Effect of Early and Prophylactic Nonsteroidal Anti-Inflammatory Drugs on Flare Duration in Pediatric Acute-Onset Neuropsychiatric Syndrome: An Observational Study of Patients Followed by an Academic Community-Based Pediatric Acute-Onset Neuropsychiatric Syndrome Clinic

Abstract

NSAIDs given prophylactically or within 30 days of flare onset may shorten neuropsychiatric symptom duration in patients with new-onset and relapsing/remitting PANS and PANDAS. A randomized placebo-control clinical trial of NSAIDs in PANS is warranted to formally assess treatment efficacy.

Alterations in the Nervous System and Gut Microbiota after β-Hemolytic Streptococcus Group A Infection—Characteristics and Diagnostic Criteria of PANDAS Recognition

“…Treatment of PANDAS is to a large extent restricted to its severity including symptoms, exacerbations, and trajectory [79]. PANDAS treatment therapy mainly includes psychoactive drugs, immunotherapeutics with steroids, antibiotics, plasmapheresis as well as intravenous immunoglobins [80,[185][186][187][188]. With regard to the proper treatment of PANDAS, it should be considered that the application of penicillin or other antibiotics alone does not constitute the only way of treatment of this disease [171].…”

Clinical Management of Pediatric Acute-Onset Neuropsychiatric Syndrome: Part II—Use of Immunomodulatory Therapies

“…If symptoms continue beyond 2 weeks (especially if the symptoms are worsening and/or impairing function), oral nonsteroidal antiinflammatory drugs (NSAIDs) may be helpful, as tolerated (Table 3 and Appendix Table A1) (Brown et al 2017b;Spartz et al 2017). Although the therapeutic mechanisms in PANS are presumed to be Application of corticosteroids late into the disease often requires higher dosing and/or more prolonged tapers.…”

Commentary: Neurobiology and Therapeutic Potential of Cyclooxygenase-2 (COX-2) Inhibitors for Inflammation in Neuropsychiatric Disorders

“…Clinical practice guidelines for the treatment of children with pediatric acute-onset neuropsychiatric syndrome (PANS) and pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (PANDAS) recommend the use of naproxen before celecoxib because of its "greater potency" (35), despite clinical studies showing benefit of adjunctive celecoxib in OCD (36,37) and pre-clinical data demonstrating celecoxibmediated enhancement of the serotonergic effects of fluoxetine in a rat model of anxiety (38). Moreover, observational studies have focused on NSAIDs as a class in children with PANS/PANDAS (39,40). Given the significance of different COX isoforms and their unknown relative "potencies" in the CNS, careful attention must be given to selection and evaluation of specific NSAIDs.…”