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Association of Group A Streptococcus Exposure and Exacerbations of Chronic Tic Disorders: A Multinational Prospective Cohort Study


Martino, Davide; Schrag, Anette; Anastasiou, Zacharias; et al; Walitza, Susanne (2021). Association of Group A Streptococcus Exposure and Exacerbations of Chronic Tic Disorders: A Multinational Prospective Cohort Study. Neurology:Epub ahead of print.

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 (ADHD) severity was assessed during 4-monthly study visits and telephone interviews. GAS exposures were analyzed using four possible combinations of measures based on pharyngeal swab and serological 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

Four-hundred-and-five 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 four 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.

CONCLUSIONS

This study does not support GAS exposures as contributing factors for tic exacerbations in children with CTD. Specific work-up or active management of GAS infections is unlikely to help modifying the course of tics in CTD and is therefore not recommended.

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 (ADHD) severity was assessed during 4-monthly study visits and telephone interviews. GAS exposures were analyzed using four possible combinations of measures based on pharyngeal swab and serological 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

Four-hundred-and-five 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 four 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.

CONCLUSIONS

This study does not support GAS exposures as contributing factors for tic exacerbations in children with CTD. Specific work-up or active management of GAS infections is unlikely to help modifying the course of tics in CTD and is therefore not recommended.

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Additional indexing

Contributors:EMTICS Collaborative Group
Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Psychiatric University Hospital Zurich > Department of Child and Adolescent Psychiatry
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:10 February 2021
Deposited On:19 Feb 2021 10:59
Last Modified:20 Feb 2021 04:41
Publisher:Lippincott Williams & Wilkins
ISSN:0028-3878
OA Status:Closed
Publisher DOI:https://doi.org/10.1212/WNL.0000000000011610
PubMed ID:33568537

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Content: Accepted Version
Language: English
Filetype: PDF - Registered users only until 28 February 2022
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Embargo till: 2022-02-28