Clinical Features in Patients With PANDAS/PANS and Therapeutic Approaches: A Retrospective Study

Rea, Isabella; Guido, Cristiana Alessia; Spalice, Alberto

doi:10.3389/fneur.2021.741176

Cited by 9 publications

(17 citation statements)

References 30 publications

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“…Our data confirm that the PANS feature triggered by COVID-19 has symptoms largely overlapping with those reported in PANS triggered by different agents. It includes OCD and/or eating disorders, associated with a heterogeneous mixture of emotional, behavioral, and physical symptoms ( 14 ). Our data also suggest that treatment with oral prednisone is associated with a global improvement, in terms of functional impairment and clinical severity and with PANS specific symptoms ameliorating or resolution.…”

Section: Discussionmentioning

confidence: 99%

Steroid treatment response to post SARS-CoV-2 PANS symptoms: Case series

Berloffa

Salvati²,

Pantalone³

et al. 2023

Front. Neurol.

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BackgroundPediatric acute-onset neuropsychiatric syndrome (PANS) is characterized by a wide spectrum of symptoms, including the onset of obsessive-compulsive disorder and/or severely restricted food intake, associated with emotional symptoms, behavioral symptoms, developmental regression, and somatic symptoms. Among the possible triggering agents, infectious agents have been extensively explored. More recently, sporadic case reports describe a possible association between PANS and SARS-CoV-2 infection but data on clinical presentation and treatment are still scarce.MethodsWe describe a case series (10 children) with acute onset or relapse of PANS symptoms after SARS-CoV-2 infection. Standardized measures (CBCL, CPRS, C-GAS, CGI-S, Y-BOCS, PANSS, and YGTSS) were used to describe the clinical picture. The efficacy of a pulse treatment with steroids for three consecutive months was assessed.ResultsOur data suggest that the clinical presentation of the COVID-19-triggered PANS is largely similar to that reported in typical PANS, including acute onset, with OCD and/or eating disorders, and associated symptoms. Our data suggest that treatment with corticosteroids may be beneficial for both global clinical severity and global functioning. No serious adverse effects were observed. Both OCD symptoms and tics consistently improved. Among psychiatric symptoms, affective and oppositional symptoms appeared more sensitive to the steroid treatment than the other symptoms.ConclusionOur study confirms that COVID-19 infection in children and adolescents could trigger acute-onset neuropsychiatric symptoms. Thus, in children and adolescents with COVID-19, a specific neuropsychiatric follow-up should be routinely included. Even if a small sample size and a follow-up with only two points (baseline and endpoint, after 8 weeks) limit the conclusions, it seems that steroid treatment in the acute phase may be beneficial and well tolerated.

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Section: Discussionmentioning

confidence: 99%

Steroid treatment response to post SARS-CoV-2 PANS symptoms: Case series

Berloffa

Salvati²,

Pantalone³

et al. 2023

Front. Neurol.

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“…For children over four, the IQ score is made up of the following indices: Verbal Comprehension, Visual Spatial Fluid Reasoning, Working Memory, Processing Speed. 198–201 Notes : See: for PANS scale and C-GAS; 32 , 135 for YGTSS and CY-BOCS; 19 , 32 for USCRS 202 and; 203 for Wechsler scales, 18 and 83 . …”

Section: Results and Considerations Of Laboratory Testsmentioning

confidence: 99%

“… Notes : See: for PANS scale and C-GAS; 32 , 135 for YGTSS and CY-BOCS; 19 , 32 for USCRS 202 and; 203 for Wechsler scales, 18 and 83 . …”

Section: Results and Considerations Of Laboratory Testsmentioning

confidence: 99%

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Pediatric Acute-Onset Neuropsychiatric Syndrome: Current Perspectives

