an MRI. There are a few though rare cases of PANDAS that have involved chorea encephalopathy and other related issues, but it May be best to rule these out.

See the following for information on MRI as it relates to these disorders.

  1. SWEDO/SNIDER 2003, Post-Streptococcal Autoimmune Disorders of the CNS.
  2. SWEDO, et al 2000, MRI Assessment of Children with OCD & Tics Associated with Strep.
  3. MABROUK/EAPEN 2008, Challenges in the Identification and Treatment of PANDAS: A Case Series.

This is not the norm but it is very important to check because brain inflammation can create serious long-term debilitation.

Some current cases have been shown to have small inflammatory issues, more like what is seen in a migrane, but it is worth noting again because you are creating a clinical picture for the child. One child had inflamed Virchow Robin Spaces around the brain stem/basal ganglia area. In and of itself, not dangerous, but indicates possible neurological basal ganglia irritation.

There is no instrument that specifically shows inflammation of the basal ganglia. These are nerves. On one occasion in our group a SPECT SCAN (showing blood flow displacement) indicated basal ganglia inflammation.

MRI’s show the displacement of fluid in the brain, swelling. In severe cases a PET scan can be done, but it does have radiation issues that should be discussed with the doctor. MRI’s do not involve radiation, but magnetic resonance only.


EEG

A few children have been found to have irregular EEG’s. This could be PANDAS or some other frontal lobe seizure issue which can create separate psychological or physical issues. It is good to rule out this type of disorder particularly if your child is having rages or lapses in memory or other neurological dysfunctions.

An EEG is also something to look into if a child experiences sleep abnormalities. A sleep study that results in abnormal findings may expedite receiving treatment.


PET SCANS: THE POSSIBLE FUTURE TEST FOR PANDAS

“Basal ganglia inflammation in children with neuropsychiatric symptoms” by Drs. Kumar, Williams, Musik and Chugani shows a significant difference in brain inflammation patterns between PANDAS children and those with Tourette Syndrome (TS). This information was obtained through special PET scanning.

These findings are very important because it reinforces the stance that PANDAS is not just Tourettes or OCD, but it is different and requires different treatment protocols. It also signifies the difference in the etiology, or cause, of the two disorders.

Basal Ganglia Imaging Study by Dr. Harry Chugani
The rogue white blood cells that cause PANDAS affect the basil ganglia of the brain. The basal ganglia are several brain structures located in the center of the brain. They function as a communication route to other parts of the brain and are partly responsible for the movement of our body. Other parts of the basal ganglia are involved in memorization, cognitive and emotional processing, and again initiating movement. There is still much to be learned about how this part of our brain functions. It is theorized that PANDAS causes an inflammation of the basal ganglia. A 1999 study by Ranjit C. Chacko, M.D. showed a connection between OCD and the basal ganglia.

Now, Dr. Harry Chugani at Children’s Hospital of Michigan, is studying the potential use of PET scans as diagnostic tools for PANDAS Dr Chugani states that the basal ganglia are not hard to detect on an MRI scan. In fact, the basil ganglia are large structures. However, the MRI scan is not useful for detection of abnormal microscopic, neurological functioning in the basal ganglia because MRI scans look at anatomy, i.e., tissue density and damage, water displacement, inflammation of tissue (and not the neurological function of this part of the brain). PET scans, or Positron Emission Tomography scans, may be used instead of, or in addition to, magnetic resonance imaging (MRI) scans. This gives anatomic and functional information.

The PET scan works by using PK-11195, a radioactive material, to target the inflammatory cells of the brain.  This chemical is attracted to inflammatory cells and gives information on how the basil ganglia are functioning. Some of the PET scans on PANDAS children are identifying inflammation in the basal ganglia. This may be useful as the long awaited confirmation of P.A.N.D.A.S. that parents have sought.

Dr Chugani said, “By finding PET scan evidence of abnormality in the basal ganglia, we may now have a biomarker for PANDASIndeed, following IVIG in some P.A.N.D.A.S. subjects, the abnormality in basal ganglia has gone away on repeated PET scan. These studies are rather preliminary, on a limited number of subjects, and much more work needs to be done.”

*Please note that Dr. Chugani is not a “PANDAS doctor”.  However this research can really make an impact in the future of diagnosing PANDAS.

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