Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection (PANDAS)

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).

The NIMH Criteria (2004) propose the following:[1]

  1. OCD or tic disorder
  2. Onset: age 3 to puberty
  3. Abrupt onset or exacerbating course
  4. Strep infection leading to onset/exacerbation of symptoms
  5. Neurological abnormalities

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:[2]

  1. Abrupt, dramatic onset of OCD or anorexia
  2. Concurrent presence of 2 or more additional neuropsychiatric symptoms with similarly severe and acute onset. These include:
    • Anxiety
    • Mood swings and depression
    • Aggression
    • Irritability and oppositional behaviors
    • Developmental regression
    • Sudden deterioration in school performance or learning abilities
    • Sensory and motor abnormalities
    • Somatic signs and symptoms
  3. Symptoms are unexplainable by a known neurologic or medical disorder