Current Pediatric Research

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Research Article - Current Pediatric Research (2020) Volume 24, Issue 5

PANS and PANDAS: Case series of patients in a Danish pediatric clinical cohort.

Objtecives: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) and Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) have been suggested to be a result of a disordered immune response after an infection causing neuropsychiatric symptoms. Although the diagnosis has been controversial, more focus has come on the diagnosis, pathophysiology, and treatment during the recent years.

Methods: We reviewed patient charts of 15 pediatric patients with suspected PANS/PANDAS from the Danish national Tourette syndrome clinic; charts were reviewed for demographics, symptoms, examinations, treatment, and outcome.

11 patients met either full criterion for PANDAS or PANS. Four patients did not fulfill all diagnostic criteria due to age at onset, absence of GAS infection and/or sub-acute onset of symptoms. Most reported symptoms were tics (86.7%), sleep disturbance (66.7%), behavioral disturbances (60.0%), anxiety (53.3%), motoric control abnormalities (53.3%) and Obsessive Compulsive Disorder (40.0%). Streptolysin-O antibody and streptococcus throat culture were positive in respectively 61.5% and 38.4%. Anti-neuronal antibody titers were taken; Calmodulindependent kinase II and anti-beta-tubulin antibodies were most often positive. Acute antibiotic treatment was given to all patients and had an effect in 73.3%. Prophylactic antibiotic was given to 53.3% of patients and had an effect in all patients. Some patients were treated with standard psychiatric treatment, intravenous immunoglobulin or steroid, and non-steroidal antiinflammatory drugs.
Conclusion: This study has shown a positive effect of acute and prophylactic antibiotic-, psychiatric- and immunomodulating treatment, according to parental reports. Until further evidence regarding diagnostic tests and treatments exists, current literature and clinical experience must guide clinicians.

Author(s): Camilla Birgitte Sørensen, Liselotte Skov, Nanette Mol Debes*

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