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. 2019 May;24(2):85-91.
doi: 10.1093/pch/pxy145. Epub 2018 Dec 9.

PANDAS/PANS in childhood: Controversies and evidence

Colin Wilbur  1   2 , Ari Bitnun  3   4 , Sefi Kronenberg  5   6 , Ronald M Laxer  4   7 , Deborah M Levy  4   7 , William J Logan  1   2   4 , Michelle Shouldice  4   8 , E Ann Yeh  1   2   4
Affiliations

PANDAS/PANS in childhood: Controversies and evidence

Colin Wilbur et al. Paediatr Child Health. 2019 May.

Abstract

Since first defined in 1998, paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) and its later, broader iteration, paediatric acute-onset neuropsychiatric syndrome (PANS), have garnered significant attention and controversy. The role of streptococcal infection in children with explosive onset obsessive-compulsive disorder and new onset tics, the natural history of this entity, and the role of symptomatic and disease-modifying therapies, including antibiotics, immunotherapy, and psychoactive drugs, are all issues that have yet to be definitively addressed. While definitive proof of the autoimmune hypothesis of PANDAS is lacking, given the heightened attention to this entity and apparent rise in use of this diagnostic category, addressing questions around diagnosis, treatment, and etiology is imperative. In this paper, we review current working definitions of PANDAS/PANS, discuss published evidence for interventions related to this entity, and propose a clinical approach to children presenting with acute symptoms satisfying criteria for PANDAS/PANS.

Keywords: Autoimmune; OCD; Paediatric; Psychiatric; Tics.

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Figures

Figure 1.
Figure 1.
Suggested algorithm for the evaluation of the child presenting with possible PANDAS/PANS. ANA Antinuclear antibody; ASOT Antistreptolysin O titre; CBC Complete blood count; CRP C-reactive protein; ESR Erythrocyte sedimentation rate; LFTs Liver function tests; OCD Obsessive/compulsive disorder; PANDAS Paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections; PANS Paediatric acute-onset neuropsychiatric syndrome.
See this image and copyright information in PMC

References

    1. Swedo SE, Leonard HL, Garvey M, et al. . Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: Clinical description of the first 50 cases. Am J Psychiatry 1998;155(2):264–71. - PubMed
    1. Orlovska S, Vestergaard CH, Bech BH, Nordentoft M, Vestergaard M, Benros ME. Association of streptococcal throat infection with mental disorders: Testing key aspects of the PANDAS hypothesis in a nationwide study. JAMA Psychiatry 2017;74(7):740–6. - PMC - PubMed
    1. Gabbay V, Coffey BJ, Babb JS, et al. . Pediatric autoimmune neuropsychiatric disorders associated with streptococcus: Comparison of diagnosis and treatment in the community and at a specialty clinic. Pediatrics 2008;122(2):273–8. - PMC - PubMed
    1. Helm CE, Blackwood RA. Pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS): Experience at a tertiary referral center. Tremor Other Hyperkinet Mov (N Y) 2015;5:270. - PMC - PubMed
    1. Swedo SE, Seidlitz J, Kovacevic M, et al. . Clinical presentation of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections in research and community settings. J Child Adolesc Psychopharmacol 2015;25(1):26–30. - PMC - PubMed