Pediatric acute-onset neuropsychiatric syndrome (PANS)

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Pediatric acute-onset neuropsychiatric syndrome (PANS) is a neuropsychiatric syndrome still under research, leading to rapid onset Obsessive-compulsive disorder (OCD) and/or tics in children and adolescents.[1][2][3] It may be either conntected to Group A streptococcal infections (PANDAS sub-group)[4][5] or caused by immunologic reactions[6] to other pathogens (PITANDS sub-group)[7][7][8][9][10][11] affecting the basal ganglia.[12][13] This portion of the brain is responsible for mediating cognition, emotion, and movement. Research into the etiology of obsessive-compulsive disorder has identified dysfunctions of the basal ganglia as a key factor for the onset of OCD.[14]

Signs and symptoms[edit]

According to Swedo, Leckman and Rose (2012, Pediatrics & Therapeutics), the criteria defining PANS will "undergo modifications and refinement as additional clinical and research experience is accrued".[9] The proposed criteria claims that children can be distinguished from traditional childhood onset OCD by the severity, abruptness and dramatic onset of symptoms.[9] According to Swedo, Leckman and Rose (2012), pediatric patients suffering from PANS would be identified by the following criteria:

  1. Abrupt, dramatic onset of obsessive-compulsive disorder or severely restricted food intake
  2. Concurrent presence of additional neuropsychiatric symptoms, with similarly severe and acute onset, from at least two of the following seven categories
    1. Anxiety
    2. Emotional lability and/or depression
    3. Irritability, aggression and/or severely oppositional behaviors
    4. Behavioral (developmental) regression
    5. Deterioration in school performance
    6. Sensory or motor abnormalities (e.g. dysgraphia or deterioration of handwriting)
    7. Somatic signs and symptoms, including sleep disturbances, enuresis or urinary frequency
  3. Symptoms are not better explained by a known neurologic or medical disorder, such as Sydenham's chorea, systemic lupus erythematosus, Tourette disorder or others.[9]

Differential diagnostics[edit]

As there are other conditions that may have similar presentation, diagnostic workup of individuals suspected of PANS should exclude Sydenham's chorea, lupus erythematosus, acute disseminated encephalomyelitis, and Tourette syndrome. Evidence of acute rheumatic fever would exclude a PANS classification.[9] Depending on neuropsychiatric symptoms, diagnostic tests may include magnetic resonance imaging (MRI), lumbar puncture, and electroencephalography (EEG).[9]


Treatment of OCD or Tourette possibly caused by PANS is generally the same as the standard therapies for OCD and Tourettes (symptomatic treatment).[15] It has, however, been observed that children with PANS appear to be unusually sensitive to the side-effects of SSRIs.[5][16] Treatment with antibiotics,[17][18] and immune-based therapeutic approaches are still considered as experimental.[5][19] Early and consequent treatment appears to be of importance to avoid chronification and lifelong persistence.[3][4][20]


