TY - JOUR
T1 - Lack of association of group A streptococcal infections and onset of TiCs
AU - on behalf of European Multicentre Tics in Children Study (EMTICS)
AU - Schrag, Anette Eleonore
AU - Martino, Davide
AU - Wang, Hanyuying
AU - Ambler, Gareth
AU - Benaroya-Milstein, Noa
AU - Buttiglione, Maura
AU - Cardona, Francesco
AU - Creti, Roberta
AU - Efstratiou, Androulla
AU - Hedderly, Tammy
AU - Heyman, Isobel
AU - Huyser, Chaim
AU - Mir, Pablo
AU - Morer, Astrid
AU - Moll, Natalie
AU - Müller, Norbert E.
AU - Müller-Vahl, Kirsten R.
AU - Plessen, Kerstin J.
AU - Porcelli, Cesare
AU - Rizzo, Renata
AU - Roessner, Veit
AU - Schwarz, Markus
AU - Tarnok, Zsanett
AU - Walitza, Susanne
AU - Dietrich, Andrea
AU - Hoekstra, Pieter J.
N1 - Publisher Copyright:
Copyright © 2022 American Academy of Neurology.
PY - 2022/3/15
Y1 - 2022/3/15
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85127908247&partnerID=8YFLogxK
U2 - 10.1212/WNL.0000000000013298
DO - 10.1212/WNL.0000000000013298
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C2 - 35110379
AN - SCOPUS:85127908247
SN - 0028-3878
VL - 98
SP - E1175-E1183
JO - Neurology
JF - Neurology
IS - 11
ER -