[PAGID] post gamma globulin psychiatric disorder

[Jung, Lawrence]

Have you considered PANDAS (pediatric autoimmune neuropsychiatric
disorders)?  Swedo et al reported the use of IVIG/plasmapheresis helped
to control the post-strept OCD or tic disorders.  While the study is
controversial, I wonder whether, in your case, the IVIg did help and its
discontinuation leads to exacerbation of the "neuropsychiatric"
symptoms.

Larry Jung
Omaha, NE 



-----Original Message-----
From: pagid-bounces at list.clinimmsoc.org
[mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Richard L.
Wasserman, M.D.,Ph.D.
Sent: Tuesday, March 11, 2008 10:44 PM
To: Pagid list serve
Subject: [PAGID] post gamma globulin psychiatric disorder

I received the following email from the mother of the patient described.

He had hypogammaglobulinemia and vaccine non-responsiveness as a young 
child and was treated IV. Reevlaution at about age 12 again demonstrated

vaccine non-responsiveness but resolution of hypogammaglobulinemia. I 
recommended stopping IVIG at that time but his parents opted to 
contine.  He developed severe infusion related migraine and was treated 
sub q for the past several years. Last spring, because he had done well 
and was getting ready for college, I again stopped sub q IgG to 
reevaluate him. He never returned for his lab studies. He had run away. 
This is my first information about him. Any comments for a reply to his 
mother?
Thanks,
Richard Wasserman
Dallas

Dr Wasserman, our son has been a patient of yours since he was 2(he is
now 18) and stopped taking gamma several months ago. When he was taking
the gamma he would feel great after the treatment and by the end of the
3-4 weeks would feel bad....not necessarily sick but just felt bad. His
energy would be down and his body hurt. Since he has been off of the
gamma he has had a dramatic and devestating change in his personality
and ability to function. Not just the I am a teenager and my parents
dont know anything change or rebellion. He is presently on his 3rd court
order commitment to the psychiatric hospital. He has also been arrested
twice in the last 2 months after which they send him to the hospital. He
has been diagnosed with major depression, bi-polar, anxiety, ADD, & OCD.
He looses major periods of time that he cant account for anywhere from a
few days to three weeks. He is now taking several medications a day to
help with his various new medical diagnoses. 

Have you ever seen a patient that the gamma helped with how they felt
and acted and then when stopped had this type of effect?  Our whole
family is just beaten down from his behavior and hospital stays over the
past 4 months. The last day he acted like himself and he could hold a
normal conversation was October 31st. I remember the day clearly as what
began to happened a couple of days later is hard to comprehend.The
hospital checks him for drugs each time he is admitted and his is always
clean. 

The therapist tells me I am trying to find a logical answer to an
illogical situation. Which I understand but dont want to overlook
anything that might help with Phillip's outcome. 

Thanks for any ideas you might have.






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