Müller N, Riedel M, Erfurth A, Möller H J
Psychiatrische Klinik, Ludwig-Maximilians-Universität, München.
Nervenarzt. 1997 Nov;68(11):914-6. doi: 10.1007/s001150050216.
It has known for a long time that Sydenham's chorea and tics, as seen in Gilles de la Tourette's syndrome (GTS), are phenomenologically very similar. Tics may occur as symptoms of acute Sydenham's chorea or persist over years as residual symptoms. Investigating of children suffering from GTS, including obsessive-compulsive symptoms, have provided signs of a poststreptococcal autoimmune process but also shown that treatment based on immunological interventions has been effective. We treated a 14-year-old boy showing all diagnostic criteria of GTS, familial susceptibility, and an increase in the antibody titer of streptococcal antigens with 75 immunoglobulins i.v. over 5 days. Response to this therapy was good regarding motor tics, vocal tics, and behavioral symptoms such as disturbed impulse control which still persisted after 9 months. These findings and the successful therapy underline reports of the literature and point to a pathogenetic mechanism of an immunologically triggered disturbance of the striatal dopaminergic system, at least in a subgroup of GTS.
长期以来，人们都知道西德纳姆舞蹈病和抽动症，如在 Gilles de la Tourette 综合征（GTS）中所见，在现象学上非常相似。抽动可能作为急性西德纳姆舞蹈病的症状出现，或作为残留症状持续数年。对患有 GTS 的儿童进行的调查，包括强迫症症状，已提供了链球菌感染后自身免疫过程的迹象，但也表明基于免疫干预的治疗是有效的。我们治疗了一名 14 岁男孩，他表现出 GTS 的所有诊断标准、家族易感性以及链球菌抗原抗体滴度升高，在 5 天内静脉注射了 75 剂免疫球蛋白。对于运动性抽动、发声性抽动以及行为症状（如冲动控制障碍，在 9 个月后仍持续存在），该治疗的反应良好。这些发现和成功的治疗证实了文献报道，并指出至少在 GTS 的一个亚组中，存在免疫触发的纹状体多巴胺能系统紊乱的发病机制。
