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.
Lack of Association of Group A Streptococcal Infections and Onset of Tics: European Multicenter Tics in Children Study / Schrag, Anette-Eleonore; Martino, Davide; Wang, Hanyuying; Ambler, Gareth; Benaroya-Milstein, Noa; Buttiglione, Maura; Cardona, Francesco Carmelo Giovanni; Creti, Roberta; Efstratiou, Androulla; Hedderly, Tammy; Heyman, Isobel; Huyser, Chaim; Mir, Pablo; Morer, Astrid; Moll, Natalie; E Müller, Norbert; R Müller-Vahl, Kirsten; J Plessen, Kerstin; Porcelli, Cesare; Rizzo, Renata; Roessner, Veit; Schwarz, Markus; Tarnok, Zsanett; Walitza, Susanne; Dietrich, Andrea; J Hoekstra Alan Apter, Pieter; Baglioni, Valentina; Ball, Juliane; Benaroya-Milshtein, Noa; Bodmer, Benjamin; Bognar, Emese; Burger, Bianka; Buse, Judith; Cardona, Francesco Carmelo Giovanni; Correa Vela, Marta; M Debes, Nanette; Dietrich, Andrea; Cristina Ferro, Maria; Fremer, Carolin; Garcia-Delgar, Blanca; Gulisano, Mariangela; Hagen, Annelieke; Hagstrøm, Julie; J Hedderly, Tammy; Heyman, Isobel; J Hoekstra, Pieter; Huyser, Chaim; Madruga-Garrido, Marcos; Marotta, Anna; Martino, Davide; Mir, Pablo; Morer, Astrid; Müller, Norbert; R Müller-Vahl, Kirsten; Münchau, Alexander; Nagy, Peter; Neri, Valeria; Jc Openneer, Thaïra; Pellico, Alessandra; Periañez Vasco, Ángela; J Plessen, Kerstin; Porcelli, Cesare; Redondo, Marina; Rizzo, Renata; Roessner, Veit; Ruhrman, Daphna; Ml Schnell, Jaana; Schrag, Anette; Silvestri, PAOLA ROSARIA; Skov, Liselotte; Steinberg, Tamar; Tagwerker Gloor, Friederike; Tarnok, Zsanett; Tübing, Jennifer; L Turner, Victoria; Walitza, Susanne; Weidinger, Elif. - In: NEUROLOGY. - ISSN 0028-3878. - (2022).
Lack of Association of Group A Streptococcal Infections and Onset of Tics: European Multicenter Tics in Children Study
Davide Martino;Francesco Cardona;Renata Rizzo;Valentina Baglioni;Francesco Cardona;Davide Martino;Valeria Neri;Alessandra Pellico;Renata Rizzo;Paola Rosaria Silvestri;
2022
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.| File | Dimensione | Formato | |
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