Makindo Medical Notes

Related Subjects: |Encopresis in Children |Enuresis/Bedwetting in Children |Acute Glomerulonephritis in Children |Nephrotic Syndrome in Children |Acute Appendicitis in Children |Gastro-oesophageal reflux in Children |Intussusception in Children |Panayiotopoulos Syndrome in Children |Reflex anoxic attacks in Children |Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections

Introduction

• PANDAS refers to a group of neuropsychiatric disorders in children that are triggered by an autoimmune response to a recent streptococcal infection.
• It is thought that following a streptococcal throat infection, the body’s immune system mistakenly attacks brain structures, leading to the sudden onset of psychiatric and neurological symptoms.

Key Symptoms

• Tics: Children with PANDAS often develop sudden-onset tics, which may resemble Tourette’s syndrome. These tics can be motor or vocal.
• Obsessive–Compulsive Disorder (OCD): A hallmark symptom of PANDAS, OCD symptoms emerge rapidly and may be severe.
• Anorexia Nervosa: Although less common, some children may exhibit symptoms resembling anorexia nervosa, including a marked reluctance to eat.

Diagnosis

• Diagnosis is often clinical, based on the rapid onset of neuropsychiatric symptoms following a streptococcal infection.
• Lab tests may show evidence of a recent or current streptococcal infection, but there is no specific diagnostic test for PANDAS.

Treatment

• Antibiotics: Aimed at eradicating the underlying streptococcal infection and preventing future infections. Long-term antibiotic therapy may help reduce relapses in children with PANDAS.
• Risperidone: Risperidone, an atypical antipsychotic, has been used to manage severe symptoms such as tics and OCD. However, its use is often off-label and requires careful monitoring.
• Plasmapheresis and IVIG: In severe cases, treatments like plasmapheresis (blood filtration) or intravenous immunoglobulin (IVIG) therapy have been considered, though evidence is still evolving.

Prognosis

• With appropriate treatment, many children with PANDAS show significant improvement in symptoms, though some may experience recurring episodes or long-term issues with OCD or tics.
• The key to managing PANDAS is early recognition and intervention to minimize the impact on the child’s mental health and quality of life.

Conclusion

• PANDAS is a rare but important condition to consider in children who develop sudden-onset neuropsychiatric symptoms following a streptococcal infection.
• Prompt diagnosis and appropriate treatment with antibiotics, psychiatric care, and, if needed, additional therapies can significantly improve outcomes.

References

• 319–321: Studies on the treatment of PANDAS with antibiotics and risperidone.
• OHCM p692: Overview of Tic Disorders and Tourette's Syndrome.