PANDAS Syndrome: diagnosis, physiopathology, etiology and treatments
https://doi.org/10.4081/wpph.2024.9897
Accepted: 8 July 2024
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
The aim of this paper is to carry out a narrative review of the main contributions in the literature relating to PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) Syndrome. The literature search was carried out using Pubmed, Psycinfo, and PsycArticles databases.
The diagnostic criteria and etiology are still debated and objects of research. Several studies suggest that streptococcal infections induce an immunological response that causes basal ganglia modifications. Currently, treatments in practice are pharmacological, immunological, surgical, and psychological, used in combination for greater efficacy. Given the complexity of the syndrome, further studies are needed to better define the syndrome and lead towards targeted treatments.
Swedo SE, Leonard HL, Garvey M, et al. Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: clinical description of the first 50 cases. Am J Psychiatry. 1998;155:264-71. DOI: https://doi.org/10.1176/ajp.155.2.264
Allen AJ, Leonard HL, Swedo SE. Case study: a new infection-triggered, autoimmune subtype of pediatric OCD and Tourette's syndrome. Journal of the American Academy of Child & Adolescent Psychiatry. 1995;34:307-11. DOI: https://doi.org/10.1097/00004583-199503000-00015
Macerollo A, Martino D. Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS): an evolving concept. Tremor and Other Hyperkinetic Movements. 2013;3:03-167-4158-7. DOI: https://doi.org/10.5334/tohm.167
Baj J, Sitarz E, Forma A, et al. Alterations in the nervous system and gut microbiota after β-hemolytic streptococcus group A infection—characteristics and diagnostic criteria of PANDAS recognition. International Journal of Molecular Sciences. 2020;21:1476. DOI: https://doi.org/10.3390/ijms21041476
Orefici G, Cardona F, Cox CJ, Cunningham MW. Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). In: Streptococcus pyogenes - basic biology to clinical manifestations. University of Oklahoma Health Sciences Center Oklahoma City (OK), USA; 2016.
Thienemann M, Murphy T, Leckman J, et al. Clinical management of pediatric acute-onset neuropsychiatric syndrome: part I—psychiatric and behavioral interventions. Journal of Child and Adolescent Psychopharmacology. 2017;27:566-73. DOI: https://doi.org/10.1089/cap.2016.0145
Cocuzza S, Maniaci A, La Mantia I, et al. Obsessive-compulsive disorder in PANS/PANDAS in children: in search of a qualified treatment—a systematic review and metanalysis. Children (Basel). 2022;9:155. DOI: https://doi.org/10.3390/children9020155
Esposito S, Bianchini S, Baggi E, et al. Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: an overview. European Journal of Clinical Microbiology & Infectious Diseases. 2014;33:2105-9. DOI: https://doi.org/10.1007/s10096-014-2185-9
Swedo SE, Frankovich J, Murphy TK. Overview of treatment of Pediatric Acute-Onset Neuropsychiatric Syndrome. J Child Adolesc Psychopharmacol 2017;27:562-5. DOI: https://doi.org/10.1089/cap.2017.0042
Murphy TK, Gerardi DM, Parker-Athill EC. The PANDAS controversy: why (and how) is it still unsettled? Current Developmental Disorders Reports. 2014;1:236-44. DOI: https://doi.org/10.1007/s40474-014-0025-3
Zibordi F, Zorzi G, Carecchio M, Nardocci N. CANS: Childhood acute neuropsychiatric syndromes. European Journal of Paediatric Neurology. 2018;22:316-20. DOI: https://doi.org/10.1016/j.ejpn.2018.01.011
Swedo SE, Leckman JF, Rose NR. From research subgroup to clinical syndrome: modifying the PANDAS criteria to describe PANS (pediatric acute-onset neuropsychiatric syndrome). Pediatr Therapeut. 2012;2:113. DOI: https://doi.org/10.4172/2161-0665.1000113
Baytunca MB, Donuk T, Erermiş S. Evaluation of a Neuropsychiatric Disorder: From PANDAS to PANS and CANS. Turk Psikiyatri Derg. 2016;27. DOI: https://doi.org/10.5080/u12265
Singer HS, Gilbert DL, Wolf DS, et al. Moving from PANDAS to CANS. The Journal of Pediatrics. 2012;160:725-31. DOI: https://doi.org/10.1016/j.jpeds.2011.11.040
Garcia AF, Yamaga KM, Shafer LA, et al. Cardiac myosin epitopes recognized by autoantibody in acute and convalescent rheumatic fever. The Pediatric Infectious Disease Journal. 2016;35:1021-6. DOI: https://doi.org/10.1097/INF.0000000000001235
