Read more about this disease, some with Classification – Types – Signs and symptoms – Genetics – Pathophysiology – Diagnosis – Screening – Prevention – Treatment and management – Cures and much more, some including pictures and video when available.
Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS) is defined as rapid, episodic onset of obsessive-compulsive disorder (OCD) and/or tic disorder symptoms after a group A ß-hemolytic streptococcal infection (GABHS).[1] The current hypothesis for the pathology PANDAS is that a streptococcal infection occurring in a vulnerable host causes antibody production and these antibodies cross-react with the cellular components of the basal ganglia. This process, known as molecular mimicry, is believed to be the process that causes the OCD and tic disorder symptoms in the PANDAS subgroup of patients. There is controversy in the medical field over the reality of this disease, as studies have failed to prove or disprove its existence.[2] PANDAS became popular in the late 1990s and continues to be a highly researched and controversial topic in the field of pediatric neuroscience.
PANDAS is not an officially recognized diagnosis. A paper published in 1998 introduced five criteria for diagnosing PANDAS:[3]
During the exacerbation periods, symptoms have been reported to sustain peak severity for several weeks before gradually sinking into remission.[1] The patients generally remain free of OCD and/or tic disorder symptoms until they are infected with GABHS again, at which time the cycle repeats.
Other symptoms of PANDAS include emotional instability, difficulty with attention, separation anxiety, motoric hyperactivity, bed-wetting, and the frequent need to urinate.[1] The most obvious symptom to notice is choreiform movements, rapid and well-performed but unintentional movements. Choreiform movements, which are thought to be linked with dysfunction of the caudate nucleus and putamen of the basal ganglia, has been noted as one the most dependable and distinguishing feature to be used in identifying a child with PANDAS.
Numerous studies have been completed to show the association between GABHS infections and the onset of OCD and tic disorders. In Rhode Island in 1989, after a GABHS outbreak a 10-fold increase of motor tics was identified.[2] A 2005 case study of 144 patients concluded that a streptococcal infection within 3 months more than doubles a child’s odds of developing a neuropsychiatric disorder, indicated by an odds ratio (OR) of 2.22.[4] Furthermore, this study found that a GABHS infection within 12 months increases a child’s likelihood of developing OCD or a tic disorder by almost double (OR 1.91). The risk of developing OCD or a tic disorder was also found to be greatly elevated after multiple GABHS infections within a 12-month period.
PANDAS and Sydenham’s chorea (SC) have the potential to be mistaken for each other during diagnosis. Sydenham’s chorea, found in 20–30% of rheumatic fever (RF) patients, is caused by a GABHS infection.[5] Since GABHS infection is also hypothesized to cause PANDAS, the similarities of the two can lead to a misdiagnosis. Studies on SC have shown that antibodies produced to fight against streptococcal antigens associated with the M-protein of GABHS cross-react with the epitopes, a component of the cell wall, on brain tissue.[1] PANDAS is thought to be misdiagnosed as Sydenham’s chorea more than normal in underdeveloped countries due to the greater prevalence of rheumatic fever.
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