Intravenous Immunoglobulin May Improve Severe OCD in Children

Researchers observed improvements in children with pediatric acute-onset neuropsychiatric syndrome (PANS) who were treated with intravenous immunoglobulin (IVIG), according to data at the 3-month mark of the study, when children went in for a third visit. These findings were recently published in BMC Psychiatry.

The primary objectives of the open-label trial include efficacy of IVIG in improving neuropsychiatric symptoms. Secondary endpoints were changes in obsessive-compulsive disorder (OCD), school attendance, adaptive and cognitive functioning, quality of life (QoL), safety, and tolerability.

“This open-label trial…is the first IVIG study to report broad baseline and follow-up data on global severity and functioning and detailed symptom development according to the defined symptom criteria of PANS,“ the study authors wrote. “All children had improved at visit 1.”

By the third visit, 2 participants showed symptom rebound; however, none of the symptoms resulted in the child leaving the trial. PANS is the sudden and dramatic onset of OCD and/or eating restrictions, along with 2 additional severe neuropsychiatric symptoms, which can include choreiform movements, separation anxiety, sensory symptoms, severe emotional lability, and hallucinations.

The origins of PANS are not known, but mechanistic triggers could include autoimmunity or inflammatory disorders, which “in first-degree relatives have been reported in around 50–70% of all PANS cases,” the study authors wrote.

Other mechanisms may include neuroinflammation with autoimmunity, postinfectious disease, and the exacerbation or relapse of underlying neurodevelopmental/neurological disorders. There are a lack of trials that assess long-term functional and QoL, safety, and tolerably of IVIG treatment for children and adolescents with PANS, according to the study authors. In a prospective longitudinal 18-month in-depth outcome study, researchers decided to evaluate these measures.

Researchers administered 2 g/kg of IVIG monthly to 10 children diagnosed with PANS. They ranked efficacy and outcomes based on the Pediatric Acute Neuropsychiatric Symptom (PANS) scale, Clinical Global Impression – Severity scale (CGI-S), Improvement (CGI-I) scale, Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS) scores, and adverse events (AEs).

At the 3-month mark, approximately 90% of patients had at least a 30% improvement on PANS scale total score. Mean scores improved for CGI-S by month 3, which indicated a decrease in illness severity. Clinically important changes in safety were not observed.

Additionally, school absences decreased—prior to IVIG treatment, students missed nearly 10 days of school per month. Monthly IVIG treatment lowered absences by 5-fold (34%) at the interim.

The most common AEs included transient headache, neck pain, nausea/vomiting (mild to severe), stomach pain, mild transient anemia, and brief allergic reaction. Study limitations included small sample size, non-randomized and uncontrolled design, nonexistent control group, and a heterogeneous patient sample (preexisting disorders, medication, and duration of illness).

“Considerable improvements of PANS global symptoms and impairment were seen on the PANS Scale, CGI-S, CGI-I, and improved OCD symptoms on the CY-BOCS scale, lasting at least one month after the third IVIG treatment,” the study authors wrote.

Reference

Hajjari, Parisa, Oldmark, Malin Huldt, Fernell, Elisabeth, et al. Paediatric Acute-onset Neuropsychiatric Syndrome (PANS) and intravenous immunoglobulin (IVIG): comprehensive open-label trial in ten children. BMC Psychiatry. August 6, 2022. 22, 535 (2022). https://doi.org/10.1186/s12888-022-04181-x