Diagnosis and treatment options for pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS): literature review

Abstract

Marta Šaulytė¹, Julija Rugelytė¹, Alvydas Navickas¹, Kęstutis Kuzmickas¹, Rūta Praninskienė² ¹Vilnius University, Faculty of Medicine, Vilnius, Lithuania ²Vilnius University, Faculty of Medicine, Institute of Clinical Medicine, Clinic of Children’s Diseases, Vilnius, Lithuania Abstract Background. Recently, more and more information has become available on the association of neurological and psychiatric conditions with immune activation and inflammation of brain structures, such as pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS). The exact prevalence and etiology of PANDAS are not known, but the development has been linked to a history of streptococcal infection and immune activation. Aim: to present the clinical presentation, diagnostic and therapeutic options for PANDAS based on the available scientific literature. Material and methods. A search of scientific articles was performed in PubMed database for the term ,,PANDAS“, in combination with ,,pathogenesis“, ,,symptoms“, ,,diagnosis“ and ,,treatment“ from 2004 to 2022. Inclusion criteria was represented by articles relevant to these searches. Exclusion criteria was represented by studies written in other languages than English and articles without free access. Results. The diagnostic criteria for PANDAS include (1) the presence of OCD symptoms or tics; (2) onset of symptoms in childhood before puberty; (3) sudden onset or exacerbation with an episodic (relapsing – remitting) course; (4) the association of onset/exacerbation of symptoms with a group A streptococcal infection; and (5) the association with other neuropsychiatric disorders. Significant symptom improvement was observed after specific treatment with antibiotics, intravenous immunoglobulin and plasmapheresis. The beneficial effect of NSAIDs and corticosteroids on the reduction of exacerbations is unquestionable. Conclusions. Diagnosis and treatment of PANDAS are challenging. Further large-scale controlled trials are needed to assess the effectiveness of treatment. Keywords. PANDAS, OCD, tic disorder. Full article https://doi.org/10.53453/ms.2023.2.3