Hugues Lamothe1,2, Ryad Tamouza1,3, Andreas Hartmann2,4, Luc Mallet1,2,5. 1. Assistance Publique-Hôpitaux de Paris, Pôle de psychiatrie, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Université Paris-Est Créteil, Créteil, France. 2. Institut du Cerveau et de la Moelle Épinière, ICM, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, 75013, Paris, France. 3. Institut Mondor de Recherche Biomédical, Université Paris-Est Créteil (UPEC), team « Psychiatrie Translationnelle », INSERM U955, Créteil, France. 4. Centre Hospitalo-Universitaire de la Pitié Salpétrière, Paris, France. 5. Department of Mental Health and Psychiatry, Global Health Institute, University of Geneva, Geneva, Switzerland.
Abstract
INTRODUCTION: The neurobiology of Gilles de la Tourette syndrome (GTS) is known to involve cortico-striatal loops possibly under genetic control. Less is known about possible environmental triggers of GTS. Specifically, immune-related events following possible environmental inducers have been evoked, but important controversies still exist. OBJECTIVES: In this systematic review and meta-analysis, we then aimed to look for evidence in favor of such possibilities. METHOD: We performed a systematic review and meta analysis of all immunological data in PubMed. RESULTS: We found large discrepancies concerning immune dysfunctions in GTS and meta-analyzing cytokines data did not allow us to conclude to an involvement of specific cytokines in GTS neurobiology. When looking specifically to the PANDAS/PANS entity, we found some important evidence of a possible infectious involvement but in limited number of studies. Our meta-analysis found an increased level of anti-streptolysin O antibodies in GTS patients, but level of anti-DNase B antibodies was not increased. CONCLUSIONS: Too many questions still exist to allow us to definitively reach the conclusion that there is an infectious and immunological etiology in GTS. Much work is still needed to elucidate the possible role of immunology in GTS neurobiology and to favor immunological treatment rather than classical treatment. This article is protected by copyright. All rights reserved.
INTRODUCTION: The neurobiology of Gilles de la Tourette syndrome (GTS) is known to involve cortico-striatal loops possibly under genetic control. Less is known about possible environmental triggers of GTS. Specifically, immune-related events following possible environmental inducers have been evoked, but important controversies still exist. OBJECTIVES: In this systematic review and meta-analysis, we then aimed to look for evidence in favor of such possibilities. METHOD: We performed a systematic review and meta analysis of all immunological data in PubMed. RESULTS: We found large discrepancies concerning immune dysfunctions in GTS and meta-analyzing cytokines data did not allow us to conclude to an involvement of specific cytokines in GTS neurobiology. When looking specifically to the PANDAS/PANS entity, we found some important evidence of a possible infectious involvement but in limited number of studies. Our meta-analysis found an increased level of anti-streptolysin O antibodies in GTS patients, but level of anti-DNase B antibodies was not increased. CONCLUSIONS: Too many questions still exist to allow us to definitively reach the conclusion that there is an infectious and immunological etiology in GTS. Much work is still needed to elucidate the possible role of immunology in GTS neurobiology and to favor immunological treatment rather than classical treatment. This article is protected by copyright. All rights reserved.