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Childhood Acute Neuropsychiatric Symptoms
Aka: Childhood Acute Neuropsychiatric Symptoms, PANDAS, Pediatric Autoimmune Neuropsychiatric Disorders, Post-streptococcal Autoimmune Neuropsychiatric Disorder, Streptococcal Associated Neuropsychiatric Disorder
- Definition
- Pediatric Autoimmune Neuropsychiatric Disorders
- Associated with Streptococcal Infections
- 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
- 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
- Autoantibodies stimulate basal ganglia Autoimmune Disease
- Similar mechanism as Rheumatic Fever and PSGN
- Differential Diagnosis
- Rheumatic Fever
- Jones Criteria include Sydenham Chorea in addition to carditis, Polyarthritis, Erythema Marginatum, skin Nodules
- Associated conditions
- See Obsessive-Compulsive Disorder
- See Tic Disorder
- Sydenham's Chorea
- Rheumatic Fever
- Diagnosis: Criteria (all 5 criteria need to be present)
- Psychiatric illness
- Obsessive-Compulsive Disorder
- Tic Disorder
- Prepubertal symptom onset
- Acute, severe onset with symptom exacerbations
- Neurologic abnormalities
- Example: Choreiform movements
- Exacerbation follows Group A streptococcal infection
- Management
- Cognitive Behavioral Therapy
- Selective Serotonin Reuptake Inhibitors
- Other agents directed at autoimmune response have been used
- Corticosteroids
- IV Immunoglobulin
- Plasmaphoresis
- References
- Farhood (2016) Int J Pediatr Otolaryngol 89:149-53 [PubMed]
- Maness (2018) Am Fam Physician 97(8): 517-22 [PubMed]
- Singer (2012) J Pediatr 160(5): 725-31 [PubMed]