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Adolescent Psychiatry

Editor-in-Chief

ISSN (Print): 2210-6766
ISSN (Online): 2210-6774

Perspective

PANDAS: Twenty-Five Years Later

Author(s): Federico Cardelle-Pérez* and María Ángeles Díaz-Caneja Greciano

Volume 14, Issue 2, 2024

Published on: 20 March, 2024

Page: [63 - 69] Pages: 7

DOI: 10.2174/0122106766298492240320044542

Price: $65

Abstract

Background: It has been 25 years since the definition of the concept of Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS). The abrupt onset of neuropsychiatric symptoms requires a comprehensive differential diagnosis involving complementary tests and optimal treatment selection.

Methods: This paper describes aspects related to the diagnosis and clinical management of PANDAS. A clinical perspective is developed starting from an example that meets the Swedo's criteria.

Discussion: A comprehensive approach, including interdisciplinary management and urgent evaluation of potential organic causes, is crucial for effective treatment. Treatment decisions should consider severity, symptoms, and available evidence. Collaboration with neuropediatric or neurological services is needed. ASLO/anti-DNase B and 25-OH-Vitamin D tests are valuable for atypical OCD/Tic presentations, always maintaining a broader organic screening.

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Allen, A.J., Leonard, H.L., Swedo, S.E. (1995). Case study: A new infection-triggered, autoimmune subtype of pediatric OCD and Tourette’s syndrome. J. Am. Acad. Child Adolesc. Psychiatry, 34(3), 307-311.

[http://dx.doi.org/10.1097/00004583-199503000-00015] [PMID: 7896671]
Chain, J.L., Alvarez, K., Mascaro-Blanco, A., Reim, S., Bentley, R., Hommer, R., Grant, P., Leckman, J.F., Kawikova, I., Williams, K., Stoner, J.A., Swedo, S.E., Cunningham, M.W. (2020). Autoantibody biomarkers for basal ganglia encephalitis in sydenham chorea and pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections. Front. Psychiatry, 11, 564.

[http://dx.doi.org/10.3389/fpsyt.2020.00564] [PMID: 32670106]
Chang, K., Frankovich, J., Cooperstock, M., Cunningham, M.W., Latimer, M.E., Murphy, T.K., Pasternack, M., Thienemann, M., Williams, K., Walter, J., Swedo, S.E. (2015). Clinical evaluation of youth with pediatric acute-onset neuropsychiatric syndrome (PANS): Recommendations from the 2013 PANS consensus conference. J. Child Adolesc. Psychopharmacol., 25(1), 3-13.

[http://dx.doi.org/10.1089/cap.2014.0084] [PMID: 25325534]
Cooperstock, M.S., Swedo, S.E., Pasternack, M.S., Murphy, T.K. (2017). Clinical management of pediatric acute-onset neuropsychiatric syndrome: Part III—treatment and prevention of infections. J. Child Adolesc. Psychopharmacol., 27(7), 594-606.

[http://dx.doi.org/10.1089/cap.2016.0151] [PMID: 36358106]
Swedo, E. (2012). From research subgroup to clinical syndrome: Modifying the PANDAS criteria to describe PANS (Pediatric Acute-onset Neuropsychiatric Syndrome). Pediatr. Ther., 02(02)

[http://dx.doi.org/10.4172/2161-0665.1000113]
Efe, A. (2022). SARS-CoV-2/COVID-19 associated pediatric acute-onset neuropsychiatric syndrome a case report of female twin adolescents. Psychiatry. Res. Case. Rep., 1(2), 100074.

[http://dx.doi.org/10.1016/j.psycr.2022.100074] [PMID: 36267397]
Frankovich, J., Swedo, S., Murphy, T., Dale, R.C., Agalliu, D., Williams, K., Daines, M., Hornig, M., Chugani, H., Sanger, T., Muscal, E., Pasternack, M., Cooperstock, M., Gans, H., Zhang, Y., Cunningham, M., Bernstein, G., Bromberg, R., Willett, T., Brown, K., Farhadian, B., Chang, K., Geller, D., Hernandez, J., Sherr, J., Shaw, R., Latimer, E., Leckman, J., Thienemann, M. (2017). Clinical management of pediatric acute-onset neuropsychiatric syndrome: Part II—use of immunomodulatory therapies. J. Child Adolesc. Psychopharmacol., 27(7), 574-593.