  1. ^ NCT01617083 Antibiotic Treatment Trial for the PANDAS/PANS Phenotype (AZT)
  2. ^ "Univetsity of Buffalo School of Public Health". Retrieved 2012-11-13. 
  3. ^ a b Jeff Szymanski (February 27, 2012). "Can an infection suddenly cause OCD?". Harvard Health Publications. 
  4. ^ a b Moretti, Germana; Pasquini, Massimo; Mandarelli, Gabriele; Tarsitani, Lorenzo; Biondi, Massimo (2008). "What every psychiatrist should know about PANDAS: A review". Clinical Practice and Epidemiology in Mental Health 4: 13. doi:10.1186/1745-0179-4-13. PMC 2413218. PMID 18495013. 
  5. ^ a b c [full citation needed] [dead link]
  6. ^ Katherine E. Muir, et al.: "A Case Report of Obsessive-Compulsive Disorder Following Acute Disseminated Encephalomyelitis". Published online August 5, 2013 (doi: 10.1542/peds.2012-2876)
  7. ^ a b Rhee, Hanna; Cameron, Daniel (2012). "Lyme disease and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS): An overview". International Journal of General Medicine 5: 163–74. doi:10.2147/IJGM.S24212. PMC 3292400. PMID 22393303. 
  8. ^ Hurley, R. A.; Taber, K. H. (2008). "Acute and Chronic Lyme Disease: Controversies for Neuropsychiatry". Journal of Neuropsychiatry 20 (1): iv–6. doi:10.1176/appi.neuropsych.20.1.iv. PMID 18305280. 
  9. ^ a b c d e f Swedo, Susan E.; Leckman, James F.; Rose, Noel R. (2012). "From Research Subgroup to Clinical Syndrome: Modifying the PANDAS Criteria to Describe PANS (Pediatric Acute-onset Neuropsychiatric Syndrome)". Pediatrics & Therapeutics 2 (2): 1000113. doi:10.4172/2161-0665.1000113 (inactive 2014-03-23). 
  10. ^ "Pandas-pitand Spring 2011". 2011-04-09. Retrieved 2012-11-13. 
  11. ^ PITANDS Information – Janice Tona, Trudy Posner. "Pediatric Autoimmune Neuropsychiatric Disorders A New Frontier for Occupational Therapy Intervention". Retrieved 2012-11-13. 
  12. ^ N. Müller et al.: Mycoplasma pneumoniae infection and Tourette’s syndrome. In: Psychiatry Res., 2004 Dec 15, 129(2)
  13. ^ Souhel Najjar, Daniel M Pearlman, Kenneth Alper, et al.: "Neuroinflammation and psychiatric illness". Journal of Neuroinflammation 2013, 10:43 doi:10.1186/1742-2094-10-43
  14. ^ Nestadt, Gerald; Grados, Marco; Samuels, Jack F. (2010). "Genetics of Obsessive-Compulsive Disorder". Psychiatric Clinics of North America 33 (1): 141–58. doi:10.1016/j.psc.2009.11.001. PMC 2824902. PMID 20159344. 
  15. ^ Danielle Ung, Chelsea M Ale, Eric A Storch: "Optimal management of pediatric obsessive-compulsive disorder". In: Pediatric Health, Medicine and Therapeutics 2012:3 9–18.
  16. ^ Storch, Eric A.; Murphy, Tanya K.; Geffken, Gary R.; Mann, Giselle; Adkins, Jennifer; J. Merlo, Lisa; Duke, Danny; Munson, Melissa et al. (2006). "Cognitive-Behavioral Therapy for PANDAS-Related Obsessive-Compulsive Disorder: Findings from a Preliminary Waitlist Controlled Open Trial". Journal of the American Academy of Child & Adolescent Psychiatry 45 (10): 1171–8. doi:10.1097/01.chi.0000231973.43966.a0. PMID 17003662. 
  17. ^ Lisa A Snider, Lorraine Lougee, Marcia Slattery, Paul Grant, Susan Swedo: Antibiotic Prophylaxis with Azithromycin or Penicillin for Childhood-Onset Neurospychiatric Disorders. In: Biol Psychiatry, 2005, 57, S. 788–792
  18. ^ Demian Obregon, Ellisa Carla Parker-Athill, Jun Tan, and Tanya Murphy: "Psychotropic effects of antimicrobials and immune modulation by psychotropics: implications for neuroimmune disorders". Neuropsychiatry (London) . 2012 August ; 2(4): 331–343. doi:10.2217/npy.12.41.
  19. ^ Perlmutter, Susan J; Leitman, Susan F; Garvey, Marjorie A; Hamburger, Susan; Feldman, Elad; Leonard, Henrietta L; Swedo, Susan E (1999). "Therapeutic plasma exchange and intravenous immunoglobulin for obsessive-compulsive disorder and tic disorders in childhood". The Lancet 354 (9185): 1153–8. doi:10.1016/S0140-6736(98)12297-3. PMID 10513708. 
  20. ^ "International OCD Foundation Warns Infections May Trigger Some Mental Illness". International OCD Foundation. Retrieved 2012-11-13. 

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