Neurobiologic, Immunologic, and Rheumatologic Markers in Youth With PANS

Study Overview
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Brief Summary
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This study is an investigation of the neurologic, immunologic, and rheumatologic markers of Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS). PANS is a condition characterized by the abrupt, dramatic onset of obsessive compulsive disorder (OCD) and/or eating restriction accompanied by equally abrupt and severe co-morbid neuropsychiatric symptoms, which include anxiety, emotional lability, depression, irritability, aggression, oppositionality, deterioration in school performance, behavioral (developmental) regression, sensory amplification, movement abnormalities, sleep disturbance, and urinary frequency. PANS is thought to be caused by infection, inflammation, or alternate triggers that is associated with a brain response that leads to these symptoms. The purpose of this study is to examine specific neurologic, immunologic, rheumatologic, and genomic, components in children with the acute-onset of psychiatric symptoms. This research may begin to uncover a much larger story of autoimmune processes that are involved in psychiatric disorders of childhood. By better understanding the etiologic components of psychiatric phenomenon, future treatments may be better targeted to underlying causes.

Detailed Description
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The investigators will recruit 500 children, 1-18 years old at onset with PANS/PANDAS. They will be treatment naive and within one month of onset/exacerbation. The 500 children with PANS will be gender- and age-matched to 100 healthy children, to allow examination of immunologic, neurologic, genomic, and behavioral differences between these two groups of children.

Conditions
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Pediatric Acute-Onset Neuropsychiatric Syndrome, Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections, PANS, PANDAS

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Children with PANS Age 1-18 at onset of PANS Diagnosis of PANS: abrupt onset of OCD or food restriction, and at least two of the following associated symptoms: frequent urination, worsening handwriting/cognition, inattention, anorexia, separation anxiety, oppositionality, irritability/rage outbursts, and emotional lability. Patients must live within 90 miles of Stanford University and have a new onset of PANS illness Patients must have an established pediatrician within 90 miles of Stanford University for 3 years. Healthy Controls Age 4-18 No psychiatric diagnosis Exclusion Criteria: Any neuropsychiatric illness that may obscure the clear diagnosis of PANS

Ages Eligible for Study
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Minimum Age: 4 Years
Maximum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| PANS group<br>500 children, 1-18 years old at onset with a strict diagnosis of PANS/PANDAS will be recruited | |
| Health Controls<br>100 healthy children age- and gender- matched to the PANS group will be recruited | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cerebral blood flow | The investigators will report results of altered cerebral blood flow from patients with PANS. | Through study completion, up to 12 years | 
| EEG patterns | The investigators will report results of abnormal EEG patterns from patients with PANS. All data will be obtained through the review of medical records, which are created during the routine clinical care of patients. | Through study completion, up to 12 years | 
| Rapid Eye Movement (REM) motor disinhibition | The investigators will report results of REM motor disinhibition from polysomnography studies. All data will be obtained through the review of medical records, which are created during the routine clinical care of patients. | Through study completion, up to 12 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Global Impairment Scores | All data will be obtained through the review of medical records, which are created during the routine clinical care of patients. | Every 2-4 weeks for up to 12 years | 
| Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) | All data will be obtained through the review of medical records, which are created during the routine clinical care of patients. | Every 2-4 weeks for up to 12 years | 
| Columbia Impairment Scale | All data will be obtained through the review of medical records, which are created during the routine clinical care of patients. | Every 2-4 weeks for up to 12 years | 
| Caregiver Burden Inventory | All data will be obtained through the review of medical records, which are created during the routine clinical care of patients. | Every 2-4 weeks for up to 12 years | 
| Neurological findings | The investigators will report data from neurological exam findings, including milk maid grip, chorea, choreiform movements of arms and legs, apraxia, overflow dystonia, truncal instability, piano-playing fingers, glabellar sign, etc. All data will be obtained through the review of medical records, which are created during the routine clinical care of patients. These results will be aggregated to report the number of participants with abnormal neurological findings. | Every 2-4 weeks for up to 12 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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PANS, PANDAS