Paediatric acute-onset neuropsychiatric syndrome (PANS): Age-related symptomatology and comparison with non-PANS neurodevelopmental disorders

SUMMARY

This prospective study examined the clinical characteristics of 56 children with pediatric acute-onset neuropsychiatric syndrome (PANS) and compared them with 106 children diagnosed with neurodevelopmental disorders (NDDs) who did not meet PANS criteria. Using a standardized clinical assessment, the investigators characterized symptom onset, disease course, family history, and behavioral impact. In the PANS group, the median age at initial onset was five years, with boys generally presenting earlier than girls. While obsessive-compulsive disorder (OCD) was nearly universal in the PANS cohort, younger children were more likely to develop speech dysfunction or loss of language skills during acute episodes, whereas depression was more commonly seen in older children. Although autism spectrum disorder and attention-deficit/hyperactivity disorder occurred at similar rates in both groups, the PANS cohort demonstrated a more severe symptom presentation, including significantly higher rates of anxiety, emotional dysregulation, behavioral regression, and eating restriction.

The study also demonstrated important differences in disease course and potential risk factors. Most children with PANS experienced recurrent episodes triggered by infection, while psychological stress exacerbated symptoms in both PANS and non-PANS neurodevelopmental disorders. Severe symptom fluctuations and relapsing-remitting illness were significantly more common in PANS. A noteworthy finding was the increased prevalence of autoimmune disease among first-degree relatives, especially maternal autoimmune thyroid disease, in children with PANS compared with the non-PANS cohort. Behavioral assessments also showed that children with PANS experienced greater emotional impairment and functional impact than the comparison group of children with neurodevelopmental disorders.

The authors conclude that PANS represents a recognizable clinical phenotype characterized by abrupt symptom onset, infection-related exacerbations, family history of autoimmune disease, and more severe emotional and functional impairment. The overlap in symptom patterns and some shared features between PANS and non-PANS NDDs suggests that research is needed to determine whether some patients may represent a broader spectrum of neuropsychiatric presentations, and to better understand what may contribute to symptom onset and progression.

LINK TO PAPER: https://doi.org/10.1016/j.ejpn.2026.07.002