Research & Studies
Research, Articles & Case Studies
2017
Streptococcal infection-related autoimmunity and autism: crosstalk in protein functional networks (Megan Huxley, Joshua Stead, Olga Vasieva – Journal of Systems and Integrative Neuroscience) Read Article
Overview of Treatment of Pediatric Acute-Onset Neuropsychiatric Syndrome (Swedo Susan E., Frankovich Jennifer, and Murphy Tanya K.. Journal of Child and Adolescent Psychopharmacology. July 2017) Abstract
Clinical Management of PANS: Part I-Psychiatric and Behavioral Interventions (Thienemann Margo, Murphy Tanya, Leckman James, Shaw Richard, Williams Kyle, Kapphahn Cynthia, Frankovich Jennifer, Geller Daniel, Bernstein Gail, Chang Kiki, Elia Josephine, and Swedo Susan. Journal of Child and Adolescent Psychopharmacology. July 2017) Abstract
Clinical Management of PANS: Part II-Use of Immunomodulatory Therapies
(Frankovich Jennifer, Swedo Susan, Murphy Tanya, Dale Russell C., Agalliu Dritan, Williams Kyle, Daines Michael, Hornig Mady, Chugani Harry, Sanger Terence, Muscal Eyal, Pasternack Mark, Cooperstock Michael, Gans Hayley, Zhang Yujuan, Cunningham Madeleine, Bernstein Gail, Bromberg Reuven, Willett Theresa, Brown Kayla, Farhadian Bahare, Chang Kiki, Geller Daniel, Hernandez Joseph, Sherr Janell, Shaw Richard, Latimer Elizabeth, Leckman James, Thienemann Margo, and PANS/PANDAS Consortium. Journal of Child and Adolescent Psychopharmacology. July 2017)
Abstract
Clinical Management of PANS: Part III–Treatment and Prevention of Infections (Cooperstock Michael S., Swedo Susan E., Pasternack Mark S., Murphy Tanya K., and for the PANS PANDAS Consortium. Journal of Child and Adolescent Psychopharmacology. July 2017)
Abstract
Effect of Early and Prophylactic Nonsteroidal Anti-Inflammatory Drugs on Flare Duration in Pediatric Acute-Onset Neuropsychiatric Syndrome: An Observational Study of Patients Followed by an Academic Community-Based Pediatric Acute-Onset Neuropsychiatric Syndrome Clinic
(Brown Kayla D., Farmer Cristan, Freeman G. Mark Jr., Spartz Ellen J., Farhadian Bahare, Thienemann Margo, and Frankovich Jennifer. JCAP. July 2017)
Abstract
A Double-Blind Randomized Placebo-Controlled Pilot Study of Azithromycin in Youth with Acute-Onset Obsessive-Compulsive Disorder.
Murphy TK1,2,3, Brennan EM1, Johnco C4, Parker-Athill EC1, Miladinovic B5, Storch EA1,2,3,6,7, Lewin AB1,2. (J Child Adolesc Psychopharmaco -2017)
Read Abstract
Association of Streptococcal Throat Infection With Mental DisordersTesting Key Aspects of the PANDAS Hypothesis in a Nationwide Study
(Sonja Orlovska, MD1; Claus Høstrup Vestergaard, MSc; Bodil Hammer Bech, PhD)
Abstract
Cognitive behavioral therapy and acceptance and commitment therapy as augmentation treatment for (PANDAS): A case report (A.Pozza – European Psychiatry – 2017) Abstract
Restless Legs Syndrome as an Atypical Case of PANDAS?(Tromba V, Spalice A, Lambiase C, Favoriti A and Tancredi G – Austin Journal of Clinical Medicine) Study
PANS Associated with Epstein-Barr Infection in Child with Noonan Syndrome (G.P.Tisi, M.Marzolini, G.Biffi – European Psychiatry – 2017) Abstract
Inflammation in the Neurocircuitry of Obsessive-Compulsive Disorder (Sophia Attwells, HBSc; Elaine Setiawan, PhD; Alan A. Wilson, PhD – JAMA Psychiatry 2017) Abstract
Hello from the Other Side: How Autoantibodies Circumvent the Blood–Brain Barrier in Autoimmune Encephalitis
(Maryann P. Platt, Dritan Agalliu, Tyler Cutforth – Frontiers in Immunology)
Abstract
Palatal Petechiae in the Absence of Group A Streptococcus in Pediatric Patients with Acute-Onset Neuropsychiatric Deterioration: A Cohort Study
(Mahony Talia, Sidell Douglas, Gans Hayley, Cooperstock Michael, Brown Kayla, Cheung Joanne M, Farhadian Bahare, Gustafson Melissa, Thienemann Margo, and Frankovich Jennifer. JCAP. April 2017)
Abstract
Impact of PANS and PANDAS Exacerbations on Occupational Performance: A Mixed-Methods Study (Janice Trigilio Tona; Sutanuka Bhattacharjya; Denise Calaprice – AJOT 2017)
Abstract
Prospective Longitudinal Analysis of Immune Responses in Pediatric Subjects After Pharyngeal Acquisition of Group A Streptococci
Nicholas D. Hysmith, Edward L. Kaplan, P. Patrick Cleary, Dwight R. Johnson, Thomas A. Penfound, James B. Dale – Journal of Pediatric Infectious Disease Society-2017
Abstract
Vitamin D Deficiency in Obsessive-Compulsive Disorder Patients with Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections: A Case Control Study.