[http://dx.doi.org/10.1089/cap.2016.0148] [PMID: 36358107]
Hedderly, T., Malik, O. (2018). Childhood acute neuropsychiatric syndromes…furthering the discussion PANS and PANDAS. Eur. J. Paediatr. Neurol., 22(2), 223-224.

[http://dx.doi.org/10.1016/j.ejpn.2018.01.022] [PMID: 29447768]
Hyman, S.E. (2021). PANDAS: Too narrow a view of the neuroimmune landscape. Am. J. Psychiatry, 178(1), 5-7.

[http://dx.doi.org/10.1176/appi.ajp.2020.20111598] [PMID: 33384008]
Jaspers-Fayer, F., Han, S.H.J., Chan, E., McKenney, K., Simpson, A., Boyle, A., Ellwyn, R., Stewart, S.E. (2017). Prevalence of acute-onset subtypes in pediatric obsessive-compulsive disorder. J. Child Adolesc. Psychopharmacol., 27(4), 332-341.

[http://dx.doi.org/10.1089/cap.2016.0031] [PMID: 28121463]
Lepri, G., Rigante, D., Randone, B.S., Meini, A., Ferrari, A., Tarantino, G., Cunningham, M.W., Falcini, F. (2019). Clinical-serological characterization and treatment outcome of a large cohort of italian children with pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection and pediatric acute neuropsychiatric syndrome. J. Child Adolesc. Psychopharmacol., 29(8), 608-614.

[http://dx.doi.org/10.1089/cap.2018.0151] [PMID: 31140830]
Marazziti, D., Palermo, S., Arone, A., Massa, L., Parra, E., Simoncini, M. (2023). Obsessive-compulsive disorder, PANDAS, and tourette syndrome: Immuno-inflammatory disorders. Adv. Exp. Med. Biol., 1411, 275-300.

[http://dx.doi.org/10.1007/978-981-19-7376-5_13]
Orefici, G., Cardona, F., Cox, C.J., Cunningham, M.W. (2016). Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. PANDAS.
Pallanti, S., Di Ponzio, M. (2023). PANDAS/PANS in the COVID-19 age: Autoimmunity and epstein–barr virus reactivation as trigger agents? Children, 10(4), 648.

[http://dx.doi.org/10.3390/children10040648] [PMID: 37189896]
PANS PANDAS Working Group. (2023). PANS PANDAS UK working group statement, 24 February 2023. Available from: https://edm.parliament.uk/early-day-motion/60673/pans-pandas-uk-working-group-statement-24-february-2023
Pavone, P., Ceccarelli, M., Marino, S., Caruso, D., Falsaperla, R., Berretta, M., Rullo, E.V., Nunnari, G. (2021). SARS-CoV-2 related paediatric acute-onset neuropsychiatric syndrome. Lancet Child Adolesc. Health, 5(6), e19-e21.

[http://dx.doi.org/10.1016/S2352-4642(21)00135-8] [PMID: 33961798]
Pavone, P., Parano, E., Battaglia, C., Marino, S., Trifiletti, R.R., Marino, S.D., Falsaperla, R. (2020). Severe psychotic symptoms in youth with PANS/PANDAS: Case-series. J. Child Adolesc. Psychopharmacol., 30(9), 567-571.

[http://dx.doi.org/10.1089/cap.2020.0050] [PMID: 32700992]
Pfeiffer, H.C.V., Wickstrom, R., Skov, L., Sørensen, C.B., Sandvig, I., Gjone, I.H., Ygberg, S., de Visscher, C., Nordstrom, I.S., Herner, L.B., Hesselmark, E., Hedderly, T., Lim, M., Debes, N.M. (2021). Clinical guidance for diagnosis and management of suspected pediatric acute‐onset neuropsychiatric syndrome in the nordic countries. Acta Paediatr., 110(12), 3153-3160.

[http://dx.doi.org/10.1111/apa.15875] [PMID: 33848371]
Quagliariello, A., Chierico, D.F., Russo, A., Reddel, S., Conte, G., Lopetuso, L.R., Ianiro, G., Dallapiccola, B., Cardona, F., Gasbarrini, A., Putignani, L. (2018). Gut microbiota profiling and gut–brain crosstalk in children affected by pediatric acute-onset neuropsychiatric syndrome and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections. Front. Microbiol., 9, 675.

