Pediatric autoimmune neuropsychiatric disorders associated with Streptococcus infections

How is PANDAS diagnosed?

A diagnosis of PANDAS is based on the presence of the following:

  • Obsessive-compulsive disorder or a tic disorder (i.e. Tourette syndrome)
  • Symptoms develop before age 12
  • Abrupt onset of symptoms and "episodic" course (relapses are separated by periods of time in which children have less severe or no symptoms)
  • Association with group A streptococcal infection (in some cases, the affected person has no obvious symptoms of a strep infection; however, a throat culture and/or blood tests may show evidence of a current or recent infection)
  • Association with other neuropsychiatric symptoms (i.e. separation anxiety, ADHD, developmental regression, etc)

There are currently no tests available to confirm a diagnosis of PANDAS.

Last updated on 05-01-20

What are the incidence and prevalence of PANDAS?

The incidence and prevalence of PANDAS are not known, although it is rare. In one prospective study, only 10 cases were identified among 30,000 throat cultures (1 in 3000) positive for group A streptococci (GAS). Since then, the annual incidence has ranged between 0 per 10,000 cultures to 10 per 30,000 cultures, depending upon the strain of GAS and other factors. Despite its rarity, some researchers suggest that it may account for ≥10% of childhood-onset obsessive-compulsive disorder (OCD) and tic disorders.

Last updated on 05-01-20

How might PANDAS be treated?

The treatment of PANDAS is symptomatic. Children who are diagnosed with a group A streptococcal infection are typically treated with antibiotics whether or not they develop symptoms of PANDAS. Obsessive-compulsive disorders are usually managed with medications (i.e. SSRI medications such as fluoxetine, fluvoxamine, sertaline, or paroxetine) and cognitive behavioral therapy. Tic disorders are often treated with a variety of medications, as well.

Some researchers suspect that therapies such as plasmapheresis and/or intravenous immunoglobulin (IVIG), which are often used to treat autoimmune disorders, may be a treatment option for children with PANDAS. Plasmapheresis is a procedure that removes antibodies from the blood. IVIG can sometimes be used to alter the function or production of abnormal antibodies. Although some studies have demonstrated that both of these therapies are effective for the treatment of severe, strep triggered OCD and tics, a number of the children in these studies experienced severe side-effects. Thus, these treatments are often reserved for severely affected children who do not respond to other therapies.

Last updated on 05-01-20

Healthcare Resources

Alliance to Solve PANS & Immune-Related Encephalopathies

The Alliance to Solve PANS & Immune-Related Encephalopathies (ASPIRE) has a Find a Provider directory which includes various types of specialists involved in the diagnosis and treatment of Pediatric autoimmune neuropsychiatric disorders associated with Streptococcus infections.

Last updated on 04-27-20

Selected Full-Text Journal Articles

Overview of Treatment of Pediatric Acute-Onset Neuropsychiatric Syndrome

Swedo SE, Frankovich J, Murphy TK. Overview of Treatment of Pediatric Acute- Onset Neuropsychiatric Syndrome. J Child Adolesc Psychopharmacol. 2017 Sep 1; 27(7): 562–565.

Last updated on 04-27-20

Clinical Management of Pediatric Acute-Onset Neuropsychiatric Syndrome: Part II—Use of Immunomodulatory Therapies

Francovich J, Swedo S, Murphy T, et al. Clinical Management of Pediatric Acute-Onset Neuropsychiatric Syndrome: Part II—Use of Immunomodulatory Therapies. J Child Adolesc Psychopharmacol. 2017 Sept;27(7).

Last updated on 04-27-20

Clinical Management of Pediatric Acute-Onset Neuropsychiatric Syndrome: Part I—Psychiatric and Behavioral Interventions

Thienemann M, Murphy T, Leckman J, et al. Clinical Management of Pediatric Acute-Onset Neuropsychiatric Syndrome: Part I—Psychiatric and Behavioral Interventions. J Child Adolesc Psychopharmacol. 2017 Sep 1; 27(7): 566–573.

Last updated on 04-27-20

Clinical Management of Pediatric Acute-Onset Neuropsychiatric Syndrome: Part III—Treatment and Prevention of Infections

Cooperstock MS, Swedo S, Pasternack MS, Murphy TK. Clinical Management of Pediatric Acute-Onset Neuropsychiatric Syndrome: Part III—Treatment and Prevention of Infections. J Child Adolesc Psychopharmacol. 2017 Sept;27(7).

Last updated on 04-27-20

Clinical evaluation of youth with pediatric acute-onset neuropsychiatric syndrome (PANS): recommendations from the 2013 PANS Consensus Conference

Chang K, Frankovich J, Cooperstock M, et al. Clinical evaluation of youth with pediatric acute-onset neuropsychiatric syndrome (PANS): recommendations from the 2013 PANS Consensus Conference. J Child Adolesc Psychopharmacol. 2015 Feb;25(1):3-13.

Last updated on 04-27-20

Where To Start

PANDAS Physicians Network

The PANDAS Physicians Network provides information about PANS and PANDAS.

Last updated on 04-27-20

International OCD Foundation

The International OCD Foundation website provides advice for practitioners and parents as well as a fact sheet about Pediatric autoimmune neuropsychiatric disorders associated with Streptococcus infections.

Last updated on 04-27-20

Name: American Autoimmune Related Diseases Association (AARDA) 22100 Gratiot Avenue
Eastpointe, MI, 48021, United States
Phone: 586-776-3900 Toll Free: 800-598-4668 Fax : 586-776-3903 Email: aarda@aarda.org Url: https://www.aarda.org/
Name: International OCD Foundation 18 Tremont Street, Suite 308
Boston, MA, 02108,
Phone: (617) 973-5801 Fax : (617) 973-5803 Email: info@iocdf.org Url: https://iocdf.org/
Name: Child Mind Institute 445 Park Avenue
New York, NY, 10022,
Phone: (212) 308-3118 Url: http://childmind.org/
Name: PANS Research Consortium Url: https://med.stanford.edu/pans/research/PANS-consortium.html
Name: PANDAS Physicians Network PPN 117 Eastbend Court
Mooresville, NC, 28117,
Toll Free: 855-347-4921 Fax : 1-800-641-7954 Email: support@pandasppn.org Url: https://www.pandasppn.org/parent-information/
Name: Pediatric Research and Advocacy Initiative PRAI P.O. BOX 2198
Chesterfield, VA, 23832,
Url: http://praikids.org/
Name: Alliance to Solve PANS & Immune-Related Encephalopathies ASPIRE Email: https://aspire.care/contact/ Url: https://aspire.care/

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