What every psychiatrist should know about PANDAS: a review

Abstract

The term Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus infections (PANDAS) was coined by Swedo et al. in 1998 to describe a subset of childhood obsessive-compulsive disorders (OCD) and tic disorders triggered by group-A beta-hemolytic Streptococcus pyogenes infection. Like adult OCD, PANDAS is associated with basal ganglia dysfunction. Other putative pathogenetic mechanisms of PANDAS include molecular mimicry and autoimmune-mediated altered neuronal signaling, involving calcium-calmodulin dependent protein (CaM) kinase II activity. Nonetheless the contrasting results from numerous studies provide no consensus on whether PANDAS should be considered as a specific nosological entity or simply a useful research framework. Herein we discuss available data that could provide insight into pathophysiology of adult OCD, or might explain cases of treatment-resistance. We also review the latest research findings on diagnostic and treatment.

Behavioral and neural effects of intra-striatal infusion of anti-streptococcal antibodies in rats

“…Dysfunction of the dopaminergic system has been implicated in motor disturbances (e.g., Parkinson’s disease, Huntington’s disease, and Alzheimer’s disease (Jahanshahi et al, 2013; Michel et al, 2013; Reeves et al, 2010) as well as in OCD (Denys et al, 2004; Hesse et al, 2005; Nikolaus et al, 2010; Olver et al, 2009), and dysfunction of the serotonergic system has been implicated in OCD and anxiety disorders (Flaisher-Grinberg et al, 2008; Hesse et al, 2005; Hesse et al, 2011; Nikolaus et al, 2010; Perani et al, 2008). Dopaminergic and serotonergic drugs are used to treat motor and psychiatric symptoms, respectively, in patients affected by GAS-related neuropsychiatric disorders (Demiroren et al, 2007; Gabbay and Coffey, 2003; Moretti et al, 2008; Murphy et al, 2010; Swedo and Grant, 2005; Swedo et al, 1993). Finally, immunoreactivity to different components of the serotonergic system, such as serotonin and serotonin receptors, has been reported in sera from panic disorder and rheumatoid arthritis patients (Coplan et al, 1999; Maes et al, 2013; Schott et al, 2003; Tanaka et al, 2003), and sera from SC and PANDAS patients reacted with D1 and D2 receptors (Brimberg et al, 2012; Cox et al, 2013; Dale et al, 2012).…”

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection (PANDAS): a Controversial Diagnosis

“…This pattern helps to differentiate PANDAS from other forms of tics/TS, and from OCD, which usually have a gradual symptom onset. However, the sudden onset should not be considered a unique feature and may fail to distinguish PANDAS from other movement disorders, because up to 53% of TS patients report the same pattern of onset and course [7][8][9].…”

“…The presence of comorbidities limits the discriminating specificity of the diagnostic criteria, but the presence of comorbidities is very common in childhood neuropsychiatric disorders [9].…”

PANDAS Hypothesis

“…Çalışmaların çoğunda Sydenham koreli hastalarda patolojik manyetik rezonans görüntüleme (MRG) değişikliği gözlenmemiştir (21) . Bunun yanında Sydenham koreli hastalar ile PANDAS tanılı hastalarda nucleus caudatus, putamen ve globus pallidus boyutlarının kontrol gruplarına göre daha büyük olduğunun gösterildiği çalışma-lar da vardır (22,23).…”