Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS)

Description

• Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) most commonly present as obsessive-compulsive disorder (OCD) and/or tic disorder developing abruptly or acutely worsening during or following a group A β-hemolytic Streptococcus (GABHS) infection.
• Proposed associations are GABHS pharyngitis or skin/soft tissue infection.
• Symptoms begin abruptly (hours) and peak by 24 to 48 hours.
• Symptoms include motor tics, vocal tics, obsessions and/or compulsions, anxiety attacks, separation anxiety, bed wetting, and hyperactivity.
• It remains unclear if PANDAS represent a true entity distinct from similar disorders in children.

Epidemiology

Incidence

• Unknown, thought to be rare
• Considered a subset of pediatric acute-onset neuropsychiatric syndrome (PANS); abrupt onset of OCD and associated symptoms not better explained by a known neuropsychiatric condition (1)
• GABHS infection likely accounts for a small proportion of antecedent exacerbations among patients meeting diagnostic criteria for PANS (1).

Etiology and Pathophysiology

• Unknown, several hypotheses
• Proposed “pseudoautoimmunity.” GABHS antibodies target brain tissue (basal ganglia) possibly causing OCD, tics, and other neuropsychiatric symptoms by suspected molecular mimicry (2)[C].
• Genetic factors (susceptible host) and environmental trigger (GABHS) (3)[B]

Risk Factors

• Streptococcal infection
• Tic disorder, Tourette syndrome, OCD
• More common in boys (3)[B]
• More common in children with family history of rheumatic fever (3)[B]