(Çelik G1, Taş D2, Tahiroğlu A1, Avci A1, Yüksel B3, Çam P2. (Noro Psikiyatr Ars-2017))
Read Abstract
Improvement of psychiatric symptoms in youth following resolution of sinusitis
Talia Mahony, Douglas Sidell, Hayley Gans, Kayla Brown, Bahare Farhadian, Melissa Gustafson, Janell Sherr, Margo Thienemann, Jennifer Frankovich (International Journal of Pediatric Otorhinolaryngology-2017)
Read Study
2016
The Neuropsychological Profile of Children with Basal Ganglia Encephalitis: A Case Series
Pawela C, Brunsdon RK, Williams TA, Porter M, Dale RC, Mohammad SS (Dev Med Child Neurol.-2016) Abstract
Microglial Dysregulation in OCD, Tourette Syndrome, and PANDAS Luciana Frick, Christopher Pittenger (Journal of Immunology Research- 2016) Read Review Article
Randomized, Controlled Trial of Intravenous Immunoglobulin for Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections
Kyle A. Williams, MD, PhD, Susan E. Swedo, MD, Cristan A. Farmer, PhD, Heidi Grantz, LCSW, Paul J. Grant, MD, Precilla D’Souza, CRNP, Rebecca Hommer, MD, Liliya Katsovich, MA, Robert A. King, MD, James F. Leckman, MD, Phd (Journal of the American Academy of Child & Adolescent Psychiatry – 2016) Read Article
Rapid Eye Movement Sleep Abnormalities in Children with Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS).
Gaughan T ,Buckley A, Hommer R, Grant P, Williams K, Leckman JF, Swedo SE (J Clin Sleep Med – 2016) Read Study
PANDAS: Baseline Immunoglobulin Levels Predict Achievement of Remission at One Year Following IVIG Therapy
David S. Younger, Phyllis A. Mast, and Denis A. Bouboulis (Journal of Neurology and Neurosurgery, 2016)
Read More at Journal of Neurology and Neurosurgery
Full PDF
Pediatric Autoimmune Disorders Associated with Streptococcal Infections and Tourette’s Syndrome in Preclinical Studies
Chiara Spinello, Giovanni Laviola and Simone Macrì (Frontiers in Neuroscience – 2016)
Full Article
Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS)
Graziella Orefici, PhD, Francesco Cardona, MD, Carol J. Cox, PhD, and Madeleine W. Cunningham, PhD. (From the Book: Streptococcus pyogenes
Basic Biology to Clinical Manifestations – University of Oklahoma Health Sciences Center; 2016) Link to Book Chapter
N-Acetylcysteine in the Treatment of Excoriation Disorder – A Randomized Clinical Trial
Jon E. Grant, JD, MD, MPH; Samuel R. Chamberlain, MD, PhD; Sarah A. Redden, BA; Eric W. Leppink, BA; Brian L. Odlaug, PhD; Suck Won Kim, MD (JAMA Psychiatry. 2016) Read More on Clinical Trial
2015
Therapeutic Plasma Apheresis as a Treatment for 35 Severely Ill Children and Adolescents with Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections
M. Elizabeth Latimer, Nathan L’Etoile, Jakob Seidlitz, Susan E. Swedo (JCAP-2015) (2015)
Abstract
Use of Intravenous Immunoglobulin in the Treatment of Twelve Youths with Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections
Miro Kovacevic, Paul Grant, Susan E. Swedo (JCAP-2015) (2015) Abstract
Antineuronal Antibodies in a Heterogeneous Group of Youth and Young Adults with Tics and Obsessive-Compulsive Disorder
Carol J. Cox, Amir J. Zuccolo, Erica V. Edwards, Adita Mascaro-Blanco, Kathy Alvarez, Julie Stoner, Kiki Chang, Madeleine W. Cunningham (JCAP-2015) (2015) Abstract
Cytokine Correlations in Youth with Tic Disorders
E. Carla Parker-Athill, Jared Ehrhart, Jun Tan, Tanya K. Murphy (JCAP-2015) (2015) Abstract
Clinical Presentation of Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections in Research and Community Settings
