Lack of Association of Group A Streptococcal Infections and Onset of Tics: European Multicenter Tics in Children Study. (15th March 2022)

• Record Type: Journal Article
• Authors: Schrag, Anette-Eleonore; Martino, Davide; Wang, Hanyuying; Ambler, Gareth; Benaroya-Milstein, Noa; Buttiglione, Maura; Cardona, Francesco; Creti, Roberta; Efstratiou, Androulla; Hedderly, Tammy; Heyman, Isobel; Huyser, Chaim; Mir, Pablo; Morer, Astrid; Moll, Natalie; Müller, Norbert E.; Müller-Vahl, Kirsten R.; Plessen, Kerstin J.; Porcelli, Cesare; Rizzo, Renata; Roessner, Veit; Schwarz, Markus; Tarnok, Zsanett; Walitza, Susanne; Dietrich, Andrea; Hoekstra, Pieter J.
• Is Part Of: Neurology. Volume 98:Number 11(2022)
• Publication Date: 2022-03-15
• Subjects: Neurology -- Periodicals; Neurology -- Periodicals; Neurologie -- Périodiques; 616.8
• DOI: 10.1212/WNL.0000000000013298
• Languages: English
• ISSNs: 0028-3878

Abstract

Abstract : Background and Objectives: The goal of this work was to investigate the association between group A streptococcal (GAS) infections and tic incidence among unaffected children with a family history of chronic tic disorders (CTDs). Methods: In a prospective cohort study, children with no history for tics who were 3 to 10 years of age with a first-degree relative with a CTD were recruited from the European Multicentre Tics in Children Study (EMTICS) across 16 European centers. Presence of GAS infection was assessed with throat swabs, serum anti–streptolysin O titers, and anti-DNAse titers blinded to clinical status. GAS exposure was defined with 4 different definitions based on these parameters. Cox regression analyses with time-varying GAS exposure were conducted to examine the association of onset of tics and GAS exposure during follow-up. Sensitivity analyses were conducted with Cox regression and logistic regression analyses. Results: A total of 259 children were recruited; 1 child was found to have tic onset before study entry and therefore was excluded. Sixty-one children (23.6%) developed tics over an average follow-up period of 1 (SD 0.7) year. There was a strong association of sex and onset of tics, with girls having an ≈60% lower risk of developing tics compared to boys (hazard ratio [HR] 0.4, 95% confidence interval [CI] 0.2–0.7). However, there was no statistical evidence to suggest an association of any of the 4 GAS exposure definitions with tic onset (GAS exposure definition 1: HR 0.310, 95% CI 0.037–2.590; definition 2: HR 0.561, 95% CI 0.219–1.436; definition 3: HR 0.853, 95% CI 0.466–1.561; definition 4: HR 0.725, 95% CI 0.384–1.370). Discussion: These results do not suggest an association between GAS exposure and development of tics. Classification of Evidence: This study provides Class I evidence that group A streptococcal exposure does not associate with the development of tics in children with first-degree relatives with chronic tic disorder.