From Research Subgroup to Clinical Syndrome: Modifying the PANDAS Criteria to Describe PANS (Pediatric Acute-onset Neuropsychiatric Syndrome)

Abstract

Despite continued debates about the role of Group A streptococcal infections in the etiopathogenesis of PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections), experts on both sides of the controversy agree that a subgroup of children with obsessive-compulsive disorder (OCD) have an unusually abrupt onset of symptoms, accompanied by a variety of comparably severe and acute neuropsychiatric symptoms. The acuity of symptom onset is the hallmark feature of their clinical presentation and the basis for the name proposed for an expanded clinical entity: Pediatric Acute-onset Neuropsychiatric Syndrome (PANS). Modifying the PANDAS criteria to eliminate etiologic factors and to clarify the initial clinical presentation produced three potential diagnostic criteria for PANS. These three criteria are discussed in detail. The article also proposes strategies for applying the PANS criteria in clinical settings and evaluating their validity and reliability through prospective research investigations.

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

“…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.…”

“…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.…”

Alzheimer’s Disease of the Immune System: A New Variant of Immune Deficiency

“…It was found that children with moderate to severe eczema had significantly lower antibody responses to pneumococcal vaccination compared to control subjects with recurrent upper respiratory infections (17% compared to 57%) [35]. It was also determined that early onset atopic dermatitis increased the risk of developing autoimmunity later in life, suggesting a common immunological determinant [36].…”

A Case Report of Obsessive-Compulsive Disorder Following Acute Disseminated Encephalomyelitis

“…The family gave a history of a subacute rather than an abrupt onset of symptoms, given that the OCD symptoms were not noticed during hospitalization. To fulfill the diagnostic criteria for PANS, 10 there should be an abrupt, dramatic onset of symptoms. There should also be concurrent presence of additional neuropsychiatric symptoms.…”

“…9 It is likely that the etiology of OCD is also multifactorial. The new clinical criteria developed for pediatric acute-onset neuropsychiatric syndrome (PANS) 10 address some of this etiologic heterogeneity by defining a distinct group of children who have an abrupt onset of OCD after either an infectious trigger or an environmental trigger.…”