Pediatric autoimmune neuropsychiatric disorders associated with streptococci (PANDAS): update

@article{Shulman2009PediatricAN,
  title={Pediatric autoimmune neuropsychiatric disorders associated with streptococci (PANDAS): update},
  author={Stanford T. Shulman},
  journal={Current Opinion in Pediatrics},
  year={2009},
  volume={21},
  pages={127–130}
}
  • S. Shulman
  • Published 1 February 2009
  • Medicine
  • Current Opinion in Pediatrics
Purpose of review To review recent developments related to the proposed entity Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococci (so-called ‘PANDAS’). Recent findings The relationship between obsessive–compulsive disorder (OCD) or tics/Tourette's syndrome in childhood to antecedent group A streptococci (GAS) is unclear. One recent prospective cohort study found that more than 85% of clinical exacerbations in OCD/tic behavior in patients who met criteria for PANDAS had… Expand
From Research Subgroup to Clinical Syndrome: Modifying the PANDAS Criteria to Describe PANS (Pediatric Acute-onset Neuropsychiatric
TLDR
Modifying the PANDAS criteria to eliminate etiologic factors and to clarify the initial clinical presentation produced three potential diagnostic criteria for PANS, which are discussed in detail. Expand
The evaluation of a relationship between group A streptococcal infection with tic disorders in children.
TLDR
The relationship between pediatric autoimmune neuropsychiatric disorders associated with streptococci (PANDAS) in childhood to antecedent GABHS remains elusive and further studies are required to revise the boundaries of PANDAS, develop psychometrically reliable and valid diagnostic strategies, and institute appropriate management. Expand
Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections.
TLDR
Evidence does not support a recommendation for long-term antibiotic prophylaxis or immunomodulatory therapy in children with PANDAS, and based on only a few studies, positive results have been found using antibiotic proPHylaxis and immunomODulatory therapy. Expand
Moving from PANDAS to CANS.
TLDR
A broader concept of childhood acute neuropsychiatric symptoms (CANS) is proposed, which requires a comprehensive history and examination, consideration of a differential diagnosis, an active search for a specific etiology through appropriate laboratory testing, and treatment with the most appropriate therapy. Expand
Streptococcal upper respiratory tract infections and exacerbations of tic and obsessive-compulsive symptoms: a prospective longitudinal study.
TLDR
This study provides no evidence for a temporal association between GABHS infections and tic/OC symptom exacerbations in children who meet the published PANDAS diagnostic criteria. Expand
Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus Immunology
TLDR
Patients diagnosed with PANDAS appear to maintain significantly different concentrations of cytokines when compared with patients afflicted by chronic group A beta hemolytic streptococcus infections and obstructive sleep apnea, which could be a basis for future mechanistic and epidemiological studies. Expand
Characterization of B-Cells in tonsils of patients diagnosed with pediatric autoimmune neuropsychiatric disorder associated streptococcus.
TLDR
In this prospective cohort study, it appears that PANDAS patients do not demonstrate increased number of B-Cells, expression ofB-Cell Activating Factor or B- Cell Activating Receptor when compared to Group A Streptococcus or Obstructive Sleep Apnea cohorts. Expand
Group A β-hemolytic Streptococcal Infection in Children and the Resultant Neuro-psychiatric Disorder; a Cross Sectional Study; Tehran, Iran
TLDR
Findings support that a post infectious immune mechanism to GABHS may play a role in the pathogenesis of PANDAS in children in Iran. Expand
Evaluation of Basal Ganglia and Thalamic Inflammation in Children With Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infection and Tourette Syndrome
TLDR
Binding potential values, suggesting underlying activated microglia-mediated neuroinflammation, were found to be increased in bilateral caudate and bilateral lentiform nucleus in the PANDAS and Tourette syndrome group, compared to control group. Expand
Immune-mediated animal models of Tourette syndrome
TLDR
Animal model studies based on immune and autoantibody findings in TS have demonstrated immunoglobulin (Ig) deposits and stereotypic movements and related behavioral disturbances reminiscent of TS following exposure to GAS, other activators of host anti-microbial responses, soluble immune mediators and anti-GAS or anti-neuronal antibodies. Expand
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Pediatric autoimmune neuropsychiatric disorders associated with streptococci (PANDAS).
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TLDR
It is possible that GAS infection may be but one of the many stressors that can exacerbate tic/Tourette’s or OCD in a subset of such patients and they were more likely to be treated with unjustified short-term to chronic antibiotic and/or immunomodulatory therapy. Expand
Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: clinical description of the first 50 cases.
TLDR
The working diagnostic criteria appear to accurately characterize a homogeneous patient group in which symptom exacerbations are triggered by GABHS infections. Expand
The pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) etiology for tics and obsessive-compulsive symptoms: hypothesis or entity? Practical considerations for the clinician.
TLDR
Until more definitive scientific proof is forthcoming, there seems to be insufficient evidence to support routine microbiologic or serologic testing for group A streptococcus in children who present with neuropsychiatric symptoms or the clinical use of antibiotic or immune-modifying therapies in such patients. Expand
The pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) subgroup: separating fact from fiction.
TLDR
Questions about the veracity of data presented in this issue of Pediatrics are raised and a brief literature review and clarification of the guidelines for management of a patient in the PANDAS subgroup are provided. Expand
Streptococcal Infection and Exacerbations of Childhood Tics and Obsessive-Compulsive Symptoms: A Prospective Blinded Cohort Study
TLDR
Patients who fit published criteria for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections seem to represent a subgroup of those with chronic tic disorders and obsessive-compulsive disorder who may be vulnerable to group A β-hemolytic strePTococcus infection as a precipitant of neuroPsychiatric symptom exacerbations. Expand
Serial Immune Markers Do Not Correlate With Clinical Exacerbations in Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections
TLDR
The failure of immune markers to correlate with clinical exacerbations in children with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections raises serious concerns about the viability of autoimmunity as a pathophysiological mechanism in this disorder. Expand
Anti‐basal ganglia antibodies in PANDAS
TLDR
ELISA measurements do not differentiate between PANDAS and controls, suggesting a lack of major antibody changes in this disorder, and further immunoblot analyses using a caudate supernatant fraction are required to completely exclude the possibility of minor antibody repertoire differences in PANDAs subjects. Expand
Therapeutic plasma exchange and intravenous immunoglobulin for obsessive-compulsive disorder and tic disorders in childhood
TLDR
Plasma exchange and IVIG were both effective in lessening of symptom severity for children with infection-triggered OCD and tic disorders. Expand
Striatal microinfusion of Tourette syndrome and PANDAS sera: Failure to induce behavioral changes
TLDR
No significant alterations in stereotypic behavior or movement were observed between the PANDAS, TS, or anti‐M5 protein and control groups, and suggest the need for further investigations to determine the validity of the model and of autoimmune‐mediated hypotheses for pediatric movement disorders. Expand
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