Susan E. Swedo, Jakob Seidlitz, Miro Kovacevic, M. Elizabeth Latimer, Rebecca Hommer, Lorraine Lougee, Paul Grant (JCAP-2015) (2015) Abstract
Five Youth with Pediatric Acute-Onset Neuropsychiatric Syndrome of Differing Etiologies
Jennifer Frankovich, Margo Thienemann, Sonal Rana, Kiki Chang (JCAP-2015) (2015) Abstract
Multidisciplinary Clinic Dedicated to Treating Youth with Pediatric Acute-Onset Neuropsychiatric Syndrome: Presenting Characteristics of the First 47 Consecutive Patients
Jennifer Frankovich, Margo Thienemann, Jennifer Pearlstein, Amber Crable, Kayla Brown, Kiki Chang (JCAP-2015) (2015)
Abstract
Group A Streptococcus intranasal infection promotes CNS infiltration by streptococcal-specific Th17 cells
Thamotharampillai Dileepan, Erica D. Smith, Daniel Knowland, Martin Hsu, Maryann Platt, Peter Bittner-Eddy, Brenda Cohen, Peter Southern, Elizabeth Latimer, Earl Harley Dritan Agalliu. and P. Patrick Cleary (Journal of Clinical Investigation-2015) Article
Diagnosis Deconstructed: A Recipe for Encephalopathy
Morchi, Ravi MD (Emergency Medicine News-2015) Read More
PANS consensus conference: Full medical evaluation needed
(The Brown University Child & Adolescent Psychopharmacology Update-2015) Abstract
Detection of anti-streptococcal, antienolase, and anti-neural antibodies in subjects with early-onset psychiatric disorders.
Nicolini H, López Y, Genis-Mendoza AD, Manrique V, Lopez-Canovas L, Niubo E, Hernández L, Bobes MA, Riverón AM, López-Casamichana M, Flores J, Lanzagorta N, De la Fuente-Sandoval C, Santana D. (Actas Esp Psiquiatr -2015) Abstract
Waking Up to a Child With Abrupt Personality Changes
Michelle M. Papachrisanthou, DNP, CPNP-PC, Renée L. Davis, DNP, CPNP-PC (Jouranl of Nurse Practitioners-2015) Abstract
Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus Immunology: A Pilot Study
Walls A, Cubangbang M, Wang H, Raiji M, Knight J, Steehler M, Latimer E, Harley EH Jr. (Otolaryngol Head Neck Surg.-2015) Abstract
The Role of Tonsillectomy in the Treatment of Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections (PANDAS)
Daniel Demesh, MD; Jordan M. Virbalas, MD; John P. Bent, MD (JAMA Otolaryngol Head Neck Surg.-2015) Abstract
Implications for Advanced Practice Nurses When Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections (PANDAS) Is Suspected: A Qualitative Study
Molly McClelland, PhD, RN, Mary-Margaret Crombez, MEd, Catherine Crombez, BSc, Catherine Wenz, MSN, RN, FNP-BC, Margaret Lisius, MSW, Amanda Mattia, BSN, RN, Suzana Marku, BSN, RN (JPED-2015) Abstract
Basal ganglia inflammation in children with neuropsychiatric symptoms
Ajay Kumar, Mitchel Williams, Otto Muzik and Harry Chugani (Journal of Nuclear Medicine – 2015) Abstract
2014
Clinical Evaluation of Youth with Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS): Recommendations from the 2013 PANS Consensus Conference
Kiki Chang, Jennifer Frankovich, Michael Cooperstock, Madeleine W. Cunningham, M. Elizabeth Latimer, Tanya K. Murphy, Mark Pasternack, Margo Thienemann, Kyle Williams, Jolan Walter, Susan E. Swedo, From the PANS Collaborative Consortium (JCAP-2015) (2014)
Abstract
PANDAS and Comorbid Kleine–Levin Syndrome
Diana M. Gerardi, Joseph Casadonte, Priyal Patel, Tanya K. Murphy (JCAP-2015) (2014)
First Page
Disordered Eating and Food Restrictions in Children with PANDAS/PANS
