Neurological Soft Signs at Presentation in Patients With Pediatric Acute-Onset Neuropsychiatric Syndrome
RESEARCH IMPACT:
“Neurological Soft Signs at Presentation in Patients With Pediatric Acute-Onset Neuropsychiatric Syndrome” provides valuable information on the neurological soft signs clinicians should look for in addition to the established clinical criteria when evaluating patients with PANS and PANDAS. The neurological markers further establish PANS as a distinct diagnosis that is linked to basal ganglia dysfunction.
SUMMARY
The study “Neurological Soft Signs at Presentation in Patients With Pediatric Acute-Onset Neuropsychiatric Syndrome ” investigates the presence of neurological soft signs reflective of basal ganglia dysfunction (NSS-BG) in children with Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) and their association with disease severity.
Researchers at the Stanford Immune Behavioral Health Clinic evaluated a group of 119 patients who met the diagnostic criteria for PANS and underwent a neurological exam assessing NSS-BG within their first three clinic visits and within three months of their initial presentation. They assessed six NSS-BG: glabellar tap reflex, abnormal tongue movements, milkmaid’s grip, choreiform movements, spooning, and overflow movements to evaluate basal ganglia dysfunction. NSS-BG are typically not observed in school-age children, with the exception of overflow movements, which are normal in children under age 6 and gradually disappear with age.
They found 79.8% of those PANS patients, most who were in a flare at time of evaluation, exhibited at least one neurological soft sign reflective of basal ganglia dysfunction, with the common signs being:
- overflow movements (59.7%)
- choreiform movements (52.1%)
- abnormal tongue movements (31.1%)
- and milkmaid’s grip (30.2%)
Patients with four or more of the six NSS-BG had significantly more PANS symptoms and higher global impairment scores, indicating a correlation between neurological abnormalities and disease severity. Neither age of onset or illness duration predicted the number of NSS–BG, reinforcing the hypothesis that PANS involves basal ganglia dysfunction.
The unusually high prevalence of NSS–BG found suggests that neurological exams could aid in PANS diagnosis and monitoring. The study advocates for routine neurological examinations in pediatric patients presenting with abrupt and dramatic neuropsychiatric symptoms.
LINK TO PAPER: https://doi.org/10.1001/jamanetworkopen.2025.0314
CITATION
Zebrack JE, Gao J, Verhey B, et al. Neurological Soft Signs at Presentation in Patients With Pediatric Acute-Onset Neuropsychiatric Syndrome. JAMA Netw Open. 2025;8(3):e250314. doi:10.1001/jamanetworkopen.2025.0314