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Plasma Exchange and Intravenous Immunoglobulin Lack Proven Benefit and Carry Risk for Children with PANDAS, Tourette´s Syndrome, or OCD

Publicity surrounding small experimental trials at NIMH has caused parents to seek unproven interventions in treating children with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). NIMH advises that these patients should not be treated outside of clinical research protocols.

NIMH is studying the effects of plasma exchange, also known as plasmapheresis, and intravenous immunoglobulin (IVIG) on clinical symptoms in PANDAS. NIMH views these interventions as experimental. But some parents are seeking plasma exchange or IVIG as treatment for children with PANDAS, Tourette's syndrome (TS) or obsessive-compulsive disorder (OCD).

NIMH data provide no evidence of benefits for either plasmapheresis or IVIG in children who lack streptococcal-triggered symptoms. Even in children with streptococcal-triggered symptoms, the effectiveness of these interventions is not proven at this time. More importantly, both plasmapheresis and IVIG are considered to be serious medical interventions that carry a potential for significant adverse reactions that is not fully understood in children with either TS or OCD. Furthermore, the use of IVIG resources for non-approved indications such as TS or OCD can have significant adverse public health consequences.

Parents and clinicians are urged to be aware of the experimental nature of these interventions, the lack of evidence for their utility in the treatment of TS or OCD, and their potential for risks in children with these disorders. Caution dictates that these interventions should be used only in the setting of NIH-approved clinical research protocols. Parents of children with streptococcal-triggered neuropsychiatric symptoms who want to consider these experimental treatments are encouraged to enroll in ongoing NIMH or other clinical studies. Further information regarding those studies is available at: http://intramural.nimh.nih.gov/research/pdn/web.htm.

Updated: July 12, 2000

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