Clinical Evaluation of Youth with Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS): Recommendations from the 2013 PANS Consensus Conference

Chang, Kiki; Frankovich, Jennifer; Cooperstock, Michael; Cunningham, Madeleine W.; Latimer, Maya; Murphy, Tanya K.; Pasternack, Mark S.; Thienemann, Margo; Williams, Kyle; Walter, Jolán E.; Swedo, Susan E.

doi:10.1089/cap.2014.0084

Cited by 252 publications

(244 citation statements)

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“…Steps should be taken to evaluate for underlying infections and inflammatory illnesses per guidelines established by the 2013 PANS Consensus Conference (Chang et al 2015). Caregivers may seek evaluation of PANS and/or PANDAS, but not all of these cases will meet the full PANS and PANDAS criteria requiring that symptoms develop and reach maximum intensity over a 24-36 hour period.…”

Section: Clinical Significancementioning

confidence: 99%

Multidisciplinary Clinic Dedicated to Treating Youth with Pediatric Acute-Onset Neuropsychiatric Syndrome: Presenting Characteristics of the First 47 Consecutive Patients

Frankovich

Thienemann

Pearlstein

et al. 2015

Journal of Child and Adolescent Psychopharmacology

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Background: Abrupt, dramatic onset obsessive-compulsive disorder (OCD) and/or eating restriction with at least two coinciding symptoms (anxiety, mood dysregulation, irritability/aggression/oppositionality, behavioral regression, cognitive deterioration, sensory or motor abnormalities, or somatic symptoms) defines pediatric acute-onset neuropsychiatric syndrome (PANS). Descriptions of clinical data in such youth are limited. Methods: We reviewed charts of 53 consecutive patients evaluated in our PANS Clinic; 47 met PANS symptom criteria but not all met the requirement for ''acute onset.'' Patients meeting full criteria for PANS were compared with patients who had a subacute/insidious onset of symptoms. Results: Nineteen of 47 (40%) patients in the study had acute onset of symptoms. In these patients, autoimmune/inflammatory diseases and psychiatric disorders were common in first-degree family members (71% and 78%, respectively). Most acuteonset patients had a relapsing/remitting course (84%), prominent sleep disturbances (84%), urinary issues (58%), sensory amplification (66%), gastrointestinal symptoms (42%), and generalized pain (68%). Inflammatory back pain (21%) and other arthritis conditions (28%) were also common. Suicidal and homicidal thoughts and gestures were common (44% and 17%, respectively) as were violent outbursts (61%). Group A streptococcus (GAS) was the most commonly identified infection at onset (21%) and during flares (74%). Rates of the abovementioned characteristics did not differ between the acute-onset group and the subacute/insidious-onset groups. Low levels of immunoglobulins were more common in the subacute/insidious-onset group (75%) compared with the acute-onset group (22%), but this was not statistically significant ( p = 0.06). Conclusions: In our PANS clinic, 40% of patients had acute onset of symptoms. However, those with and without acute onset of symptoms had similar symptom presentation, rates of inflammatory conditions, somatic symptoms, and violent thoughts and behaviors. GAS infections were the most commonly identified infection at onset and at symptom flares. Because of the wide variety of medical and psychiatric symptoms, youth with PANS may require a multidisciplinary team for adequate care management.

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Section: Clinical Significancementioning

confidence: 99%

Multidisciplinary Clinic Dedicated to Treating Youth with Pediatric Acute-Onset Neuropsychiatric Syndrome: Presenting Characteristics of the First 47 Consecutive Patients

Frankovich

Thienemann

Pearlstein

et al. 2015

Journal of Child and Adolescent Psychopharmacology

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“…23 Sleep complaints are reported to affect as many as 84% of children with PANS, and include initial, middle, and/or terminal insomnia and various parasomnias. 23,24 However, there is a complete lack of data from polysomnographic studies in this population. 24 With this case series, we describe observed polysomnographic abnormalities that may contribute to the symptomatology or illuminate underlying mechanisms involved in the syndrome's etiologies.…”

Section: Brief Summarymentioning

confidence: 99%

Rapid Eye Movement Sleep Abnormalities in Children with Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS)

