Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS)

1. Pediatric Autoimmune Neuropsychiatric Disorders
Associated with Streptococcal Infections
(PANDAS)
Ade Wijaya, MD – November 2019

2. Outline:
• Introduction
• Diagnosis
• Patophysiology
• Treatment
• Summary

3. Introduction
• A subgroup of pediatric acute-onset neuropsychiatric syndrome
(PANS)
(Swedo, Leckman, & Rose, 2012)

4. Diagnosis Criteria
• OCD and/or tic syndrome (DSM-IV)
• Prepubertal symptom onset
• Episodic course
• Abrupt onset of symptoms or of symptom exacerbation
• Association with GABHS infection (positive throat culture and/or
elevated anti-GABHS antibody titers)
• Association with neurological abnormalities
(Swedo et al., 1998)

5. Neurological Symptoms
• Hyperactivity
• Choreiform movements
• Tourette’s syndrome
Pavone P, Falsaperla R, Nicita F, Zecchini A, Battaglia C, Spalice A, Iozzi L, Parano E, Vitaliti G, Verrotti A, Belcastro V. Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infection (PANDAS): Clinical
Manifestations, IVIG Treatment Outcomes, Results from a Cohort of Italian Patients.

6. Patophysiology
• Autoimmune; molecular mimicry
• Autoantibodies to brain structures such as dopamine D1 and D2
receptors, leading to the alteration of dopaminergic transmission
Brimberg L, Benhar I, Mascaro-Blanco A, et al. Behavioral, pharmacological, and immunological abnormalities after streptococcal exposure: a novel rat model of Sydenham chorea and related neuropsychiatric
disorders. Neuropsychopharmacology 37(9), 2076-2087 (2012).

7. Treatment
• Antibiotics
• Therapeutic plasma exchange
• Intravenous immunoglobulin
• Tonsillectomy and adenoidectomy
• Cognitive behavior therapy
• Nonsteroidal anti-inflammatory drugs
• Corticosteroids
• Selective serotonin reuptake inhibitors
Sigra S, Hesselmark E, Bejerot S. Treatment of PANDAS and PANS: a systematic review. Neuroscience & Biobehavioral Reviews. 2018 Mar 1;86:51-65.

8. Summary
• PANDAS is a subgroup of pediatric acute-onset neuropsychiatric
syndrome (PANS)
• Acute onset prepubertal OCD and/or tic syndrome (DSM-IV)
• Association with GABHS infection
• Autoimmune; molecular mimicry

9. THANK YOU