II. Definition
- Pediatric Autoimmune Neuropsychiatric Disorders
- Associated with Streptococcal Infections
III. Precautions
- Controversial diagnosis
- Streptococcal infection is common
- Tic Disorders are common
- When both are present, is it simply coincidence?
- Avoid testing ASO Titers (rarely helpful)
- Even if diagnosis is made, there is no treatment
- Even daily Penicillin does not alter Tic Disorder
IV. Pathophysiology
- Multiple infectious, toxic and metabolic causes have been proposed
- Initially thought specific to autoantibody formation in response to streptococcal infection
- Associated with Group A Beta Hemolytic Streptococcus
- Initially thought specific to autoantibody formation in response to streptococcal infection
- Autoantibodies stimulate basal ganglia Autoimmune Disease
- Similar mechanism as Rheumatic Fever and PSGN
V. Differential Diagnosis
-
Rheumatic Fever
- Jones Criteria include Sydenham Chorea in addition to carditis, Polyarthritis, Erythema Marginatum, skin Nodules
VI. Associated conditions
VII. Diagnosis: Criteria (all 5 criteria need to be present)
- Psychiatric illness
- Prepubertal symptom onset
- Acute, severe onset with symptom exacerbations
- Neurologic abnormalities
- Example: Choreiform movements
- Exacerbation follows Group A streptococcal infection
VIII. Management
- Cognitive Behavioral Therapy
- Selective Serotonin Reuptake Inhibitors
- Other agents directed at autoimmune response have been used
- Corticosteroids
- IV Immunoglobulin
- Plasmaphoresis