Megan D. Toufexis, Rebecca Hommer, Diana M. Gerardi, Paul Grant, Leah Rothschild, Precilla D’Souza, Kyle Williams, James Leckman, Susan E. Swedo, Tanya K. Murphy (JCAP-2015) (2014)
Abstract
Cefdinir for Recent-Onset Pediatric Neuropsychiatric Disorders: A Pilot Randomized Trial
Tanya K. Murphy, E. Carla Parker-Athill, Adam B. Lewin, Eric A. Storch, P. Jane Mutch (JCAP-2015) (2014) Abstract
Characterization of the Pediatric Acute-Onset Neuropsychiatric Syndrome Phenotype
Tanya K. Murphy, Priyal D. Patel, Joseph F. McGuire, Allison Kennel, P. Jane Mutch, E. Carla Parker-Athill, Camille E. Hanks, Adam B. Lewin, Eric A. Storch, Megan D. Toufexis, Gul H. Dadlani, Carina A. Rodriguez (JCAP-2015) (2014) Abstract
Pediatric inflammatory brain diseases: a diagnostic approach
Van Mater, Heather (Current Opinion in Rheumatology- 2014) Abstract
Brain Imaging Differences in Tourette and PANDAS
(Medscape Medical News from the Society of Nuclear Medicine and Molecular Imaging (SNMMI) 2014 Annual Meeting – 2014)
Article
Post-infectious autoimmune disorders: Sydenham’s chorea, PANDAS and beyond
Kyle A. Williams, Susan E. Swedo (Elsevier-2014) Abstract
Evaluation of Basal Ganglia and Thalamic Inflammation in Children With Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infection and Tourette Syndrome-A Positron Emission Tomographic (PET) Study Using 11C-[R]-PK11195
Ajay Kumar, MD, PhD, DNB; Mitchel T. Williams, MD; Harry T. Chugani, MDhttp://jcn.sagepub.com/content/30/6/749 – aff-1 (Journal of Child Neurology-2014)
Abstract
Behavioral and neural effects of intra-striatal infusion of anti-streptococcal antibodies in rats
Dafna Lotan, Itai Benhar, Kathy Alvarez, Adita Mascaro-Blanco, Lior Brimberg, Dan Frenkel, Madeleine W. Cunningham, Daphna Joel (Elsevier-2014) Abstract
The curious case of the “inseparable child”
Praveen Navkhare, Gurvinder Kalra (Indian Journal of Psychiatry-2014) Full Text
2013
A Link Between Perianal Strep and Pediatric Autoimmune Neuropsychiatric Disorder Associated With Streptococcal Infection (PANDAS)
Megan Toufexis, D.O.; Caroline DeOleo, M.D.; Josephine Elia, M.D.; Tanya K. Murphy, M.D. (Journal of Neuropsychiatry & Clinical Neurosciences-2013) Full PDF
Periodic Fever and Hyperimmunoglobulin D Syndrome in a Boy with Pediatric Autoimmune Neuropsychiatric Disorders Associated with Group A β-Hemolytic Streptococcus
Perihan Cam Ray, Didem Arslan Tas, Gonca Gul Celik, Ayşegul Yolga Tahiroglu, Ayşe Avci, and Eren Erken (Journal of Child and Adolescent Psychopharmacology- 2013) First Page
From Research Subgroup to Clinical Syndrome: Modifying the PANDAS Criteria to Describe PANS (Pediatric Acute-onset Neuropsychiatric Syndrome)
Susan E. Swedo, James F. Leckman, Noel R. Rose (Pediatrics and Therapeutics-2013)
Full PDF
A Case Report of Obsessive-Compulsive Disorder Following Acute Disseminated Encephalomyelitis
Katherine E. Muir, Katherine S. McKenney, Mary B. Connolly, S. Evelyn Stewart (AAP Gateway-2013) Read More Full PDF
Dopamine Receptor Autoantibodies Correlate with Symptoms in Sydenham’s Chorea
Hilla Ben-Pazi, Julie A. Stoner, and Madeleine W. Cunningham (PLoS One-2013) Full Study
2012-2011
Lyme disease and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS): an overview
Hanna Rhee, Daniel J Cameron (Int’l Journal of General Medicine-2012) Full Paper
Behavioral, pharmacological, and immunological abnormalities after streptococcal exposure: a novel rat model of Sydenham chorea and related neuropsychiatric disorders.
