Anti-basal ganglia antibodies in primary obsessive–compulsive disorder: systematic review and meta-analysis

Autoimmune-mediated basal ganglia dysfunction is implicated in the pathophysiology of neuropsychiatric disorders commonly manifesting with obsessive-compulsive features (e.g. Sydenham chorea). The relationship between autoimmunity and primary obsessive-compulsive disorder (OCD), however, is less cle...

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Bibliographic Details
Published in:	British journal of psychiatry Vol. 205; no. 1; pp. 8 - 16
Main Authors:	Pearlman, Daniel M., Vora, Haily S., Marquis, Brian G., Najjar, Souhel, Dudley, Lauren A.
Format:	Journal Article
Language:	English
Published:	Cambridge, UK Cambridge University Press 01-07-2014 Maney
Subjects:	Adult and adolescent clinical studies Antibodies Antigens Anxiety disorders. Neuroses Attention deficit hyperactivity disorder Autoantibodies - immunology Autoimmunity Basal ganglia Basal Ganglia - immunology Bias Biological and medical sciences Brain research Cerebrospinal fluid Chorea Circumstantial evidence Comorbidity Encephalitis Humans Hyperactivity Immunoglobulins Medical sciences Mental disorders Meta-analysis Obsessive compulsive disorder Obsessive-Compulsive Disorder - immunology Obsessive-compulsive disorders Pathophysiology Psychiatry Psychology. Psychoanalysis. Psychiatry Psychopathology. Psychiatry Review Article Serum Systematic review Tourette syndrome Obsessive compulsive disorder Antibody Central nervous system Anxiety disorder Basal ganglion Review Encephalon Metaanalysis
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Summary:	Autoimmune-mediated basal ganglia dysfunction is implicated in the pathophysiology of neuropsychiatric disorders commonly manifesting with obsessive-compulsive features (e.g. Sydenham chorea). The relationship between autoimmunity and primary obsessive-compulsive disorder (OCD), however, is less clear. To pool data on serum and cerebrospinal fluid (CSF) anti-basal ganglia antibody (ABGA) positivity in primary OCD (without neurological or autoimmune comorbidity) relative to controls or neuropsychiatric disorders previously associated with increased odds of ABGA positivity. We performed electronic database and hand-searches for studies meeting pre-specified eligibility criteria from which we extracted data using a standardised form. We calculated pooled estimates of ABGA positivity using a random-effects model. Seven case-control studies totalling 844 participants met the eligibility criteria. Meta-analysis showed that a significantly greater proportion of those with primary OCD were ABGA seropositive compared with various controls (odds ratio (OR) = 4.97, 95% CI 2.88-8.55, P<0.00001). This effect was not associated with heterogeneity or publication bias, and remained significant after stratifying the analysis by age, gender, disease severity, illness duration, immunostaining methodology, study quality, publication type, kind of control group, and sample size. There were no significant differences in ABGA seropositivity for comparisons between primary OCD and Tourette syndrome, attention-deficit hyperactivity disorder or paediatric acute-onset neuropsychiatric syndrome. of one study testing CSF samples showed that a significantly greater proportion of participants with primary OCD were ABGA CSF-positive compared with healthy controls (OR = 5.60, 95% CI 1.04-30.20, P = 0.045). Odds of ABGA seropositivity are increased fivefold in primary OCD compared with controls, but are comparable to those associated with disorders previously associated with ABGA, providing circumstantial evidence of autoimmunity in a subset of those with primary OCD. Further experimental studies are needed to ascertain whether this relationship is causal.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 ObjectType-Review-4 content type line 23 ObjectType-Undefined-3
ISSN:	0007-1250 1472-1465
DOI:	10.1192/bjp.bp.113.137018