PANDAS is a rare neuropsychiatric disorder caused by an autoimmune response to a Group A streptococcal (strep) throat infection. It is characterized by abrupt onset of obsessive-compulsive disorder or tic symptoms following a strep infection in children. Diagnosis involves determining if a child meets criteria for OCD or tic disorders, has had a recent strep infection, and neurological abnormalities are present. Treatment involves antibiotics for strep, along with cognitive behavioral therapy and medications like SSRIs or clonidine to manage OCD and tic symptoms. While symptoms often improve within 4-6 weeks of treating the infection, recurrent episodes can be triggered by other infections and may lead to lifelong OCD or tic disorders if

1. 19/1/16PANDAS

2. ETIOLOGY
Outline PATHO
GENESIS
CLINICAL
FEATURES
DIAGNOSTIC
CRITERIA
TREATMENT PROGNOSIS
PSYCHIATRIC
COMORBIDITY

3. INTRODUCTION
- Neuropsychiatric disorders
- Autoimmune basis
- Related to infection with group A
beta-hemolytic streptococci (GAS)
- OCD, Tic disorder and Tourette’s
syndrome
- Genetic predisposition:
Tic disorders and OCD in
first-degree relatives --> higher
GAS OCD Tics Tourette

4. ETIOLOGY
True incidence/prevalance not known, rare disorder, 10 cases were
identified among 30,000 throat cultures positive for GAS
M:F = 2.6:1 SYMPTOMS
Prepubertal
3-11 yo.

5. PATHOGENESIS
MRI scans- enlargements of the caudate, putamen, and globus pallidus,
which points to regional inflammatory changes

6. Clinicalfeatures
Tics
- Classic form, appear for the
first time
- Abrupt onset
- Dramatic exacerbations
- Occur during or after a strep
infection
abnormal results of neurological
examination (hyperactivity, choreiform
movements, or tics) during an exacerbation
OCD

7. OCD symptoms of Children with PANDAS
and Primary OCD or Tic Disorder

9. Some or all of the following symptoms:

11. depend on clinical
history and
severity
Blood test
for ASO
titers
45 MIN
at symptom onset of
<2 weeks duration and again
4-8 weeks laterThroat swab
(rapid and
culture)
Rule out
Other
diseases
Lyme Disease, Thyroid
Disease, Celiac Disease,
Lupus, Sydenham
Chorea, Kawasaki’s
Disease, and acute
Rheumatic Fever
Investigations

12. Presenceof
OCD and/or Tic
GABHS
Pediatric onset
Episodic course
Diagnosticcriteria
Neurological
Abnormalities

13. SUB HEADER
Psychiatriccomorbidity
ADHD Mood&Affective Anxiety
Mood
Anxiety
ADHD

14. Therapy for GAS infection
Therapy for OCD/Tic disorder
Immunomodulatory therapy
Prophylactic therapy
TREATMENT
No approved evaluation and
treatment protocols

15. ↓Incidence
suppurative
complications
↓nonsuppurative
complications
↓ Risk of
transmission
Therapy for GAS infection
Antistreptococcal therapy
positive culture or
rapid antigen detection test for GAS

16. Standard pharmacologic and behaviour
therapies
Pharmacological;
Childhood OCD- SSRIs -->first-line tx.
Tic disorder/Touretteʼs syndrome-
- α adrenergic agonists - clonidine, guanfacine
- atypical neuroleptic agents - risperidone
- typical neuroleptic agents- haloperidol,
pimozide
Nonpharmacological interventions;
CBT-cognitive behavioral therapy
(i.e., ERP-exposure and response
prevention)
Consider evaluated for fine motor deficits
by an occupational therapist if handwriting
or coordination skills have deteriorated
Therapy for OCD/Tic disorder

17. Immunomodulatory therapy
- Not recommended outside of the research setting
- May be considered an alternative for severely ill patients who have not responded
to standard therapies
Glucocorticoids
Plasma exchange
IVIG

18. Prophylactic therapy
Prophylactic antibiotics to prevent recurrences
- not recommended
Future studies are required to develop guidelines
Prospective case-control study
- continuous prophylaxis against GAS might
prevent an average of 0.06 exacerbations per
patient-year

19. Prognosis
- Assuming the infection is adequately treated,
the first symptoms generally improve within 4-6
weeks
- The next OCD episode- may last longer- may be triggered by a variety of immunological
challenges such as another strep infection, or by
other bacterial or viral infections (ear infections,
sinusitis, pneumonia, meningitis, impetigo)
- Long-term outcome of children who meetcriteria for PANDAS is not known
- Unrecognized PANDAS and untreated PANDAS
may result in an increased risk of progression to
lifelong OCD and tic disorders
4-6
wks