Brimberg L, Benhar I, Mascaro-Blanco A, Alvarez K, Lotan D, Winter C, Klein J, Moses AE, Somnier FE, Leckman JF, Swedo SE, Cunningham MW, Joel D (Neuropsychopharmacology-2012 Aug)
Abstract
A case of PANDAS with Kleine–Levin type periodic hypersomnia
Abhijit Das, Ashalatha Radhakrishnan (Sleep Medicine-2012) Abstract
Neurocognitive Functioning in Youth With Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcus
Adam B. Lewin, Ph.D., A.B.P.P., Eric A. Storch, Ph.D., P. Jane Mutch, Ph.D., Tanya K. Murphy, M.D. (J Neuropsychiatry Clin Neurosci – 2011)
Full PDF
Clinical Factors Associated with PANDAS
Tanya K. Murphy, MD, Eric A. Storch, PhD, Adam B. Lewin, PhD., Paula J. Edge, BS., and Wayne K. Goodman, MD (Journal of Pediatrics – 2011) Abstract
Neurocognitive functioning in youth with pediatric autoimmune neuropsychiatric disorders associated with streptococcus
Lewin AB, Storch EA, Mutch PJ, Murphy TK (J Neuropsychiatry Clin Neurosci – 2011)
Abstract
Lewin AB, Storch EA, Murphy TK (J Neuropsychiatry Clin Neurosci – 2011)
Abstract
Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS): an indication for tonsillectomy
Alexander AA, Patel NJ, Southammakosane CA, Mortensen MM (Int J Pediatr Otorhinolaryngol. – 2011) Abstract
Oral inflammatory process and general health. Part 2: How does the periapical inflammatory process compromise general health?
Somma F, Castagnola R, Bollino D, Marigo L (Eur Rev Med Pharmacol Sci. – 2011) Abstract
Maternal History of Autoimmune Disease in Children Presenting with Tics and/or Obsessive-Compulsive Disorder
T.K. Murphy, E.A. Storch, A. Turner, J.M. Reid, J. Tan, A.B. Lewin (J Neuroimmunol – 2011)
Full Article
2009-1999
The relationship between group A beta hemolytic streptococcal infection and psychiatric symptoms: a pilot study
Cengel-Kültür SE, Cöp E, Kara A, Cengiz AB, Uludağ AK, Unal F (Turk J Pediatr- 2009)
Abstract
Cross-cutting issues and future directions for the OCD spectrum.
Hollander E, Kim S, Braun A, Simeon D, Zohar J (Psychiatry Res. – 2009) Abstract
Executive and Attention Functioning Among Children in the Pandas Subgroup
Matthew E. Hirschtritt, Christopher J. Hammond, David Luckenbaugh, Jason Buhle, Audrey E. Thurm, B. J. Casey, and Susan E. Swedo (Child Neuropsychol. – 2009)
Full Article
Challenges in the identification and treatment of PANDAS: a case series.