Jaspers-Fayer F, Han SH, Chan E, et al. Prevalence of acute-onset subtypes in pediatric obsessive-compulsive disorder. Journal of Child and Adolescent Psychopharmacology. 2017;27:332-41. DOI: https://doi.org/10.1089/cap.2016.0031
Bernstein GA, Victor AM, Pipal AJ, Williams KA. Comparison of clinical characteristics of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and childhood obsessive-compulsive disorder. Journal of Child and Adolescent Psychopharmacology. 2010;20:333-40. DOI: https://doi.org/10.1089/cap.2010.0034
Geller D, Biederman J, Jones J, et al. Is juvenile obsessive‐compulsive disorder a developmental subtype of the disorder? A review of the pediatric literature. Journal of the American Academy of Child & Adolescent Psychiatry. 1998;37:420-7. DOI: https://doi.org/10.1097/00004583-199804000-00020
Mancuso E, Faro A, Joshi G, Geller DA. Treatment of pediatric obsessive-compulsive disorder: a review. Journal of Child and Adolescent Psychopharmacology. 2010;20:299-308. DOI: https://doi.org/10.1089/cap.2010.0040
Pavone P, Bianchini R, Parano E, et al. Anti-brain antibodies in PANDAS versus uncomplicated streptococcal infection. Pediatric Neurology. 2004;30:107-10. DOI: https://doi.org/10.1016/S0887-8994(03)00413-2
Giedd JN, Rapoport JL, Garvey MA, et al. MRI assessment of children with obsessive-compulsive disorder or tics associated with streptococcal infection. American Journal of Psychiatry. 2000;157:281-3. DOI: https://doi.org/10.1176/appi.ajp.157.2.281
Carapetis JR, Beaton A, Cunningham MW, et al. Acute rheumatic fever and rheumatic heart disease. Nature Reviews Disease Primers. 2016;2:1-24. DOI: https://doi.org/10.1038/nrdp.2015.84
Cunningham MW. Molecular mimicry, autoimmunity, and infection: the cross-reactive antigens of group A streptococci and their sequelae. Microbiology Spectrum. 2019;7:10. DOI: https://doi.org/10.1128/microbiolspec.GPP3-0045-2018
Cabrera B, Romero-Rebollar C, Jiménez-Ángeles L, et al. Neuroanatomical features and its usefulness in classification of patients with PANDAS. CNS Spectrums. 2019;24:533-43. DOI: https://doi.org/10.1017/S1092852918001268
Tay TL, Béchade C, D’Andrea I, et al. Microglia gone rogue: impacts on psychiatric disorders across the lifespan. Frontiers in Molecular Neuroscience. 2018;10:421. DOI: https://doi.org/10.3389/fnmol.2017.00421
Kelly JR, Clarke G, Cryan JF, Dinan TG. Brain-gut-microbiota axis: challenges for translation in psychiatry. Annals of Epidemiology. 2016;26:366-72. DOI: https://doi.org/10.1016/j.annepidem.2016.02.008
Rudzki L, Szulc A. “Immune gate” of psychopathology—The role of gut derived immune activation in major psychiatric disorders. Frontiers in Psychiatry. 2018;9:205. DOI: https://doi.org/10.3389/fpsyt.2018.00205
Quagliariello A, Del Chierico F, Russo A, et al. Gut microbiota profiling and gut–brain crosstalk in children affected by pediatric acute-onset neuropsychiatric syndrome and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections. Frontiers in Microbiology. 2018;9:675. DOI: https://doi.org/10.3389/fmicb.2018.00675
Buse J, Kirschbaum C, Leckman JF, et al. The modulating role of stress in the onset and course of Tourette’s syndrome: a review. Behavior Modification. 2014;38:184-216. DOI: https://doi.org/10.1177/0145445514522056
Chappell P, Riddle M, Anderson G, et al. Enhanced stress responsivity of Tourette syndrome patients undergoing lumbar puncture. Biological Psychiatry. 1994;36:35-43. DOI: https://doi.org/10.1016/0006-3223(94)90060-4
Corbett BA, Mendoza SP, Baym CL, et al. Examining cortisol rhythmicity and responsivity to stress in children with Tourette syndrome. Psychoneuroendocrinology. 2008;33:810-20. DOI: https://doi.org/10.1016/j.psyneuen.2008.03.014
Sigra S, Hesselmark E, Bejerot S. Treatment of PANDAS and PANS: a systematic review. Neuroscience & Biobehavioral Reviews. 2018;86:51-65. DOI: https://doi.org/10.1016/j.neubiorev.2018.01.001
La Bella S, Scorrano G, Rinaldi M, et al. Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS): Myth or Reality? The State of the Art on a Controversial Disease. Microorganisms. 2023;11:2549. DOI: https://doi.org/10.3390/microorganisms11102549
Dèttore D. Il disturbo ossessivo-compulsivo: Caratteristiche cliniche e tecniche d'intervento. Seconda edizione. McGraw-Hill Education; New York, USA; 2003.
