Neuropsychiatric aspect of Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infection (PANDAS)

Volume 6 Issue 8 August, 2016

Pediatric Autoimmune Neuropsychiatric Disorders associated with Streptococcal infection (PANDAS) is a unique constellation of signs and symptoms that exist in a subset of children with rapid onset or exacerbation of obsessive-compulsive disorder (OCD) and/or tic disorders. This is due to an initial autoimmune reaction to a Group ‘A’ Beta Hemolytic Streptococcal (GABHS) infection which produces antibodies that interfere with the basal ganglia function. According to the National Institute of Mental Health (NIMH), five clinical characteristics that define the PANDAS group are the presence of OCD and/or tic disorder, pre-pubertal age of onset, abrupt onset and relapsing-remitting symptom course, association with neurological abnormalities (adventitious movements or motor hyperactivity) during exacerbations, and a temporal association between symptom exacerbations and a Group-A beta-hemolytic streptococcal (GABHS) infection.

In addition to the OCD and tic symptoms, these PANDAS children experiences a variety of other neuropsychiatric symptoms, including emotional lability, irritability, temper tantrums, hyperactivity, inattention, separation anxiety, handwriting changes and enuresis etc.

The relapsing–remitting course of PANDAS is in striking contrast to the gradual onset and persistent symptoms typically seen in childhood-onset OCD and also differs substantially from the waxing and waning course of tic disorders.

Treatment for the PANDAS subgroup of children with OCD is not different from treatment of others with this diagnosis. Use of combined behavioral therapies and low doses of selective serotonin reuptake inhibitors (SSRIs) has been recommended. Children with PANDAS appear to be unusually sensitive to the side-effects of SSRIs and other medications, so it is important to ‘‘start low and go slow’’ when using these medications. A throat culture should be done and if it is positive, a single course of antibiotics will usually get rid of the streptococcal infection and allow the PANDAS symptoms to subside. IV immunoglobulin therapy is generally recommended only for severe or persistent cases.

Group A Streptococcal infections being highly endemic in India, it is likely that the prevalence of PANDAS is relatively higher as compared to non-endemic regions; however, very little information regarding this is available in the Indian literature. This can be attributed to an inadequate awareness regarding this disorder and infrequent liaising among the various specialties. A good cross referral between the pediatricians and the psychiatrists can serve in decreasing and eliminating the morbidity and the disability associated with this disease.