Mabrouk AA, Eapen V (J Trop Pediatr – 2009)
Abstract
Neuropsychiatric Disorders Associated with Streptococcal Infection: A Case-Control Study among Privately Insured Children
Douglas L. Leslie, Ph.D., Laura Kozma, B.A., Andrés Martin, M.D., M.P.H., Angeli Landeros, M.D., Liliya Katsovich, M.B.A., Robert A. King, M.D., James F. Leckman, M.D. (J Am Acad Child Adolesc Psychiatry – 2009)
Full Article
Mycoplasma pneumoniae infection and obsessive-compulsive disease: a case report
Ercan TE, Ercan G, Severge B, Arpaozu M, Karasu G (J Child Neurol.- 2008 Mar)
Abstract
Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus: Comparison of Diagnosis and Treatment in the Community and at a Specialty Clinic
Vilma Gabbay, MD, Barbara J. Coffey, MD, MS,a James S. Babb, PhD, Laura Meyer, MD, Carly Wachtel, MD, Seeba Anam, MD, Beth Rabinovitz, BA (Pediatrics – 2008) Full Article
Certain Eating Disorders May Be a Neuropsychiatric Manifestation of PANDAS: Case Report
Cynthia V. Calkin, MD, Carlo G. Carandang, MD ABPN (J Can Acad Child Adolesc Psychiatry – 2007) Full Article
Relationship of movements and behaviors to Group A Streptococcus infections in elementary school children
Murphy TK, Snider LA, Mutch PJ, Harden E, Zaytoun A, Edge PJ, Storch EA, Yang MC, Mann G, Goodman WK, Swedo SE (Biol Psychiatry – 2007) Abstract
Selective Serotonin Reuptake Inhibitor-Induced Behavioral Activation in the PANDAS Subtype
Tanya K. Murphy, MD, Eric A. Storch, PhD, and Melissa S. Strawser, BA (Primary Psychiatry-2006) Full PDF
Strep and Urinary Frequency: Is There a Connection?
Christina Kim, MD, Steven G. Docimo, MD, Kathleen McKay, PhD (NE Section of the American Urological Association -2006)
Article
Tourette’s syndrome: a cross sectional study to examine the PANDAS hypothesis
A Church, R Dale, A Lees, G Giovannoni, and M Robertson (J Neurol Neurosurg Psychiatry -2003) Full PDF
The PANDAS subgroup: recognition and treatment
Swedo SE, Garvey M, Snider L, Hamilton C, Leonard HL (CNS Spectr – 2001) Abstract
PANDAS Variant and Body Dysmorphic Disorder
Sanjay Mathew (American Journal of Psychiatry-2001) Letter to Editor
Therapeutic plasma exchange and intravenous immunoglobulin for obsessive-compulsive disorder and tic disorders in childhood
Perlmutter SJ, Leitman SF, Garvey MA, Hamburger S, Feldman E, Leonard HL, Swedo SE (Lancet -1999) Abstract
Therapeutic plasma exchange and intravenous immunoglobulin for obsessive-compulsive disorder and tic disorders in childhood.
Perlmutter SJ, Leitman SF, Garvey MA, Hamburger S, Feldman E, Leonard HL, Swedo SE (Lancet – 1999) Abstract
JCAP Consensus, Treatment & Articles
Pediatric Acute-Onset Neuropsychiatric Syndrome: A Data Mining Approach to a Very Specific Constellation of Clinical Variables
- Antonella Gagliano, MD, PhD
- Cecilia Galati, MD
- Massimo Ingrassia, BS
- Massimo Ciuffo, BS
- Maria Ausilia Alquino, BS
- Marcello G. Tanca, BS
- Sara Carucci, MD, PhD
- Alessandro Zuddas, and MD
- Enzo Grossi, MD
Published Online: 7 Oct 2020Doi: https://doi.org/10.1089/cap.2019.0165
Abstract
Objectives: Pediatric acute onset neuropsychiatric syndrome (PANS) is a clinically heterogeneous disorder presenting with: unusually abrupt onset of obsessive compulsive disorder (OCD) or severe eating restrictions, with at least two concomitant cognitive, behavioral, or affective symptoms such as anxiety, obsessive-compulsive behavior, and irritability/depression. This study describes the clinical and laboratory variables of 39 children (13 female and 26 male) with a mean age at recruitment of 8.6 years (standard deviation 3.1).
Methods: Using a mathematical approach based on Artificial Neural Networks, the putative associations between PANS working criteria, as defined at the NIH in July 2010 (Swedo et al. 2012), were explored by the Auto Contractive Map (Auto-CM) system, a mapping method able to compute the multidimensional association of strength of each variable with all other variables in predefined dataset.