Dettore D, Melli G. Strategie motivazionali per l'esposizione e prevenzione della risposta nel trattamento del disturbo ossessivo-compulsivo. Cognitivismo Clinico. 2005;2:27-38.
Gromark C, Hesselmark E, Djupedal IG, et al. A two-to-fiveyear follow-up of a pediatric acute-onset neuropsychiatric syndrome cohort. Child Psychiatry & Human Development. 2022;53:354-64. DOI: https://doi.org/10.1007/s10578-021-01135-4
Lebowitz ER, Omer H, Hermes H, Scahill L. Parent training for childhood anxiety disorders: the SPACE program. Cognitive and Behavioral Practice. 2014;21:456-69. DOI: https://doi.org/10.1016/j.cbpra.2013.10.004
Hollis C, Pennant M, Cuenca J, et al. Clinical effectiveness and patient perspectives of different treatment strategies for tics in children and adolescents with Tourette syndrome: a systematic review and qualitative analysis. Health Technology Assessment. 2016;20:1-450. DOI: https://doi.org/10.3310/hta20040
Hopkins K, Crosland P, Elliott N, Bewley S. Diagnosis and management of depression in children and young people: summary of updated NICE guidance. BMJ. 2015;350:h824 DOI: https://doi.org/10.1136/bmj.h824
Conti E, Sgandurra G, De Nicola G, et al. Behavioural and emotional changes during covid-19 lockdown in an Italian paediatric population with neurologic and psychiatric disorders. Brain Sciences. 2020;10:918. DOI: https://doi.org/10.3390/brainsci10120918
Liu JJ, Bao Y, Huang X, et al. Mental health considerations for children quarantined because of COVID-19. The Lancet Child & Adolescent Health. 2020;4:347-9. DOI: https://doi.org/10.1016/S2352-4642(20)30096-1
Tanir Y, Karayagmurlu A, Kaya İ, et al. Exacerbation of obsessive compulsive disorder symptoms in children and adolescents during COVID-19 pandemic. Psychiatry Research. 2020;293:113363. DOI: https://doi.org/10.1016/j.psychres.2020.113363
Guido CA, Loffredo L, Zicari AM, Pavone P, Savasta S, Gagliano A, Brindisi G, Galardini G, Bertolini A, Spalice A. The impact of the COVID-19 epidemic during the lockdown on children with the Pediatric Acute-Onset Neuropsychiatric Syndrome (PANDAS/PANS): the importance of environmental factors on clinical conditions. Frontiers in Neurology. 2021 Aug 11;12:702356. DOI: https://doi.org/10.3389/fneur.2021.702356
Cocuzza S., Marino S., Gulino A., Pustorino E., Murabito P., Maniaci A., Sabino L., Taibi R., Di Luca M., Falsaperla R., Campione G., Vecchio M., Pavone P. ENT involvement and orobuccal movements’ disorders in Pandas patients: assessment and rehabilitations tools. European Review for Medical and Pharmacological Sciences. 2019;23(10):4110-4117.
Copyright (c) 2024 Chiara Volpini, Rossella Sterpone, Monica Franscini, Valentina Manfredi
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Downloads
Citations
