PANDAS and PANS: An Inflammatory Hypothesis for a Childhood Neuropsychiatric Disorder

Abstract

Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) and pediatric acute-onset neuropsychiatric syndrome (PANS) are recently described conditions that refer to the acute and dramatic onset of specific neuropsychiatric symptoms in children in the setting of infection. PANDAS is defined by obsessive-compulsive and tic symptoms as well as inattention, hyperactivity, food restriction, and separation anxiety in association with Group A streptococcal infection. Pathogenesis is not yet known but is suspected to include subcortical structures such as the basal ganglia nuclei. It is a diagnosis that is still actively being researched and defined. PANDAS and PANS have been controversial for a variety of reasons. One significant objection by some is that symptoms are due not to inflammatory or autoimmune etiology but rather the same multifactorial causes hypothesized as underlying classical obsessive-compulsive and tic disorders. This is the case of a 9-year-old girl whose presentation, diagnostic, and treatment courses follow those classically characterized as PANDAS. This case allows for a discussion of the evidence basis for the disorder as well as work-up, evidence-based treatment options, pathophysiology, and outcomes.