Results: The PANS symptoms were strictly linked to one another on the semantic connectivity map, shaping a central “diamond” encompassing anxiety, irritability/oppositional defiant disorder symptoms, obsessive-compulsive symptoms, behavioral regression, sensory motor abnormalities, school performance deterioration, sleep disturbances, and emotional lability/depression. The semantic connectivity map also showed the aggregation between PANS symptoms and laboratory and clinical variables. In particular, the emotional lability/depression resulted as a highly connected hub linked to autoimmune disease in pregnancy, allergic and atopic disorders, and low Natural Killer percentage. Also anxiety symptoms were shown to be strongly related with recurrent infectious disease remarking the possible role of infections as a risk factor for PANS.
Conclusion: Our data mining approach shows a very specific constellation of symptoms having strong links to laboratory and clinical variables consistent with PANS feature.
Revised Treatment Guidelines Released for Pediatric Acute Onset Neuropsychiatric Syndrome (PANS/PANDAS) -JCAP 2017
The special issue on PANS/PANDAS treatment guidelines was led by Guest Editors Jennifer Frankovich, MD, Stanford University, Susan Swedo, MD, NIH, and Tanya Murphy, MD, University of South Florida .
Treatment of PANS depends on three complementary modes of intervention:
1. Treating the symptoms with psychoactive medications, psychotherapies (particularly cognitive behavioral therapy), and supportive interventions.
2. Removing the source of the inflammation with antimicrobial interventions.
3. Treating disturbances of the immune system with immunomodulatory and/or anti-inflammatory therapies.
Clinical Management of Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS)
Part I—Psychiatric and Behavioral Interventions
Part II—Use of Immunomodulatory Therapies
Part III—Treatment and Prevention of Infections
Full List of Articles
Introduction
Overview of Treatment of Pediatric Acute-Onset Neuropsychiatric Syndrome
Abstract
Full Text
Clinical Management of PANS
Clinical Management of PANS: Part I–Psychiatric and Behavioral Interventions
Part I—Psychiatric and Behavioral Interventions, Margo Thienemann, MD, Stanford University and coauthors present consensus guidelines for treating the psychiatric and behavioral symptoms of children with PANS/PANDAS. Symptom improvement is aimed at decreasing suffering, improving functioning, and making it easier for the children to adhere to therapeutic interventions.
Abstract
Full Text
Clinical Management of PANS: Part II—Use of Immunomodulatory Therapies
Part II—Use of Immunomodulatory Therapies, Jennifer Frankovich, MD, and coauthors provide recommendations to help guide the use of therapies targeting the neuroinflammation and post-infectious autoimmunity that are common in PANS-PANDAS.
Abstract
Full Text
Clinical Management of PANS: Part III—Treatment and Prevention of Infections
Part III—Treatment and Prevention of Infections, Michael Cooperstock, MD, MPH, University of Missouri School of Medicine (Columbia) and coauthors representing the PANS PANDAS Consortium, present a consensus guideline for managing the infection components of these neuropsychiatric conditions.
Abstract
Full Text
Studies
Pediatric Acute-Onset Neuropsychiatric Syndrome Response to Oral Corticosteroid Bursts: An Observational Study of Patients in an Academic Community-Based PANS Clinic
(Brown Kayla, Farmer Cristan, Farhadian Bahare, Hernandez Joseph, Thienemann Margo, and Frankovich Jennifer. JCAP. July 2017)
Abstract
Course of Neuropsychiatric Symptoms After Introduction and Removal of Nonsteroidal Anti-Inflammatory Drugs: A Pediatric Observational Study
(Spartz Ellen J., Freeman G. Mark Jr., Brown Kayla, Farhadian Bahare, Thienemann Margo, and Frankovich Jennifer. JCAP. July 2017)
Abstract
Effect of Early and Prophylactic Nonsteroidal Anti-Inflammatory Drugs on Flare Duration in Pediatric Acute-Onset Neuropsychiatric Syndrome: An Observational Study of Patients Followed by an Academic Community-Based Pediatric Acute-Onset Neuropsychiatric Syndrome Clinic
(Brown Kayla D., Farmer Cristan, Freeman G. Mark Jr., Spartz Ellen J., Farhadian Bahare, Thienemann Margo, and Frankovich Jennifer. JCAP. July 2017)
Abstract