Gaughan

Buckley

Hommer

et al. 2016

Journal of Clinical Sleep Medicine

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Study Objectives: Polysomnographic investigation of sleep architecture in children presenting with pediatric acute-onset neuropsychiatric syndrome (PANS). Methods: Fifteen consecutive subjects meeting criteria for PANS (mean age = 7.2 y; range 3-10 y) underwent single-night full polysomnography (PSG) read by a pediatric neurologist. Results: Thirteen of 15 subjects (87%) had abnormalities detected with PSG. Twelve of 15 had evidence of rapid eye movement (REM) sleep motor disinhibition, as characterized by excessive movement, laughing, hand stereotypies, moaning, or the continuation of periodic limb movements during sleep (PLMS) into REM sleep. Conclusions: This study shows various forms of REM sleep motor disinhibition present in a population of children with PANS. Keywords: obsessive compulsive disorder, PANS, polysomnography, REM sleep behavior disorder Citation: Gaughan T, Buckley A, Hommer R, Grant P; Williams K, Leckman JF, Swedo SE. Rapid eye movement sleep abnormalities in children with pediatric acute-onset neuropsychiatric syndrome (PANS). J Clin Sleep Med 2016;12(7):1027-1032. I NTRO DUCTI O N Schenck et al.1 were the first to suggest that rapid eye movement (REM) sleep neurobehavioral disorders were a separate category of parasomnia in a 1986 case series of four males aged 67-72 y. Polysomnography (PSG) of these four subjects showed a loss of chin atonia and high limb-twitch activity among other REM sleep pathology, whereas videography showed various REM sleep behaviors including punching, kicking, and dream enactment.1 Since then, REM sleep behavior disorder (RBD) has been recognized across a wide range of ages, sometimes decades prior to the onset of other neurobehavioral changes and often heralding serious neurodegenerative conditions affecting synuclein.2 A recent retrospective study of patients showing REM sleep without atonia on PSG found a majority (73%) of patients had idiopathic RBD, defined as RBD in the absence of known neurological or sleep disorders.3 Recent reports suggest that clinical and subclinical forms of RBD occur in children and adolescents.4 Although pediatric RBD is considered to be a rare occurrence, its prevalence may be underestimated due to limited awareness, overlap with other parasomnias, and the requirement of nocturnal PSG for diagnosis.4,5 Additionally, it is unclear whether or not the adult clinical definitions should pertain to pediatric presentations due to a current lack of neuropathologic studies of childhood RBD.4 Differentiating RBD from other parasomnias in the younger population is significant clinically because of the potential to inform on neuropsychiatric state and therefore guide treatment choices, as evidenced in conditions such as narcolepsy where 60% of patients will have RBD. In adult psychiatric populations, RBD has been associated with the use of psychotropic medications and particularly with serotonin reuptake-blocking antidepressants.3,7 However, a recent study suggests that antidepressants cannot fully explain RBD symptomatology in their psychiat...

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“…Support for the role of infectious agents in childhood psychiatric disorders has come from research into both Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS) and Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) [9][10][11]. The former is felt to be associated with a previous Group A Beta Hemolytic Streptococcal infection while the latter has a non-streptococcal trigger, whether infectious, environmental, or metabolic, that creates a misdirected immune response.…”

Section: Introductionmentioning

confidence: 99%

Infections and Childhood Psychiatric Disorders: Tick-Borne Illness and Bipolar Disorder in Youth

Greenberg¹

2017

Bipolar Disord

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Objective: To explore possible links between tick-borne illness (TBI) and pediatric bipolar disorder (PBD) in a retrospective series of youth from a Northeast U.S. psychiatric private practice.Methods: PBD diagnosis in 27 youth (15 Bipolar I and 12 Bipolar II) was based on DSM-IV TR criteria following interviews with parents and children, questionnaires and school reports. Testing for Borrelia burgdorferi (Lyme disease), Babesia, Bartonella, Mycoplasma pneumoniae, Anaplasma and Ehrlichia occurred between February 2013 and July 2015. Lyme testing included an ELISA and Western Blot IgM/IgG and cultures; Babesia and Bartonella were ascertained by IgM/IgG antibody titers and fluorescent in-situ hybridization (FISH) tests. Other pathogen exposure was determined by IgM/IgG antibody titers. Testing was performed at LabCorp, Mayo Medical, IgeneX, Advanced Labs and/or Galaxy Diagnostics Laboratories. Clinical diagnoses were confirmed by physicians familiar with TBI. Data was summarized using descriptive statistics.Results: Eighty-one percent of the sample was male and 19% was female. Mean age at PBD diagnosis was 7.3 years. Exposure to one or more pathogens was found in 24/27 (89%) of the patients. Frequency of positive serology included: Babesia (n=16), Mycoplasma pneumoniae (n=11), Bartonella (N=8), and Lyme (n=6). Twenty-two of these 24 agreed to clinical evaluation and 92% (20/22) were diagnosed with TBI. Conclusion:The high rate of TBI in PBD patients presented here is provocative. If confirmed, this association may suggest gene-environment interactions and has implications for the prevention and treatment of PBD. Research evaluating TBI in bipolar cases vs. matched controls with other psychopathology and without psychiatric disease using standardized serological testing is needed.

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Clinical Evaluation of Youth with Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS): Recommendations from the 2013 PANS Consensus Conference

Cited by 252 publications

References 43 publications

Multidisciplinary Clinic Dedicated to Treating Youth with Pediatric Acute-Onset Neuropsychiatric Syndrome: Presenting Characteristics of the First 47 Consecutive Patients

Multidisciplinary Clinic Dedicated to Treating Youth with Pediatric Acute-Onset Neuropsychiatric Syndrome: Presenting Characteristics of the First 47 Consecutive Patients

Rapid Eye Movement Sleep Abnormalities in Children with Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS)

Infections and Childhood Psychiatric Disorders: Tick-Borne Illness and Bipolar Disorder in Youth

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