[http://dx.doi.org/10.3389/fmicb.2018.00675] [PMID: 29686658]
Shimasaki, C., Frye, R.E., Trifiletti, R., Cooperstock, M., Kaplan, G., Melamed, I., Greenberg, R., Katz, A., Fier, E., Kem, D., Traver, D., Dempsey, T., Latimer, M.E., Cross, A., Dunn, J.P., Bentley, R., Alvarez, K., Reim, S., Appleman, J. (2020). Evaluation of the cunningham panel™ in pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (PANDAS) and pediatric acute-onset neuropsychiatric syndrome (PANS): Changes in antineuronal antibody titers parallel changes in patient symptoms. J. Neuroimmunol., 339, 577138.

[http://dx.doi.org/10.1016/j.jneuroim.2019.577138] [PMID: 31884258]
Sigra, S., Hesselmark, E., Bejerot, S. (2018). Treatment of PANDAS and PANS: A systematic review. Neurosci. Biobehav. Rev., 86, 51-65.

[http://dx.doi.org/10.1016/j.neubiorev.2018.01.001] [PMID: 29309797]
Singer, H.S., Gilbert, D.L., Wolf, D.S., Mink, J.W., Kurlan, R. (2012). Moving from PANDAS to CANS. J. Pediatr., 160(5), 725-731.

[http://dx.doi.org/10.1016/j.jpeds.2011.11.040] [PMID: 22197466]
Swedo, S.E., Leonard, H.L., Garvey, M., Mittleman, B., Allen, A.J., Perlmutter, S., Dow, S., Zamkoff, J., Dubbert, B.K., Lougee, L. (1998). Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: Clinical description of the first 50 cases. Am. J. Psychiatry, 155(2), 264-271.

[http://dx.doi.org/10.1176/ajp.155.2.264] [PMID: 9464208]
Thienemann, M., Murphy, T., Leckman, J., Shaw, R., Williams, K., Kapphahn, C., Frankovich, J., Geller, D., Bernstein, G., Chang, K., Elia, J., Swedo, S. (2017). Clinical management of pediatric acute-onset neuropsychiatric syndrome: Part I—psychiatric and behavioral interventions. J. Child Adolesc. Psychopharmacol., 27(7), 566-573.

[http://dx.doi.org/10.1089/cap.2016.0145] [PMID: 28722481]
Vreeland, A., Thienemann, M., Cunningham, M., Muscal, E., Pittenger, C., Frankovich, J. (2023). Neuroinflammation in obsessive-compulsive disorder. Psychiatr. Clin. North Am., 46(1), 69-88.

[http://dx.doi.org/10.1016/j.psc.2022.11.004] [PMID: 36740356]
Wald, E.R., Eickhoff, J., Flood, G.E., Heinz, M.V., Liu, D., Agrawal, A., Morse, R.P., Raney, V.M., Veerapandiyan, A., Madan, J.C. (2023). Estimate of the incidence of PANDAS and PANS in 3 primary care populations. Front Pediatr., 11, 1170379.

[http://dx.doi.org/10.3389/fped.2023.1170379] [PMID: 37808558]
Wells, L., O’Hara, N., Frye, R.E., Hullavard, N., Smith, E. (2024). Folate receptor alpha autoantibodies in the pediatric acute-onset neuropsychiatric syndrome (PANS) and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) population. J. Pers. Med., 14(2), 166.

[http://dx.doi.org/10.3390/jpm14020166] [PMID: 38392599]
Xu, J., Liu, R.J., Fahey, S., Frick, L., Leckman, J., Vaccarino, F., Duman, R.S., Williams, K., Swedo, S., Pittenger, C. (2021). Antibodies from children with PANDAS bind specifically to striatal cholinergic interneurons and alter their activity. Am. J. Psychiatry, 178(1), 48-64.

[http://dx.doi.org/10.1176/appi.ajp.2020.19070698] [PMID: 32539528]
Zibordi, F., Zorzi, G., Carecchio, M., Nardocci, N. (2018). CANS: Childhood acute neuropsychiatric syndromes. Eur. J. Paediatr. Neurol., 22(2), 316-320.

[http://dx.doi.org/10.1016/j.ejpn.2018.01.011] [PMID: 29398245]

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