Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS).

Refers to the hypothesis that some children with rapid onset of obsessive-compulsive disorder (OCD) or tic disorders and these symptoms are caused by group A beta-hemolytic streptococcal (GABHS) infections.

It is suggested that a link exists between group A beta-hemolytic streptococcal infections and disorders that are initial autoimmune reactions producing antibodies that interfere with basal ganglia function.

This autoimmune response can result in a broad range of neuropsychiatric symptoms.

PANDAS is a subset of the pediatric autoimmune neuropsychiatric syndrome (PANS) hypothesis.

Streptococcus pyogenes, a common group A streptococcal bacterium, induces an autoimmune condition in which the body’s own antibodies to streptococci attack the basal ganglion cells of the brain.

by a concept known as molecular mimicry.

Studies have demonstrarted children appear to have dramatic and sudden OCD exacerbations and tic disorders following infections.

Proof of causality has remained elusive, and the PANDAS hypothesis is controversial.

Other symptoms associated with exacerbations include as emotional lability, enuresis, anxiety, and deterioration in handwriting.

The hypothesis is that the mechanism is similar to that of rheumatic fever, an autoimmune disorder triggered by streptococcal infections, where antibodies attack the brain and cause neuropsychiatric conditions.

The basaL ganglia may be affected in PANDAS and is believed to be responsible for movement and behavior.

It is implied the antibodies cross-react with neuronal brain tissue in the basal ganglia to cause the tics and OCD that characterize PANDAS.

Prospective longitudinal studies have not produced conclusive results confirming the above hypothesis.

Five diagnostic criteria were proposed for PANDAS:

the presence of a tic disorder and/or OCD consistent with DSM-IV;

prepubertal onset of neuropsychiatric symptoms

a history of a sudden onset of symptoms and/or an episodic course with abrupt symptom exacerbation interspersed with periods of partial or complete remission.

evidence of a temporal association between onset or exacerbation of symptoms and a prior streptococcal infection.

adventitious movements, such as motoric hyperactivity and choreiform movements during symptom exacerbation.

Treatments include cognitive behavioral therapy and medications to treat OCD such as selective serotonin reuptake inhibitors, and therapy for tics.

The use of prophylactic antibiotics to treat PANDAS is widespread, but the evidence supporting their use is equivocal.

PANDAS is characterized by sudden and extreme behavior, including outbursts of anger and violence.

Strep throat is a bacterial infection, most commonly associated with sore throat in children.

In most cases, it can be effectively treated with antibiotics.

A streptococcal throat infection can also lead to serious psychological and neurological complications known as pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, or PANDAS.

Symptoms include vocal and physical tics, anxiety, and obsessive-compulsive disorder (OCD).

Children may also show signs of anger and even violence.

Symptoms can be relatively mild, so the child just has some behavioral regression.

Streptococcus pyogenes (group A strep) throat infection is spread by contact with secretions from an infected person’s respiratory tract when that person coughs or sneezes.

It mostly affects children ages 5 to 15, but anyone can get it.

It is estimated that two-thirds to three-quarters of grade-school-age children have a strep throat infection every year; but only as few as 1 in 500 will have the post-strep reaction that manifests as PANDAS.

Patients may need psychiatric treatments, behavior therapy, and medications.

Severe cases may require plasmapheresis, or intravenous immunoglobulin (IVIG).

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