Pediatric acute-onset neuropsychiatric syndrome

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Pediatric acute-onset neuropsychiatric syndrome

Pediatric acute-onset neuropsychiatric syndrome (PANS)[1] is a disorder characterized by the sudden onset of obsessive-compulsive (OCD) symptoms or eating restrictions, concomitant with acute behavioral deterioration and/or motor/sensory changes in at least two of seven domains.[1] Those domains are anxiety, emotional lability and/or depression, irritability, aggressive or oppositional behavior, academic decline, cognitive decline, and sleep disruption.[1] The diagnosis necessitates a course that follows a relapsing–remitting pattern. In the case of post-puberty chronicity residual symptoms and their severity increases.[2]

OCD and tic disorders are hypothesized to arise in a subset of children as a result of a post-streptococcal autoimmune process.[3][4][5] The earlier PANDAS hypothesis was unconfirmed and unsupported by data, and two new categories were proposed: PANS and CANS (childhood acute neuropsychiatric syndrome).[4][5] The CANS/PANS hypotheses include different possible mechanisms underlying acute-onset neuropsychiatric conditions.[4][5] PANDAS, PANS and CANS are the focus of clinical and laboratory research but remain unproven.[3][4][5]


PANS is an exclusively clinical diagnosis based on the exclusion of other disorders (exclusion diagnostics) and is characterized by symptoms typical of basal ganglia dysfunction and the results of altered functions of the inert part of the immune system.[medical citation needed] PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections) is basically PANS caused by streptococcal infection and has symptoms similar (but not equal) to PANS. However, the pathological mechanisms of PANDAS are still under research.[6]


  1. ^ a b c Chang K, Frankovich J, Cooperstock M, et al. (February 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. doi:10.1089/cap.2014.0084. PMC 4340805. PMID 25325534.
  2. ^ Swedo SE, Frankovich J, Murphy TK (September 2017). "Overview of Treatment of Pediatric Acute-Onset Neuropsychiatric Syndrome". J Child Adolesc Psychopharmacol. 27 (7): 562–565. doi:10.1089/cap.2017.0042. PMC 5610386. PMID 28722464.
  3. ^ a b Dale RC (December 2017). "Tics and Tourette: a clinical, pathophysiological and etiological review". Curr Opin Pediatr (Review). 29 (6): 665–673. doi:10.1097/MOP.0000000000000546. PMID 28915150.
  4. ^ a b c d Marazziti D, Mucci F, Fontenelle LF (July 2018). "Immune system and obsessive-compulsive disorder". Psychoneuroendocrinology (Review). 93: 39–44. doi:10.1016/j.psyneuen.2018.04.013. PMID 29689421.
  5. ^ a b c d Zibordi F, Zorzi G, Carecchio M, Nardocci N (March 2018). "CANS: Childhood acute neuropsychiatric syndromes". Eur J Paediatr Neurol (Review). 22 (2): 316–320. doi:10.1016/j.ejpn.2018.01.011. PMID 29398245.
  6. ^ Thienemann M, Murphy T, Leckman J, et al. (September 2017). "Clinical Management of Pediatric Acute-Onset Neuropsychiatric Syndrome: Part I-Psychiatric and Behavioral Interventions". J Child Adolesc Psychopharmacol (Review). 27 (7): 566–573. doi:10.1089/cap.2016.0145. PMC 5610394. PMID 28722481.

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