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 connected to Group A streptococcal infections (PANDAS sub-group)[4][5] or[clarification needed] caused by immunologic reactions[6] to other pathogens (PITANDS sub-group)[7][7][8][9][10] affecting the basal ganglia.[11][12] 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.[13] A similar syndrome in adults is known as Post-inflammatory Brain Syndrome (PIBS).[14]

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.

Treatment[edit]

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]

References[edit]

  1. ^ Clinical trial number NCT01617083 for "Antibiotic Treatment Trial for the PANDAS/PANS Phenotype (AZT)" at ClinicalTrials.gov
  2. ^ "Univetsity of Buffalo School of Public Health". Sphhp.buffalo.edu. 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 http://intramural.nimh.nih.gov/pdn/web.htm[full citation needed]
  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. ^ "Pandas-pitand Spring 2011". Scribd.com. 2011-04-09. Retrieved 2012-11-13. 
  10. ^ PITANDS Information – Janice Tona, Trudy Posner. "Pediatric Autoimmune Neuropsychiatric Disorders A New Frontier for Occupational Therapy Intervention" (PDF). Retrieved 2012-11-13. 
  11. ^ N. Müller et al.: Mycoplasma pneumoniae infection and Tourette’s syndrome. In: Psychiatry Res., 2004 Dec 15, 129(2)
  12. ^ 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
  13. ^ 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. 
  14. ^ Alasdair Timothy Llewelyn Rathbone et al.: A review of the neuro- and systemic inflammatory responses in post concussion symptoms: Introduction of the ‘‘post-inflammatory brain syndrome’’ PIBS. In: Brain, Behavior, and Immunity 46 (2015) 1–16
  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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