Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection (PANDAS) is the presence of Obsessive-Compulsive Disorder (OCD) and/or tic disorder at prepubertal age of onset with abrupt onset and relapsing-remitting symptom course. The defining features are a temporal association between symptom exacerbations and a Group-A beta-hemolytic streptococcal (GAS) infection. There are also neurological abnormalities during exacerbations (adventitious movements or motoric hyperactivity). PANDAS remains a somewhat controversial diagnosis.[1]
The NIMH Criteria (2004) propose the following:[2]
Pediatric acute-onset neuropsychiatric syndrome (PANS) is a condition defined by sudden onset of obsessive-compulsive symptoms and/or severe eating restrictions, along with at least two other cognitive, behavioural, or neurological symptoms. This diagnostic construct allows for identification of cases without clear evidence of autoimmune process, and is not restricted to streptococcal infection:[3]
2
or more additional neuropsychiatric symptoms with similarly severe and acute onset. These include:Unfortunately, detailed and consensus recommendations for the treatment of PANDAS remain lacking, and various treatments have been used (but have high risk for bias).[4] Some general treatment principles include: