Moving from PANDAS to CANS

Abstract

Encountering a previously healthy child with the acute, sudden onset of obsessive-compulsive behaviors, tics, abnormal movements, or other neuropsychiatric symptoms poses a dilemma for most physicians. The differential diagnosis is broad (infectious, post-infectious, drug-induced, autoimmune, metabolic, traumatic, psychogenic, etc), and the selection of rational therapeutic agents is dependent on the identification of a specific etiology or symptom complex. One entity in particular, pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS) is frequently considered because of its apparent association with a highly prevalent bacterial infection. This report reviews each of the required clinical criteria for PANDAS. On the basis of inconclusive and conflicting scientific support for this diagnosis, a broader concept of childhood acute neuropsychiatric symptoms (CANS) is proposed. Although inclusion in CANS requires only the acute dramatic onset of symptoms, we mandate a comprehensive history and examination, consideration of a differential diagnosis, an active search for a specific etiology through appropriate laboratory testing, and treatment with the most appropriate therapy. CorrectionThe Journal of PediatricsVol. 160Issue 5PreviewThe following disclosures were inadvertently undeclared for the authors of the article, “Moving from PANDAS to CANS,” J Pediatr 2012;160:725-31. Full-Text PDF