Gagliano¹,

Carta²,

Tanca³

et al. 2023

NDT

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Pediatric acute-onset neuropsychiatric syndrome (PANS) features a heterogeneous constellation of acute obsessive-compulsive disorder (OCD), eating restriction, cognitive, behavioral and/or affective symptoms, often followed by a chronic course with cognitive deterioration. An immune-mediated etiology is advocated in which the CNS is hit by different pathogen-driven (auto)immune responses. This narrative review focused on recent clinical (ie, diagnostic criteria, pre-existing neurodevelopmental disorders, neuroimaging) and pathophysiological (ie, CSF, serum, genetic and autoimmune findings) aspects of PANS. We also summarized recent points to facilitate practitioners with the disease management. Relevant literature was obtained from PubMed database which included only English-written, full-text clinical studies, case reports, and reviews. Among a total of 1005 articles, 205 were pertinent to study inclusion. Expert opinions are converging on PANS as the effect of post-infectious events or stressors leading to “brain inflammation”, as it is well-established for anti-neuronal psychosis. Interestingly, differentiating PANS from either autoimmune encephalitides and Sydenham’s chorea or from alleged “pure” psychiatric disorders (OCD, tics, Tourette’s syndrome), reveals several overlaps and more analogies than differences. Our review highlights the need for a comprehensive algorithm to help both patients during their acute distressing phase and physicians during their treatment decision. A full agreement on the hierarchy of each therapeutical intervention is missing owing to the limited number of randomized controlled trials. The current approach to PANS treatment emphasizes immunomodulation/anti-inflammatory treatments in association with both psychotropic and cognitive-behavioral therapies, while antibiotics are suggested when an active bacterial infection is established. A dimensional view, taking into account the multifactorial origin of psychiatric disorders, should suggest neuro-inflammation as a possible shared substrate of different psychiatric phenotypes. Hence, PANS and PANS-related disorders should be considered as a conceptual framework describing the etiological and phenotypical complexity of many psychiatric disorders.

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“…Inflammation is suggested to play a role in the pathophysiology of both PANS and POTS, although the purported immunological mechanisms are still unclear ( 7 , 8 ). Moreover, neuropsychiatric symptoms such as fatigue, anxiety, panic, fears, problems with concentration and memory, and sleep disturbance are common across these diagnoses ( 6 , 9 , 10 ). Almost 80% of Swedish children with PANS present anxiety at onset, and 43% present hyperactivity ( 11 ).…”

Section: Introductionmentioning

confidence: 99%

Joint Hypermobility in Paediatric Acute-Onset Neuropsychiatric Syndrome—A Preliminary Case-Control Study

et al. 2021

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Background: Individuals with generalised joint hypermobility (GJH, present in 10–20% of the general population) are at increased risk of being diagnosed with a range of psychiatric and rheumatological conditions. It is unknown whether Paediatric acute-onset neuropsychiatric syndrome (PANS), characterised by childhood onset obsessive-compulsive disorder or restricted eating and typically associated with several comorbid neuropsychiatric symptoms, is associated with GJH. It is also unknown whether extensive psychiatric comorbidity is associated with GJH.Method: This is a case-control study including 105 participants. We compared three groups: Individuals with PANS, individuals with other mental disorders and healthy controls. Joint mobility was assessed with the Beighton scoring system, psychiatric comorbidity with the M.I.N.I. or MINI-KID interview and symptoms of PANS with the PsychoNeuroInflammatory related Signs and Symptoms Inventory (PNISSI).Results: Hypermobility was similar across groups, and high rates of psychiatric comorbidity was not associated with higher Beighton scores.Conclusion: Although GJH is associated with several psychiatric conditions, such as ADHD and anxiety, this does not seem to be the case for PANS according to this preliminary study.

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Clinical Features in Patients With PANDAS/PANS and Therapeutic Approaches: A Retrospective Study

Cited by 9 publications

References 30 publications

Steroid treatment response to post SARS-CoV-2 PANS symptoms: Case series

Steroid treatment response to post SARS-CoV-2 PANS symptoms: Case series

Pediatric Acute-Onset Neuropsychiatric Syndrome: Current Perspectives

Joint Hypermobility in Paediatric Acute-Onset Neuropsychiatric Syndrome—A Preliminary Case-Control Study

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