Pediatric acute-onset neuropsychiatric syndrome

Pediatric acute-onset neuropsychiatric syndrome (PANS) is the name of a disease that normally begins in childhood. It causes Obsessive-compulsive disorder (OCD) and/or tics. The symptoms begin very suddenly.University of Florida, Antibiotic Treatment Trial for the PANDAS/PANS Phenotype (AZT). http://clinicaltrials.gov/ct2/show/NCT01617083Univetsity of Buffalo School of Public Health: http://sphhp.buffalo.edu/rs/ot/ms/PANS%20Page.phpJeff Szymanski: "Can an infection suddenly cause OCD?". Harvard Health Publications. Feb 27, 2012. http://www.health.harvard.edu/blog/can-an-infection-suddenly-cause-ocd-201202274417 If it is not treated at the beginning the disease can be there also in adults.Jeff Szymanski: "Can an infection suddenly cause OCD?". Harvard Health Blog, Feb 2012. http://www.health.harvard.edu/blog/can-an-infection-suddenly-cause-ocd-201202274417  The reason for PANS can be a bacteria called "Group A streptococcus" (PANDAS type)Study about PANDAS and PITANDS: Moretto, Germana, Pasquini Massimo, et.al.: "What every psychiatrist should know about PANDAS: a review". Department of Psychiatric Sciences and Psychological Medicine, "Sapienza" University of Rome. In: Clinical Practice and Epidemiology in Mental Health 2008. NIMH PANS/PANDAS Information Page: http://intramural.nimh.nih.gov/pdn/web.htm or an immunologic reaction to other pathogens like certain bacteria or viruses.Rhee, H; Cameron DJ: "Lyme disease and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS): an overview". Int J Gen Med. 2012;5:163-74. Epub 2012 Feb 22.Hurley R, Taber K, “Acute and Chronic Lyme Disease: Controversies for Neuropsychiatry.” J. Neuropsychiatry Clin Neurosci 20;iv-6, Feb 2008. (PITANDS type).Swedo SE, Leckman JF, Rose NR: From Research Subgroup to Clinical Syndrome: Modifying the PANDAS Criteria to Describe PANS; Pediatr Therapeut 2012, 2:2; doi:10.4172/2161-0665.1000113 PITANDS Information - Janice Tona, Trudy Posner: "Pediatric Autoimmune Neuropsychiatric Disorders A New Frontier for Occupational Therapy Intervention". http://pandasnetwork.org/wp-content/uploads/2012/01/PANDAS-OT-Article.pdf  

 Signs and symptoms 
Patients suffering from PANS show sudden begin OCD and/or tics and at least two of these symptoms:NIMH Definition of PANS: http://intramural.nimh.nih.gov/pdn/web.htm

 Obsessive-compulsive disorder, or finding it hard to eat. This begins very suddenly and very intensely.
 At the same time, more neuropsychiatric symptoms begin. These are just as quick and severe. The symptoms are from at least two of these categories:
 Fear with or without a reason (Anxiety)
 Problems with feelings and/or sadness (Depression)
 Aggression 
 Behavioral regression (acting like a younger child)
 Problems in school
 Sensory or movement problems (e.g. suddenly bad handwriting)
 Other symptoms, including sleep problems, bed-wetting or using the toilet very often
 Symptoms cannot be better explained by other illnesses such as Sydenham's chorea, systemic lupus erythematosus, Tourette disorder or others.Swedo, S., Leckman, F., Rose, N.  From Research Subgroup to Clinical Syndrome: Modifying the PANDAS Criteria to Describe PANS (Pediatric Acute-onset Neuropsychiatric Syndrome). Pediatrics & Therapeutics, 2012 Feb; 2(2). 

 Similar conditions 
PANS shares symptoms with other diseases. Therefore diagnostic tests must be done to exclude other conditions like Sydenham's chorea, lupus erythematosus, acute disseminated encephalomyelitis, and Tourette syndrome.  Proof of acute rheumatic fever would exclude a PANS classification.

 Treatment 
There is no direct treatment for PANS available yet. This means today only some of the symptoms can be treated.Storch EA, Murphy TK, Geffken, G et al, "Cognitive-Behavioral Therapy for PANDAS-Related Obsessive-Compulsive Disorder: Findings From a Preliminary Waitlist Controlled Open Trial", Journal of the American Academy of Child & Adolescent Psychiatry: October 2006 - Volume 45 - Issue 10 - pp 1171-1178 . But scientists are already working to develop treatments with antibiotics and immune-based therapies that can heal the disease.Perlmutter SJ, Leitman SF, Garvey MA, "Therapeutic plasma exchange and intravenous immunoglobulin for obsessive-compulsive disorder and tic disorders in childhood", Lancet 1999; 354 : 1153 – 58. Nevertheless early and consequent  treatment of the symptoms seems to be important. Otherwise the disease can become a lifelong problem.Germana Moretti, Massimo Pasquini, Gabriele Mandarelli et.al.: "What every psychiatrist should know about PANDAS: a review". In: Clinical Practice and Epidemiology in Mental Health 2008, 4:13.International OCD Foundation: "International OCD Foundation Warns Infections May Trigger Some Mental Illness". http://www.multivu.com/mnr/54781-ocd-foundation-pandas-psa-obsessive-compulsive-disorder 

 References 

 Other websites 
PANS/PANDAS Information - National Institute of Mental Health
PANS/PANDAS Information provided by the International OCD Foundation
NIMH Director's Blog 
From Research Subgroup to Clinical Syndrome: Modifying the PANDAS Criteria to Describe PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) 

Harvard Health Publications about PANS/PANDAS

Category:Psychiatry
Category:Diseases and disorders of the nervous system