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Clinical Presentation of PANDAS (and PANS)

Reference
[Gaughan2016]
Gaughan T, Buckley A, Hommer R, et al. Rapid Eye Movement Sleep Abnormalities in Children with Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS). Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine. 2016;12(7):1027-1032. doi:10.5664/jcsm.5942.

Findings/Critique
Thirteen of 15 subjects (87%) had abnormalities detected with PSG. Twelve of 15 had evidence of rapid eye movement (REM) sleep motor disinhibition, as characterized by excessive movement, laughing, hand stereotypies, moaning, or the continuation of periodic limb movements during sleep (PLMS) into REM sleep.

Reference
[Frankovich2015]
Frankovich J, Thienemann M, Pearlstein J, Crable A, Brown K, Chang K. Multidisciplinary Clinic Dedicated to Treating Youth with Pediatric Acute-Onset Neuropsychiatric Syndrome: Presenting Characteristics of the First 47 Consecutive Patients. Journal of Child and Adolescent Psychopharmacology. 2015;25(1):38-47. doi:10.1089/cap.2014.0081.

Reference
[Frankovich2015]
Frankovich J, Thienemann M, Rana S, Chang K. Five Youth with Pediatric Acute-Onset Neuropsychiatric Syndrome of Differing Etiologies. Journal of Child and Adolescent Psychopharmacology. 2015;25(1):31-37. doi:10.1089/cap.2014.0056.

Reference
[Swedo2015]
Swedo SE, Seidlitz J, Kovacevic M, et al. Clinical Presentation of Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections in Research and Community Settings. Journal of Child and Adolescent Psychopharmacology. 2015;25(1):26-30. doi:10.1089/cap.2014.0073.

Reference
[Gerardi2015]
Gerardi DM, Casadonte J, Patel P, Murphy TK. PANDAS and Comorbid Kleine–Levin Syndrome. Journal of Child and Adolescent Psychopharmacology. 2015;25(1):93-98. doi:10.1089/cap.2014.0064.

Reference
[Toufexis2015]
Toufexis MD, Hommer R, Gerardi DM, et al. Disordered Eating and Food Restrictions in Children with PANDAS/PANS. Journal of Child and Adolescent Psychopharmacology. 2015;25(1):48-56. doi:10.1089/cap.2014.0063.

Reference
[Chang2015]
Chang K, Frankovich J, Cooperstock M, et al. Clinical Evaluation of Youth with Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS): Recommendations from the 2013 PANS Consensus Conference. Journal of Child and Adolescent Psychopharmacology. 2015;25(1):3-13. doi:10.1089/cap.2014.0084.

Reference
[Swedo2012]

Findings/Critique
From research subgroup to clinical syndrome: modifying the PANDAS criteria to describe PANS (pediatric acute-onset neuropsychiatric syndrome). Findings: Consensus position of six clinicians treating over 400 children/adolescence with acute-onset neuropsychiatric symptoms. Diagnostic criteria is acute onset OCD or AN with distinct comorbid neuropsychiatric conditions. PANS is introduced to separate the clinical presentation from the proposed pathogenesis (PITANDS, PANDAS, other).

Critique: Needs to clarify that PANDAS is not a strict subset of PANS (e.g., patients with tics and acute onset comorbidities (but no OCD or restrictive eating) may still meet the PANDAS criteria while not meeting the PANS criteria)

Reference
[Bernstein2010]

Findings/Critique
Comparison of clinical characteristics of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) and childhood obsessive-compulsive disorder. Findings: (N=21, C=18) PANDAS subjects were more likely to present with separation anxiety, urinary urgency, hyperactivity, impulsivity, deterioration in handwriting, and decline in school performance during their initial episode of neuropsychiatric illness.

Critique:comorbid symptoms with tic-only PANDAS not addressed

Reference
[Sokol2000]

Findings/Critique
Infection-triggered anorexia nervosa in children. Clinical description of four cases. Findings: (N=4) Case studies with sudden onset Anorexia Nervosa associated with prior GABHS infection. AN symptoms were responsive to conventional treatment when augmented with antibiotic treatment.

Critique: small sample size, no control.

Reference
[Swedo2004]

Findings/Critique
The pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) subgroup: separating fact from fiction. Findings: (commentary) Clarifies PANDAS clinical diagnostic criteria to ensure researchers are comparing similar subjects. Focuses on requirement of sudden/severe onset and dramatic episodic course.

Critique: Improves research criteria, but clinicians seldom see child at sentinel event.

Reference
[Murphy2004]

Findings/Critique
Detecting pediatric autoimmune neuropsychiatric disorders associated with streptococcus in children with obsessive-compulsive disorder and tics. Findings: (N=15, C=10) Severity of symptom fluctuation correlates with elevated antibody GABHS titers (p=.001).

Critique: sample size is small.

Reference
[Murphy2002]

Findings/Critique
Prospective identification and treatment of children with Pediatric Autoimmune Neuropsychiatric Disorders Associated with Group A Streptococcal infection (PANDAS). Findings: (N=12) Patient had abrupt appearance of severe OCD behaviors, accompanied by mild symptoms and signs of acute GABHS tonsillopharyngitis. Comorbid daytime urinary urgency/frequency without dysuria/incontinence or positive urinalysis were notable. OCD symptoms resolved when patients were treated with antibiotics at sentinel event.

Critique: Missing controls for non-sudden onset OCD.

Reference
[Sokol1997]

Findings/Critique
An infection-triggered, autoimmune subtype of anorexia nervosa. Findings: (N=3) Case studies with sudden onset Anorexia Nervosa that appear responsive to antibiotic treatment.

Critique: Small sample size, no control.

Reference
[Swedo1998]

Findings/Critique
Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections: Clinical Description of the First 50 Cases. Findings: (N=50) Defines PANDAS and a diagnostic criteria to separate a homogeneous subgroup of patients with tic disorders and/or OCD symptoms in which the onset of symptoms is severe and sudden and ongoing exacerbations are episodic and associated with GABHS infections.

Critique: Other researchers struggled to distinguish sudden/severe onset and dramatic episodic course from more modest waxing and waning of symptoms