Misdiagnosed bipolar: One girl's struggle through psychiatric wards

[Bob]

This article is a few months old, but very interesting. The WPI Tweeted it.

It's about a patient who was diagnosed with bipolar that didn't respond to treatment.

And then she was rediagnosed with PANS or PANDAS, and treated accordingly with autoimmune and anti-inflammatory therapies.

Also, the following treatment was tried:
"Frankovich knew she needed more aggressive measures to bring Tessa back. In December 2012, after much debate within Stanford itself, agreement was reached to conduct a three-day treatment called plasmapheresis that would run Tessa's blood through a machine to clean out toxic antibodies, followed by a powerful immune-suppressing drug called Rituximab."



Misdiagnosed bipolar: One girl's struggle through psych wards before Stanford doctors make bold diagnosis and treatment
Julia Prodis
April 19 2014
www.mercurynews.com/health/ci_25600426/misdiagnosed-bipolar-one-girls-struggle-through-psych-wards

It's all interesting, so it's difficult to pick out extracts, but here are some extracts:

"Doctors diagnosed her with bipolar disorder, prescribed psychiatric drugs that didn't work and sent the San Jose family on a nightmarish odyssey through psych wards, group homes and isolation rooms.

Then, suddenly, more than 10 months into the Gallos' terrifying ordeal, a pair of Stanford University doctors told the family that Tessa wasn't bipolar at all. She was probably suffering from a tragically misdiagnosed condition that mimics mental illness in a way doctors are only starting to understand."

"This is not bipolar," Chang said. "This is an autoimmune disease, and I'm so sorry it took me this long to see you."

"What Frankovich, a pediatric rheumatologist, and Dr. Kiki Chang, a child psychiatrist, concluded was that Tessa likely had an infection or other trigger that caused her immune system to mistakenly attack her brain, dramatically changing Tessa's behavior overnight. It's a condition called PANS -- pediatric acute-onset neuropsychiatric syndrome -- that in some cases, if caught early enough, could be cured by commonly used antibiotics. Without early treatment, they say, children can suffer needlessly."

"PANS is so new and so misunderstood, that there are no reliable estimates of how many children are affected. A national PANS parent support group believes the number nationwide could be more than 150,000, or about a quarter of the children who have obsessive compulsive disorder or other tics.

But skeptics within the medical community question whether PANS even exists. At a symposium in Burlingame on Saturday, Teresa Gallo and Frankovich will try to dispel the lingering controversy that has thwarted efforts to legitimize the diagnosis, fund research and spread the word about possible treatments."

"It was 2012 and Chang and Frankovich were preparing to open the world's first PANS clinic, but the hospital provided only enough funding to operate a half day a week out of a room in the rheumatology department. Soon, there were 60 patients and a five-month waiting list. The two doctors, plus their mostly-volunteer staff, began working nights and weekends answering desperate calls from parents and pleading with insurance companies to fund novel treatments."

"Tessa's is an extreme case and Frankovich is the first to admit there's a lot she and Chang don't understand. But when she began treating Tessa with the same autoimmune and anti-inflammatory therapies she used on her lupus patients -- whose immune systems become hyperactive and attack healthy tissues -- Tessa started getting better."

 

[Bob]

Note that Dr Mady Hornig & Dr Lipkin do research in this area.

 

[Simon]

Note that Dr Mady Hornig & Dr Lipkin work do research in this area.

See Mady Hornig: How do you solve a problem like CFS? - section on PANDAS
this relates to a form of PANS triggered by Streptococcus.