Topic
PANDAS
About: PANDAS is a research topic. Over the lifetime, 445 publications have been published within this topic receiving 16399 citations. The topic is also known as: Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections & Paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections.
Papers published on a yearly basis
Papers
TL;DR: The working diagnostic criteria appear to accurately characterize a homogeneous patient group in which symptom exacerbations are triggered by GABHS infections.
Abstract: Objective: The purpose of this study was to describe the clinical characteristics of a novel group of patients with obsessive-compulsive disorder (OCD) and tic disorders, designated as pediatric autoimmune neuropsychiatric disorders associated with streptococcal (group A β-hemolytic streptococcal [GABHS]) infections (PANDAS). Method: The authors conducted a systematic clinical evaluation of 50 children who met all of the following five working diagnostic criteria: presence of OCD and/or a tic disorder, prepubertal symptom onset, episodic course of symptom severity, association with GABHS infections, and association with neurological abnormalities. Results: The children’s symptom onset was acute and dramatic, typically triggered by GABHS infections at a very early age (mean=6.3 years, SD=2.7, for tics; mean=7.4 years, SD=2.7, for OCD). The PANDAS clinical course was characterized by a relapsing-remitting symptom pattern with significant psychiatric comorbidity accompanying the exacerbations; emotional lability, separation anxiety, nighttime fears and bedtime rituals, cognitive deficits, oppositional behaviors, and motoric hyperactivity were particularly common. Symptom onset was triggered by GABHS infection for 22 (44%) of the children and by pharyngitis (no throat culture obtained) for 14 others (28%). Among the 50 children, there were 144 separate episodes of symptom exacerbation; 45 (31%) were associated with documented GABHS infection, 60 (42%) with symptoms of pharyngitis or upper respiratory infection (no throat culture obtained), and six (4%) with GABHS exposure. Conclusions: The working diagnostic criteria appear to accurately characterize a homogeneous patient group in which symptom exacerbations are triggered by GABHS infections. The identification of such a subgroup will allow for testing of models of pathogenesis, as well as the development of novel treatment and prevention strategies. (Am J Psychiatry 1998; 155:264‐271)
1,498 citations
TL;DR: In rheumatic chorea the presence of anti-neuronal antibody appeared to correlate with severity and duration of clinical attacks, and appeared to represent cross-reaction with antigens shared by Group A streptococcal membranes.
Abstract: 46% of sera from 30 children with rheumatic chorea showed IgG antibody reacting with neuronal cytoplasm of human caudate and subthalamic nuclei. The antibody was also detected in 14% of 50 children with active rheumatic carditis. 55 normal control sera, as well as 148 sera from a broad variety of other disease states showed a low prevalence (1.8-4.0%) of positive reactions. In rheumatic chorea the presence of anti-neuronal antibody appeared to correlate with severity and duration of clinical attacks. Antibody reacting with neuronal cytoplasm was completely removed by absorption with Group A streptococcal membranes or with isolated human neurons from caudate nucleus. Partial absorption of antibody was also recorded using Group A cell wall preparations but not with Group A carbohydrate. No absorption of positive reactions was seen with streptococcal Group D membranes or cell walls. In rheumatic chorea, anti-neuronal antibody appeared to represent cross-reaction with antigens shared by Group A streptococcal membranes.
544 citations
TL;DR: The 20-item Leyton Obsessional Inventory--Child Version was completed by children and adolescents who had had Sydenham's chorea or rheumatic fever without chorea and suggests that obsessive-compulsive disorder, at least in some patients, may be due to basal ganglia dysfunction.
Abstract: The 20-item Leyton Obsessional Inventory--Child Version was completed by children and adolescents who had had Sydenham's chorea (N = 23) or rheumatic fever without chorea (N = 14). The Sydenham's chorea subjects had significantly more obsessive thoughts and compulsive behaviors and significantly greater interference from these behaviors. Three Sydenham's chorea patients but no rheumatic fever patients had substantial obsessional interference and met criteria for obsessive-compulsive disorder when interviewed by telephone. This suggests that obsessive-compulsive disorder, at least in some patients, may be due to basal ganglia dysfunction.
438 citations
TL;DR: Modifying the PANDAS criteria to eliminate etiologic factors and to clarify the initial clinical presentation produced three potential diagnostic criteria for PANS, which are discussed in detail.
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.
371 citations
TL;DR: The hypothesis is that infections with group A beta-hemolytic streptococci, among others, may trigger autoimmune responses that cause or exacerbate some cases of childhood-onset obsessive-compulsive disorder (OCD) or tic disorders (including Tourette's syndrome).
Abstract: A review of clinical observations and literature reports leads to the hypothesis that, via a process analogous to Sydenham's chorea, infections with group A beta-hemolytic streptococci, among others, may trigger autoimmune responses that cause or exacerbate some cases of childhood-onset obsessive-compulsive disorder (OCD) or tic disorders (including Tourette's syndrome). If this hypothesis is correct, then immunological treatments should lead to decreased symptoms in some cases. Four cases with abrupt, severe onset or worsening of OCD or tics are presented from an open treatment study. All were boys aged 10 to 14 years. One had OCD, one had Tourette's syndrome, and two had both OCD and Tourette's syndrome. Clinically and on standardized rating scales, their symptoms were in the moderate to very severe range. Two had evidence of recent group A beta-hemolytic streptococci infections, and the others had histories of recent viral illnesses. Two were treated with plasmapheresis, one with intravenous immunoglobulin, and one with immunosuppressive doses of prednisone. All had a clinically significant response immediately after treatment. Diagnostic criteria are provided that describe these cases of pediatric, infection-triggered, autoimmune neuropsychiatric disorders (PITANDs). Suggestions are made regarding the evaluation and management of patients who may have this condition.
362 citations
Related Topics (5)
Performance Metrics
| Year | Papers |
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| 2025 | 28 |
| 2024 | 47 |
| 2023 | 44 |
| 2022 | 58 |
| 2021 | 30 |
| 2020 | 15 |