PANDAS

1. PANDAS: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections.

2. Common in the West but quite rare in our practice. Reasons: (i) acute condition, most acute cases are referred, treated and discharged. A week or 2 later patients developed neuropsychiatric disorders, waxing and waning with subsequent reinfection  (ii) diagnosis is controversial; not classified in DSM/ICD (iii) temporal relationship between beta hemolytic strep infection and neuropsychiatric manifestation is unclear.

3. Childhood-onset neuropsychiatric disorder is widely used to describe a disorder caused by antineuronal antibodies which appear to arise in response to group A [beta]-hemolytic streptococcal (GABHS) infections and to cross-react with cells within the central nervous system (CNS).

4. Based on clinical observations of children with Sydenham’s chorea, Tourette’s syndrome (TS), and/or obsessive-compulsive disorder (OCD), scientists hypothesize that neuroimmunological dysfunction secondary to anti-neuronal antibodies may result in behavioral disturbances, such as:

-anxiety,

-emotional lability,

-obsessive-compulsive symptoms,

-hyperactivity, and inattention,

-sleep disturbances; and

-neurological abnormalities, such as motor and phonic tics, ballismus, chorea, and choreiform movements.

4. Unlike Rheumatic Fever, treatment using antibiotic prophylaxis is inconclusive. Symptomatic treatment for tics and OCD is warranted.