Abstract 79 Poster Session III, Monday 5/3 (poster 362)

In several studies, childhood movement disorders including Sydenham's chorea (SC), tics, and Tourette syndrome (TS), have been shown to be associated with antibodies in the serum to central nervous system (CNS) cells. A critical question is whether such antibodies are found in the cerebrospinal fluid (CSF) of the symptomatic child. A putamen membrane ELISA for determining serological antibodies has been found to be both sensitive and specific in identifying children with movement disorders. This case report is of a 12 year old white male with an intermittent 4 year history of a movement disorder characterized by tics, chorea and choreiform movements, and obsessive compulsive behavior. While under treatment for Attention Deficit Hyperactivity Disorder (ADHD), movement symptoms occurred after a documented group A beta hemolytic streptococcal infection which was treated with antibiotics. Over the period of 4 years he was treated with stimulant medication and clonidine, during which time he showed characteristic waxing and waning of symptoms. A severe exacerbation was characterized by marked chorea, impaired handwriting, excessive tiredness, and brief hallucinations. Streptococcal titers at exacerbation were negative [Antistreptolysin O (ASO)<200, Antideoxyribonuclease B (AntiDNaseB <60)]. Symptoms persisted and one month later lumbar puncture was successful with CSF negative for myelin basic protein, oligoclonal bands, and evidence of Lyme disease. However, both CSF (+ at 1:3) and sera (+ at 1:6000) showed evidence of antibodies to putamen membranes. ASO was <200 IU while AntiDNaseB was now positive at 1:240 and continued to rise to 1:680. This case report is the first we know of that documents antibodies to CNS cells in both CSF and sera in a child with an active movement disorder.