Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus

Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus (PANDAS) Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus, commonly abbreviated as PANDAS, is a hypothesized disorder characterized by the sudden onset of obsessive-compulsive disorder (OCD) or tic disorders in children, following a streptococcal infection. This condition is thought to be a result of an autoimmune response to the infection, where the body's immune system mistakenly attacks healthy brain tissue.

Overview

PANDAS is part of a broader category of disorders known as Pediatric Acute-onset Neuropsychiatric Syndrome (PANS). The concept of PANDAS was first introduced in the late 1990s by Dr. Susan Swedo and her colleagues at the National Institute of Mental Health.

Symptoms

The primary symptoms of PANDAS include:

• Sudden onset of OCD symptoms
• Motor or vocal tics
• Anxiety
• Emotional lability or depression
• Behavioral regression
• Deterioration in school performance
• Sensory or motor abnormalities

Pathophysiology

The pathophysiology of PANDAS is not fully understood, but it is believed to involve an autoimmune mechanism. After a streptococcal infection, the immune system produces antibodies to fight the bacteria. In some children, these antibodies may cross-react with neuronal tissue in the brain, particularly in the basal ganglia, leading to the neuropsychiatric symptoms observed in PANDAS.

Diagnosis

The diagnosis of PANDAS is primarily clinical and based on the following criteria:

• Presence of OCD or tic disorder
• Pediatric onset (usually between 3 years and puberty)
• Episodic course of symptom severity
• Association with Group A beta-hemolytic streptococcal infection
• Association with neurological abnormalities (e.g., motor hyperactivity, choreiform movements)

Treatment

Treatment for PANDAS may include:

• Antibiotic therapy to treat the underlying streptococcal infection
• Immunomodulatory therapies such as intravenous immunoglobulin (IVIG) or plasmapheresis
• Cognitive-behavioral therapy (CBT) for OCD symptoms
• Medications such as selective serotonin reuptake inhibitors (SSRIs) for managing OCD

Controversy and Research

PANDAS remains a controversial diagnosis within the medical community. Some experts question the existence of PANDAS as a distinct clinical entity, while others advocate for its recognition and further research. Ongoing studies aim to better understand the immunological mechanisms involved and to develop more effective treatments.

See Also

• Pediatric Acute-onset Neuropsychiatric Syndrome (PANS)
• Obsessive-Compulsive Disorder
• Tic Disorders
• Autoimmune Disorders
• Swedo, S. E., et al. (1998). "Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: clinical description of the first 50 cases." *American Journal of Psychiatry*.
• Murphy, T. K., et al. (2010). "PANDAS: Basal ganglia encephalitis with obsessive-compulsive disorder and tics." *Pediatric Annals*.

NIH genetic and rare disease info

• NIH info on Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus

Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus is a rare disease.